Chapter 26 PP Bleeding

Question 1

Types of bleeding

Answer 1

Internal

External

Question 2

Sources of bleeding

Answer 2

Arteries

Veins

Capillaries

Question 3

Arterial bleeding

Answer 3

Blood is bright red and spurts

Question 4

Venous bleeding

Answer 4

Blood is dark red and does not spurt

Question 5

Capillary bleeding

Answer 5

Blood oozes out and is controlled easily

Question 6

Signs of internal bleeding

Answer 6

Blunt trauma

Signs and symptoms of shock

Severe bruising

Abdominal rigidity or distention

Tenderness or instability in the pelvic region

Closed deformity of the femoral areas

Most dangerous bleeding occurs in the abdomen, pelvis, or the femurs

Question 7

Grey turners sign vs. Cullen’s sign

Answer 7

Grey turner’s sign is bruising near the flanks

Cullen’s sign is also called periumbilical ecchymosis or bruising around the navel (belly button)

These findings may indicate severe internal hemorrhage or pancreatitis

Question 8

Kehr’s sign

Answer 8

Pain referred to the left shoulder on palpation of the abdomen

Classically associated with splenic rupture

Question 9

Examples of non traumatic causes of internal bleeding

Answer 9

Bleeding ulcers

Bleeding from colon

Ruptured ectopic pregnancy

Aneurysms

Question 10

Signs and symptoms of internal bleeding

Answer 10

Pain (most common)
Rigidity
Distention
Signs of shock
Coffee ground emesis
Hematemesis (vomiting blood)
Melena (dark, tarry stool)
Hematochezia (bloody stool)
Rectal or vaginal bleeding
Bruising

Question 11

Emergency medical care for external bleeding

Answer 11

Non life threatening - direct pressure and transport

Life threatening:

Control bleeding
Place supine
High flow oxygen
Prevent heat loss
Rapid transport

Question 12

Methods to control external bleeding

Answer 12

Direct, even pressure and elevation

Pressure dressings and/or splints

Tourniquets

Hemostatic dressings

Wound packing

Question 13

Tourniquets

Answer 13

Do not apply a tourniquet directly over a joint

Make sure the tourniquet is tightened securely

Make sure tourniquet is clearly visible once applied

Do not loosen the tourniquet after applied

Mark patient and note the time of application

Question 14

Wound packing

Answer 14

Apply pressure directly to artery

Hemostatic gauze preferred

Maintain pressure until bleeding stops - pressure dressing on top

Question 15

Junctional tourniquets

Answer 15

Allow for compression on life threatening bleeding in areas where standard tourniquet application is not possible

May be indicated for severe hemorrhage at the junction of the torso with the arms and legs

Question 16

Splints

Answer 16

Air splints

Soft splints or pressure splints

Can control internal or external bleeding associated with severe injuries

Question 17

Pelvic binder

Answer 17

A type of splint that may be indicated for a suspected closed unstable pelvic fracture

Helps to control internal bleeding

Question 18

Bleeding from nose, ears, and mouth

Answer 18

Causes:

Skull fracture
Facial injuries
High blood pressure
Coagulation disorders
Digital trauma

Epistaxis

Common
Can indicate serious condition
Usually easily controlled

Question 19

Which of the following is not a component of the cardiovascular system?
A. Heart
B. Lungs
C. Venules
D. Plasma

Answer 19

C. Venules

Question 20

Perfusion is most accurately defined as:
A. The removal of adequate amounts of carbon dioxide during exhalation
B. The intake of adequate amounts of oxygen during the inhalation phase
C. Circulation of blood within an organ with sufficient amounts of oxygen
D. The production of carbon dioxide, which accumulates at the cellular level

Answer 20

C. Circulation of blood within an organ with sufficient amounts of oxygen

Question 21

A man involved in a motorcycle crash has multiple abrasions and lacerations. Which of the following injuries has the highest treatment priority?
A. Widespread abrasions to the back with pinkish ooze
B. 3 inch laceration to the forehead with dark red, flowing blood
C. Laceration to the forearm with obvious debris in the wound
D. 1 inch laceration to the thigh with spurting, bright red blood

Answer 21

D. 1 inch laceration to the thigh with spurting, bright red blood

Question 22

Which of the following sets of vital signs is least indicative of internal bleeding?
A. BP 140/90 mmHg; pulse rate 58bpm; respirations 8 breaths/min
B. BP 100/50mmHg; pulse rate 120bpm; respirations 24 breaths/min
C. BP 98/60mmHg; pulse rate 110bpm; respirations 28 breaths/min
D. BP 102/48mmHg; pulse rate 100bpm; respirations 22 breaths/min

Answer 22

A. BP 140/90mmHg; pulse rate 58bpm; respirations 8 breaths/min

Question 23

When caring for a patient with internal bleeding, the EMT must first:
A. Ensure a patent airway
B. Obtain baseline vital signs
C. Control any external bleeding
D. Take appropriate standard precautions

Answer 23

D. Take appropriate standard precautions

Question 24

The quickest and most effective way to control external bleeding from an extremity is:
A. A pressure bandage
B. Direct pressure and elevation
C. A splint
D. Tourniquet

Answer 24

B. Direct pressure and elevation

Question 25

When applying a tourniquet to an amputated arm, the EMT should: A. Use the narrowest bandage possible B. Avoid applying the tourniquet over a joint C. Cover the tourniquet with a sterile bandage D. Use rope to ensure that the tourniquet is tight

Answer 25

B. Avoid applying the tourniquet over a joint

Question 26

A 70 year old man is experiencing a severe nosebleed. When you arrive, you find him leaning over a basin, which contains an impressive amount of blood. He has a history of coronary artery disease, diabetes, and migraine headaches. His BP is 180/100 and his heart rate is 100bpm. Which of the following is the most likely contributing factor to his nosebleed? A. His blood pressure B. His history of diabetes C. The fact that he is elderly D. His heart rate of 100bpm

Answer 26

A. His blood pressure

Question 27

When caring for a patient with severe epistaxis, the most effective way to prevent aspiration of blood is to: A. Insert a nasopharyngeal airway and lean the patient back B. Tilt the patient head forward while he or she is leaning forward C. Place the patient supine with his or her head in the flexed position D. Tilt the patients head forward while he or she is leaning backward

Answer 27

B. Tilt the patients head forward while he or she is leaning forward

Question 28

Controlling internal bleeding requires A. Applying a tourniquet B. Surgery in a hospital C. Positioning the patient in the siting position D. Providing slow and considerate transport

Answer 28

B. Surgery in the hospital