3) Hemorrhage & Shock Flashcards

1
Q

Internal Hemorrhage being forced between tissue layers (fascia):
Internal Hemorrhage:
Pregnant internal hemorrhage worry:
Internal blood loss may be self limiting:

A

= Hematoma (pocket of blood) usally from arterie)
= Blood accumulation in interstitial spaces, forming visible contusions
= multiple uterine arteries in umbilical cord
= Large body cavities (chest, ABDMN, pelvis) have little resistance & internal blood loss may be severe.

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2
Q

Vascular system consists of 3 types of vessels:
Arteries, veins, Capillary:
blood vessels that are called the “capacitance system” are the:
A blockage in the delivery of oxygenated blood to the cells:
Vessels that’re only 1 cell thick, allow efficient gas and metabolic substrate M-nt into & out of interstitial space are:

A

= Arteries, Veins, Capillaries
= “A Away”, “V Venga”, “Cap C venioles & arterioles for exchanging”
= Veins
= Ischemia
= Capillaries

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3
Q

If a decision is made to use a tourniquet to stop external hemorrhage, an important point to remember is that:

A

The accumulation of lactic acid, potassium, and anaerobic metabolites can occur with tourniquet use

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3
Q

The middle, muscular layer of the blood vessels that controls lumen size:

A

Tunica Media

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4
Q

The blood volume of an infant or young child is proportionally:
Population most at risk for trauma & trauma death:

A

= ~20%> than that of an adult
= Young adult male

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4
Q

Network of fibers that stick together, form strong protein mesh, & entrap RBCs, to form a stronger, more durable clot is:
Platelets are Important for:
Protein fibers that trap red blood cells as part of the clotting process:

A

= Fibrin
= clotting and blood vessel repair
= Fibrin

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5
Q

During Stage 2 hemorrhage, PT’s pulse pressure will:
PT lost ~20% of total blood vol/ anxious, restless, & cool clammy skin is In which stage of hemorrhage is he?

A

= Be noticeably narrower
= Stage 2

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6
Q

Patients with epistaxis should be placed:
Nose bleeding result from injury, disease, or environmental factors:

A

= In the recovery position
= Epistaxis

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7
Q

Stroke volume is predicated by:
Amount of blood ejected by heart in one cardiac contraction:
Pressure w/in ventricles at the end of diastole:
Blood vol/ moved by heart in 1 min:
Measurement of peripheral vascular resistance is the:
Resistance a heart contraction must overcome in order to eject blood:

A

= Preload, afterload, and cardiac contractility
= Stroke Volume
= Preload
= Cardiac output
= Mean arterial pressure
= Afterload

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8
Q

ETCO2 Lvs in head-injured intubated PT shouldn’t drop below:
When vent/ing a adult PT, each breath should have tidal volume of:

A

= 30 mmHg
= approximately _500 mL’s.

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8
Q

Body maintaining steady, norm/ internal environment:
A condition in which the blood’s ability to clot is impaired:
The body’s response to stop the loss of blood:
Clotting phase when smooth blood vessel M. contracts <lumen size:
1 common factor hindering clotting process is:
aggregation:

A

= Homeostasis
= Coagulopathy
= Clotting
= Vascular phase
= Medications such as aspirin
= process of coming & sticking together

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9
Q

Precapillary sphincters dilate & permit blood flow through capillaries during times of low O2 & CO2 build up in cells b/c:

A

= release of chemical Histamine

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10
Q

CUPS acronym, the “P” stands for:

A

the “P” stands for: Potentially unstable

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11
Q

An abnormal internal or external discharge of blood:
Venous bleeding usually looks:

A

= Hemorrhage
= Dark red and flowing

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12
Q

A state of inadequate tissue perfusion:
The ultimate killer of all trauma victims is:
A precipitous drop in blood pressure signals which stage of shock?
Cutaneous vasoconstriction in the shock victim contributes to:
In irreversible shock, if aggressive resuscitation restores pulse & BP:

A

= Shock
= Shock
= Decompensated
= Hypothermia
= Death still occurs

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13
Q

Tension pneumo & pulmonary emboli is which type of shock?
Pericardial tamponade presents w/:

A

= Obstructive
= Becks triad JVD, tachycardia, hypotension, & Muffled heart tones

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14
Q

1st step used to control external bleeding is:
med w/ beneficial role in management of trauma/hemorrhagic shock:
A weak pulse:

A

= Direct pressure
= Tranexamic acid TXA
= Thready

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15
Q

If you suspect a pelvic fracture in your patient, you should:

A

Not compress or otherwise manipulate the pelvis

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16
Q

The molecule in the blood to which oxygen attaches is:
Able to live without oxygen:
Protein that spurs production of RBC in bone marrow:

A

= Hemoglobin
= Anaerobic
= Erythropoietin

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17
Q

Cardiogenic shock:

A

Has a high mortality rate

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17
Q

Septic shock

A

Toxins release affecting vascular system’s control of blood vessels

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18
Q

Recent evidence suggests that Mechanism of Injury:

A

may not be as good an injury severity predictor as once thought.

