3) Hemorrhage & Shock Flashcards
Internal Hemorrhage being forced between tissue layers (fascia):
Internal Hemorrhage:
Pregnant internal hemorrhage worry:
Internal blood loss may be self limiting:
= 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.
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:
= Arteries, Veins, Capillaries
= “A Away”, “V Venga”, “Cap C venioles & arterioles for exchanging”
= Veins
= Ischemia
= Capillaries
If a decision is made to use a tourniquet to stop external hemorrhage, an important point to remember is that:
The accumulation of lactic acid, potassium, and anaerobic metabolites can occur with tourniquet use
The middle, muscular layer of the blood vessels that controls lumen size:
Tunica Media
The blood volume of an infant or young child is proportionally:
Population most at risk for trauma & trauma death:
= ~20%> than that of an adult
= Young adult male
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:
= Fibrin
= clotting and blood vessel repair
= Fibrin
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?
= Be noticeably narrower
= Stage 2
Patients with epistaxis should be placed:
Nose bleeding result from injury, disease, or environmental factors:
= In the recovery position
= Epistaxis
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:
= Preload, afterload, and cardiac contractility
= Stroke Volume
= Preload
= Cardiac output
= Mean arterial pressure
= Afterload
ETCO2 Lvs in head-injured intubated PT shouldn’t drop below:
When vent/ing a adult PT, each breath should have tidal volume of:
= 30 mmHg
= approximately _500 mL’s.
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:
= Homeostasis
= Coagulopathy
= Clotting
= Vascular phase
= Medications such as aspirin
= process of coming & sticking together
Precapillary sphincters dilate & permit blood flow through capillaries during times of low O2 & CO2 build up in cells b/c:
= release of chemical Histamine
CUPS acronym, the “P” stands for:
the “P” stands for: Potentially unstable
An abnormal internal or external discharge of blood:
Venous bleeding usually looks:
= Hemorrhage
= Dark red and flowing
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:
= Shock
= Shock
= Decompensated
= Hypothermia
= Death still occurs
Tension pneumo & pulmonary emboli is which type of shock?
Pericardial tamponade presents w/:
= Obstructive
= Becks triad JVD, tachycardia, hypotension, & Muffled heart tones
1st step used to control external bleeding is:
med w/ beneficial role in management of trauma/hemorrhagic shock:
A weak pulse:
= Direct pressure
= Tranexamic acid TXA
= Thready
If you suspect a pelvic fracture in your patient, you should:
Not compress or otherwise manipulate the pelvis
The molecule in the blood to which oxygen attaches is:
Able to live without oxygen:
Protein that spurs production of RBC in bone marrow:
= Hemoglobin
= Anaerobic
= Erythropoietin
Cardiogenic shock:
Has a high mortality rate
Septic shock
Toxins release affecting vascular system’s control of blood vessels
Recent evidence suggests that Mechanism of Injury:
may not be as good an injury severity predictor as once thought.
if one lung needs to be darted:
= dart the other lung
Sympathetic NS is the division of the autonomic nervous system that:
+ tropic effects, GI constriction, vasoconstriction, mydriasis
Orthostatic hypotension
PT’s BP drops 20 HR+20 when moved from supine to a seated position
Starling’s law of the heart process:
= increase CO occurs in proportion to diastolic stretch of heart M. fibers
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
Baroreceptors:
Baroreceptors:
= receptors that monitor blood pressure
= Great vessels recept/ Gives feedback to brain > Sympathetic NS Activation, AArch & carotid arteries> feedback to medulla >SNS
Multi organ dysfunction:
organs dying b/c lacking perfusion (ICU dying shock)
Beta blockers effect w/ blood
Ca-blockers effect w/ blood
= block norepi & epi
= cant shunt/vaso-constrict
(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
Hypoadrenalism
- hard response to stress
Ventilations increasing indicates
Pale cool diaphoretic skin indicates
= aerobic to anaerobic drive
= shock
Shock’s 5 categories
Hypovolemic, Cardiogenic, Distributive, Obstructive, resp/metabolic
(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)
3 parts of circulatory system:
maintain homeostasis via:
Pos feedback:
= “pump fluid pipes” heart, blood, & blood vessels
= negative feedback loop
= childbirth & blood clots
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
DIC intra cholopathy (septic shock)
Ventricles separated by:
Atriums separated by:
bi/tricuspid valves separate:
= intraventricular septum
= interatrial septum
= upper & lower chambers
Pericardial steatosis:
Pericarditis PT’s will have more pain with:
= extract blood from pericardial sac fixing tamponade
= laying down & coughing
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”
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
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)
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
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
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)
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
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.
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%
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
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
body’s 1st line comp response:
= Blood loss > decreased arterial pressure, altered blood gases > baro&chemoreceptor reflex >cardiac stim/ systemic vasoconstriction, flow&Vol/ retribution
2nd line comp response:
Blood loss > RAAS, Catecholamine & Vasopressin released> vasoconstriction, increased Vol, cardiac stim
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
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)
(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
(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
(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
(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
(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
