NYS EMT > Chapter 26 – Bleeding > Flashcards

Chapter 26 – Bleeding Flashcards

(46 cards)

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1
Q

Bleeding

A

Internal

External

Can cause weakness, shock, death

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2
Q

Blood

A

Circulated to cells and tissues

Delivers oxygen and nutrients

Carries away metabolic waste products

Cardiovascular system is responsible for supplying and maintaining adequate blood flow

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3
Q

The heart

A

Needs a rich and well-distributed blood supply

Works as two paired pumps
Upper chamber (atrium)
Lower chamber (ventricle)

Blood leaves each chamber through a one-way valve.

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4
Q

Capillaries

A

Oxygen and nutrients pass from the capillaries into the cells. (leave)

Waste and carbon dioxide diffuse into the capillaries. (enter)

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5
Q

RBCs

A

Responsible for the transportation of oxygen to the cells and carbon dioxide away from the cells to the lungs

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6
Q

WBCs

A

Fight infection

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7
Q

Platelets

A

Form blood clots

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8
Q

Blood clot formation depends on:

A

Blood stasis

Changes in the blood vessel walls

Blood’s ability to clot

When tissues are injured, platelets begin to collect at the site of injury. Red blood cells to become sticky and clump together.

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9
Q

Autonomic nervous system

A

Monitors the body’s needs

Adjusts blood flow

Automatically redirects blood away from other organs to the heart, brain, lungs, and kidneys in an emergency

Adapts to maintain homeostasis and perfusion
(shock is a failure of ANS)

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10
Q

Speed of blood flow

A

Fast enough to maintain circulation

Slow enough to allow cells to exchange oxygen and nutrients for carbon dioxide and waste

Some need constant supply (heart and brain) others need very little

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11
Q

All organs and organ systems

A

Depend on adequate perfusion to function properly.

Death of organ system—> death of patient

Prehospital care supports perfusion until hospital arrival

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12
Q

Hemorrhage

A

Bleeding

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13
Q

Visible hemorrhage

A

external bleeding

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14
Q

Body will not tolerate a blood loss

A

greater than 20% of blood volume.

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15
Q

Changes in vital signs with significant blood loss

A

Increase in heart rate

Increase in respiratory rate

Decrease in blood pressure

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16
Q

How well people compensate for blood loss is related to how rapidly they bleed

A

An adult can comfortably donate 1 unit (500 mL) of blood over 15 to 20 minutes.

If a similar blood loss occurs in a much shorter time, the person may rapidly develop symptoms of hypovolemic shock.

Consider age and preexisting health.

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17
Q

Serious conditions with bleeding

A

Significant MOI

Patient has a poor general appearance and is calm.

Signs and symptoms of shock

Significant blood loss

Rapid blood loss

Uncontrollable bleeding

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18
Q

Arterial bleeding

A

Pressure causes blood to spurt and makes bleeding difficult to control.

Typically brighter red and spurts in time with the pulse

Wrist

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19
Q

Venous bleeding

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A

Dark red

Flows slowly or rapidly depending on the size of the vein

Does not spurt and is easier to manage.

More likely to clot

Calf

20
Q

Capillary bleeding

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A

Bleeding from damaged capillary vessels (fingertip)

Dark red, oozes steadily but slowly

21
Q

Clotting

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A

Bleeding will not stop until a clot forms (within 10 mins)

When skin is broken, blood flows rapidly.

The cut end of the vessel begins to narrow, reducing the amount of bleeding.

Then a clot forms.

22
Q

Hemophilia

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A

Patient lacks blood-clotting factors.

Bleeding may occur spontaneously.

All injuries, no matter how trivial, are potentially serious.

Patients should be transported immediately.

23
Q

Internal bleeding

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A

Not easy to immediately detect

Injury or damage to internal organs (ex. Stomach ulcer, Lacerated liver, Ruptured spleen, Broken bones)

Hypovolemic shock

High energy MOI (blunt or penetrating trauma)

Or NOI (bleeding ulcers, bleeding colon, ruptured ectopic pregnancy, aneurysms)

24
Q

DCAP BTLS

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A

Deformities
Contusions
Abrasions
Punctures/penetrations
Burns
Tenderness
Lacerations
Swelling

25
Signs and symptoms of internal bleeding
Pain (most common) Tenderness, bruising, guarding, or swelling Distention Hematoma Bruising Dyspnea (low RR), tachycardia (high pulse), hypotension (low BP) External bleeding Hematemesis Melena broken ribs shock
26
Primary
Address obvious external bleeding first
27
Airway and breathing
CSpine stabilization High flow o2 (NRB) or BVM Unconscious: OPA
28
Circulation
Skin color, condition, temp Capillary refill time Treat for shock
29
Rapid transport
Tachycardia or tachypnea Low blood pressure Weak pulse Clammy skin
30
Secondary
Check if on blood thinners Determine blood loss amount Look for shock DCAP BTLS Maybe not enough time
31
Overall care
Control external bleeding (first) Enmsure open airway then provide high-flow oxygen. Provide treatment for shock and transport rapidly. Do not delay transport of a patient to complete an assessment.
32
Bleeding documentation
Volume, speed, over what period of time
33
Bleeding control methods
Direct, even pressure and elevation Pressure dressings and/or splints Tourniquets Hemostatic dressing Wound packing
34
Direct pressure
At least 5 mins With gloved fingertip or hand over the top of a sterile dressing.
35
Pressure dressing
Firmly wrap a sterile, self-adhering roller bandage around the entire wound. Stretch the band tight enough to control bleeding. Do not remove until a physician has evaluated the patient. A tourniquet is useful if cannot be managed with direct pressure.
36
Hemostatic agents
Gauze in wound packing impregnated with a chemical compound promotes clot formation.
37
Wound packing
Gauze can be packed into larger wounds when direct pressure is inadequate, or tourniquet is not possible.
38
Tourniquet
Lots of bleeding from extremity injury If direct pressure doesn't work Junctional tourniquet when standard tourniquet doesn't work: the junction of the torso with the arms and legs/pelvic binder
39
Tourniquet rules
never apply over joint widest bandage possible. no narrow material like rope secure tightly until bleeding stops never cover with bandage, leave open in full view never use for closed, soft tissue, internal injuries
40
Air splints
Soft/pressure splints Can control internal or external bleeding associated with severe extremity injuries Immobilize fractures Act like a pressure dressing applied to an entire extremity rather than to a small, local area
41
Pelvic binder
A type of splint that may be indicated for a suspected closed unstable pelvic fracture Helps to control internal bleeding
42
Bleeding from nose, ears, mouth
Skull fracture Facial injuries Sinusitis, infections, use and abuse of nose drops, dried or cracked nasal mucosa, or other abnormalities High blood pressure Coagulation disorders Digital trauma Cancer
43
Epistaxis
Nosebleed Controlled by pinching nostrils together May be small part of total blood loss Position: lean head and body forward NO NPA Rarely: shock
44
Bleeding from nose/ears after head injury care
Possible skull fracture Loosely cover the bleeding site with a sterile gauze pad. Apply light compression with a dressing. Hard to control Don't try to stop A target or halo-shaped stain may occur on the dressing if blood or drainage contains cerebrospinal fluid.
45
Emergency Medical Care for Internal Bleeding
Usually requires hospital procedures (surgery) Keep patient calm Provide high-flow oxygen. Maintain body temperature. Splint the injured extremity (air splint). Never use a tourniquet to control the bleeding from closed, internal, and/or soft-tissue injuries.
46
Steps in treating any kind of bleeding
standard precautions ensure patent airway external bleeding control internal bleeding control baseline vitals
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