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19
Q

if one lung needs to be darted:

A

= dart the other lung

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19
Q

Sympathetic NS is the division of the autonomic nervous system that:

A

+ tropic effects, GI constriction, vasoconstriction, mydriasis

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19
Orthostatic hypotension
PT’s BP drops 20 HR+20 when moved from supine to a seated position
20
Starling’s law of the heart process:
= increase CO occurs in proportion to diastolic stretch of heart M. fibers
21
Perfusion is: Internal cellular gas exchange: External gas exchange:
= Adequate supply of oxy/gen/ed blood & nutrients to all vital organs = blood/ cells = pulmonary gas exchange
21
Baroreceptors: Baroreceptors:
= receptors that monitor blood pressure = Great vessels recept/ Gives feedback to brain > Sympathetic NS Activation, AArch & carotid arteries> feedback to medulla >SNS
22
Multi organ dysfunction:
organs dying b/c lacking perfusion (ICU dying shock)
23
Beta blockers effect w/ blood Ca-blockers effect w/ blood
= block norepi & epi = cant shunt/vaso-constrict
24
(Blood Vessel Control) Blood flow through capillary beds which vessel vaso-constricts best & which barely can constrict: blood sits in which vessel systems:
= reg/ed by capillary sphincters: Under control of ASNS = Cap constrict most, Veins >greatly & arteries barely constrict = Venous system> 2/3s & ~13% in arterial system
24
Hypoadrenalism
- hard response to stress
25
Ventilations increasing indicates Pale cool diaphoretic skin indicates
= aerobic to anaerobic drive = shock
26
Shock's 5 categories
Hypovolemic, Cardiogenic, Distributive, Obstructive, resp/metabolic
26
(Shock categories) Hypovolemic: Cardiogenic: Distributive: Obstructive: resp/metabolic:
= fluid loss non/hemorrhagic (most common) = heart can no longer pump = anaphylaxis, sepsis, Neurogenic = obstructsion to blood flow/hemostasis = DKA- bohr haldane (compartment)
27
3 parts of circulatory system: maintain homeostasis via: Pos feedback:
= “pump fluid pipes” heart, blood, & blood vessels = negative feedback loop = childbirth & blood clots
28
Base of the heart @ Apex of the heart @: Apex of heart attachs to Heart's 4 chambers:
= ~2nd rib = just above the diaphragm = diaphragm = Atriums 2 upper chambers & ventricles 2 lower chambers
29
DIC intra cholopathy (septic shock)
30
Ventricles separated by: Atriums separated by: bi/tricuspid valves separate:
= intraventricular septum = interatrial septum = upper & lower chambers
31
Pericardial steatosis: Pericarditis PT's will have more pain with:
= extract blood from pericardial sac fixing tamponade = laying down & coughing
31
Stroke volume: Cardiac Output (CO): Amount of blood moved in 1min CO = HR X SV > 5-6 L of blood moved in 1 minute 3 factors that affect cardiac output: preload, afterload, contractility Dynamic CO:
= blood amount ejected in 1 contraction> varies 60-100mL 70average = Amount of blood moved in 1min = HR X SV -> 5-6 L of blood moved in 1 min = preload, afterload, contractility = "1 up & other down"
32
Frank Starling law/mechanism: Vascular Resistance: SVR vs. PVR: SVR (Systemic Vascular Resistance): PVR (Pulmonary Vascular Resistance):
= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction) = Resistance to overcome to push blood through circulatory system = Body's circulation resistance & Lung's circulation resistance = resistance blood faces in systemic circulation (arteries size) = resistance blood faces in pulmonic circulation EX CHF, R ventricle
33
Preload: Afterload: Mean Arterial Pressure (MAP):
= pressure/vol/ w/in ventricles @ end of diastole “End-diastole vol/“ = resistance against which the heart must pump against (increase afterload= increase ventricular workload) = average pressure in arteries during a single cardiac cycle = pressure that drives blood to tissues (ensuring organ perfusion)
34
cardiovascular system arrangement of connected tubes: Tunicas: Capillaries made by Capillaries sphincters:
= Arteries, Arterioles, Capillaries, Venules, Veins = Intima, Media, Externa = venules & arterioles connecting = “muscles” determine shunt/flow
35
Pulse pressure: Pulse pressure signifies: Pulse pressure <25 mmHg may be seen w/
= dif/ between DBP & SBP pressures (PP= SBP-DBP) = amount of force the heart generates with each contraction = PTs w/ sings of shock
36
External Hemorrhage: Transmural Pressure: Intramural Pressure: How to treat both:
= Transmural Pressure > Intramural Pressure = Pressure inside of blood vessels = pressure outside of blood vessels = apply more pressure outside than inside to tamponade (direct P)
36
Hemostasis: Hemostasis order: Factors that effect hemostasis:
= Body’s response to a local hemorrhage w/ 3 phases = Vascular, Platelet, Coagulation "flow, stick, build" = Wound type(can pull w/in>cant constrict), M-nt, Temp, Meds( most blood thinners stop/prevent fibrin) Warfrin/Coumadin), IV Fluids
36
Body’s response to a local hemorrhage: Vascular Phase:
= hemostasis 3 steps: Vascular, Platelet, & Coagulation phase = Blood vessel is damaged & begins to lose blood , Smooth muscle w/in walls contracts, thus vessel to withdraw into the wound, thicken vascular wall, & reduce lumen.
36
Blood: Plasma: Leukocytes: Erythrocytes:
= Mixture of water, cells, proteins, & suspended elements. = makes up 55% of the blood volume = WBC & platelets make up the “Buffy Coat" = RBC make up 45%
37
Fluid accounts for ~% of the body’s weight, Only ~% of the fluid is contained in our vascular system
= 60% of the body’s weight, Only about 7% of the fluid is contained in our vascular system
37
tools for external hemorrhage: Trauma Clamps: Tourniquets: Tourniquet use adverse effects: Hyperkalemia & Sign:
= Hemostatic Agents/Dressings, (combat gauze), trauma clamp, Tourniquets, = IT clamps "teeth chomper" = Commercial best at least 1in diameter/width (Willis=turning stick), Improvised (ad hawk), Air inflatable (like BP cuff), Junctional (sam splint=pelvic) = Due to distal hypo-perfusion, toxins build up>Hyperkalemia: = tall sharp T waves & treat w/ sodium bicarb bc Acidosis
38
body's 1st line comp response:
= Blood loss > decreased arterial pressure, altered blood gases > baro&chemoreceptor reflex >cardiac stim/ systemic vasoconstriction, flow&Vol/ retribution
39
2nd line comp response:
Blood loss > RAAS, Catecholamine & Vasopressin released> vasoconstriction, increased Vol, cardiac stim
40
Platelet Phase of hemostasis:
2nd phase, Platelets aggregate, or collect and adhere. Slows hemorrhage from capillaries and small vessels- splint fractures to decrease of clots being broken down & bleeding again
41
Coagulation Phase of hemostasis:
3rd phase Clotting factors activated and released into bloodstream through a very complex cascade of events Triggers series of chemical reactions; formation of strong protein fibers (fibrin)
42
(Class I Hemorrhage) 1 injuries: 2Compensation for blood: 3Blood Loss: 4Pulse: 5Vent rate, BP & Pulse Pressure: 6Cap-Refill: 7Urine Output (mL/hr): 8Mental Status:
1= Broken humorous 750mL 2= Healthy PTs can easily compensate for such blood volume loss 3= Blood Loss: < 15% (<750 mL’s) 4= Pulse: Slightly Tachy 5= all Normal 6= Cap-Refill <2secs 7= 30mL/Hr or more 8= Slightly Anxious
43
(Class II Hemorrhage) 1 injuries: 2Compensation for blood: 3Blood Loss: 15 - 30% 4Pulse: 5Blood Pressure: 6Pulse Pressure: 7Capillary Refill: 8Ventilation Rate: 9Urine Output (mL/hr): 10Mental Status:
1= 1/2 Humorous fractures, a femur fracture, 1 full Hemopneumo 2= 1st line comp/ no longer maintain perfusion & 2ndary employed 3= 15 - 30% 750mLs-1.5L 4= > 100BPM 5= Normal 6= Starts to narrow 7= 2-3 secs 8= 20-30RR 9= (mL/hr) 20-30 10= Mildly Anxious
44
(Class IV Hemorrhage) 1 injuries: 2= Compensation to blood: 3= blood loss: 4= Pulse: 5= Blood Pressure: 6= Pulse Pressure: 7= Capillary Refill: 8= Ventilation Rate: 9= Urine Output (mL/hr): 10= Mental Status:
1= GSWs, multiple major fractures, Pelvis 2= Irreversible Shock! 3= > 40% (>2000mLs) of total blood 4= > 140 & barely palpable in central arteries 5= Very low 6= Narrows more 7= > 5 seconds 8= > 40 or agonal 9= Negligible 10= Lethargic or Unconscious
44
(Class III Hemorrhage)1 injuries/fractures: 2 Compensation to blood: 3 Blood Loss: 4 Pulse: 5 Blood Pressure: 6 Pulse Pressure: 7 Capillary Refill: 8 Ventilation Rate: 9 Urine Output (mL/hr): 10 Mental Status:
1= 2 Humorous, 1-2femur, 1 full Hemopneumo 2= Both 1&2nd comp/ responses failing to maintain perfusion & entering/in Decompensated Shock! (SBP <90) 3= Blood Loss: 30 - 40%, (1500 - 2000 mL’s) 4= >120 5= Starts to decrease 6= Narrows more 7= 3-4secs 8= 30-40 9= 5-10mL/hr 10= Anxious/Confused
45
(Non& Hemorrhagic treatment) If hemorrhage can be controlled: If hemorrhage cannot be controlled: Med for Sig/hemorrhage, in/external (after external controlled)
= IV/IO therapy (don’t delay transport) can administer 20 mL/kg bolus. =administer just enough IV fluid to obtain a radial pulse (permissive hypotension therapy!)NO MORE SBP 80-90 (IV fluids Warm) = Tranexamic Acid (TXA) Adult 1G/10 mins (mix in 50 mL of NS) follwed w/ 1G/8Hrs (500 mL bag) & Pediatric Not recommended