Bleeding Flashcards
As blood flows out of the heart, it passes into the ___
Aorta
The largest artery in the body
Aorta
The smaller blood vessels that connect the arteries and capillaries
Arterioles
Small tubes, with the diameter of a single red blood cell, that pass among all the cells in the body
Capillaries
The capillaries link the ___
Arterioles and venules
Blood leaving the distal side of the capillaries flows into the ___
Venules
These small, thin-walled vessels empty into the veins
Venules
The veins empty into the ___
Inferior and superior venae cavae
Blood contains ___
- Red cells
- White cells
- Platelets
- Plasma
Key to the formation of blood clots
Platelets
Blood clot formation depends on several factors
- Blood stasis
- Changes in the blood vessel wall
- Blood’s ability to clot
Monitors the body’s needs and adjusts the blood flow by constricting or dilating blood vessels as required
Autonomic nervous system
The cardiovascular system adapts to changing conditions in the body to maintain ___
Homeostasis and perfusion
If blood volume is significantly diminished and the system fails to provide sufficient circulation for every body part to perform its function, then ___ results
Hypoperfusion or shock
The circulation of blood within an organ or tissue to allow it to meet the cells’ current needs for oxygen, nutrients, and waste removal
Perfusion
Cells in the brain and spinal cord will start to die after ___ minutes without adequate perfusion
4 to 6
The lungs can survive only ___ minutes without adequate perfusion
15 to 20
Kidneys can be damaged after ___ minutes without adequate perfusion
45
Skeletal muscle demonstrates evidence of injury after ___ hours of inadequate perfusion
2 to 3
An organ that is kept at a considerably lower temperature may be better able to ___ from hypoperfusion
Resist damage
Bleeding
Hemorrhage
Visible hemorrhage
External bleeding
Treatment of a patient with external bleeding should be based on ___
The patient’s presentation and MOI
Amount of blood in the typical adult male body
70 mL of blood per kg of body weight
Amount of blood in the typical adult female body
65 mL of blood per kg of body weight
The body cannot tolerate an acute blood loss of greater than ___
20% of total blood volume
Typical blood volume of a 1-year old
27 oz (800 mL)
A child will show significant symptoms of blood loss after only ___
3 to 6 oz (100 to 200 mL)
20% of blood loss in an adult is about how much blood?
2 pints (1L)
Volume of blood in a typical 175 lb adult male
10 to 12 pints (6L)
An adult can comfortable donate ___ of blood within ___ and adapt well to this decrease in blood volume
- 1 pint (500 mL)
- 15 to 20 minutes
If the volume of blood loss occurs in a much shorter time, symptoms of ___ might result
Hypovolemic shock
You should consider bleeding to be severe if any of the following conditions exist ___
- The patient has a poor general appearance and has no response to external stimuli
- Assessment reveals signs and symptoms of shock
- You note a significant amount of blood loss
- The blood loss is rapid and ongoing
- You cannot control the bleeding
- The bleeding is associated with a significant MOI
On its own, bleeding tends to stop within about ___
10 minutes
Soon after being cut, the ends of the blood vessels begin to ___
Vasoconstrict
Lacking one or more of the blood’s clotting factors
Hemophilia
Any bleeding that occurs in a cavity or space inside the body
Internal bleeding
Local swelling and bruising around a broken none
Contusion or ecchymosis
A contusion or ecchymosis is caused by ___
The accumulation of blood around the ends of the broken bone
If you suspect that a patient is bleeding internally, ___
Treat for shock and promptly transport to the hospital
Always suspect internal bleeding in a patient who as sustained ___
A penetrating injury or blunt trauma
Some of the more common causes of nontraumatic internal bleeding
- Bleeding ulcers
- Bleeding from the colon
- Ruptured ectopic pregnancy
- Aneurysm
In older patients, ___ may be the first sign of nontraumatic internal bleeding
Dizziness, faintness, or weakness
Ulcers or other GI problems may cause ___
Vomiting of blood or bloody diarrhea
Frequent signs of nontraumatic internal bleeding (not always present)
- Abdominal tenderness
- Guarding
- Rigidity
- Pain
- Distention
Internal bleeding is most common in ___
Head, extremity, and pelvic injuries and is often associated with significant abdominal trauma
Intra-abdominal bleeding will often cause ___
Pain and abdominal distention
Bleeding into the chest cavity or lung may cause ___
Dyspnea, tachycardia, hemoptysis, and hypotension
The coughing up of bright red blood
Hemoptysis
A mass of blood that has collected in the soft tissues beneath the skin
Hematoma
The only sign of severe pelvic or abdominal trauma may be ___
Redness, skin abrasions, or pain
Blood in the urine
Hematuria
Bleeding from any body opening usually indicates ___
Internal bleeding that is not easy to see or control
Bright red bleeding from the mouth or rectum or blood in the urine may suggest ___
Serious internal injury or disease
___ vaginal bleeding is always significant
Non-menstrual
Vomiting of blood
Hematemesis
If the blood vomited has been partially digested, the vomit may look like ___
Coffee grounds
Black, foul-smelling, tarry stool that contains digested blood
Melena
Other signs and symptoms of internal bleeding in trauma and medical patients
- Hematemesis
- Melena
- Pain, tenderness, bruising, guarding, or swelling
- Broken ribs, bruises over the lower part of the chest, or a rigid, distended abdomen
Pain, tenderness, bruising, guarding, or swelling, especially in an extremity may mean that ___
A closed fracture is bleeding
Broken ribs, bruises over the lower part of the chest, or a rigid, distended abdomen may indicate a ___
Lacerated spleen or liver
Patients with an injury to their spleen or liver may have referred pain in the ___
- Right shoulder (liver)
- Left shoulder (spleen)
First sign of hypovolemic shock
Change in mental status
In a nontrauma patient___ can all be early signs of hypovolemic shock
Weakness, faintness, or dizziness on standing
Later signs of hypovolemic shock suggesting internal bleeding
- Tachycardia
- Weakness, fainting, or dizziness at rest
- Thirst
- Nausea and vomiting
- Cold, moist skin
- Shallow, rapid breathing
- Dull eyes
- Slightly dilated pupils that are slow to respond to light
- Capillary refill time longer than 2 seconds in infants in children
- Weak, rapid pulse
- Decreasing BP
- Altered level of consciousness
If the patient has obvious, life-threatening external bleeding, treat it ___
First
Cool, moist skin that is pale or gray suggests a ___ problem
Perfusion
If the patient is able to speak, this indicates that the airway is ___
Patent
It is important to ask the bleeding patient if they take ___ medications
Blood thinning
Blood-thinners are often prescribed for patients with a history of ___
Stroke, pulmonary embolism, or heart attack
Common blood thinners
- Antiplatelets such as aspirin, clopidogrel (Plavix), and ticagrelor (Brilinta)
- Anticoagulants such as warfarin (Coumadin), rivaroxaban (Xarelto), dabigatran (Pradaxa), apixaban (Eliquis), and edoxaban (Savaysa)
When examining the head, be alert for ___
Uncontrolled bleeding from large scalp lacerations
When examining the abdomen, ___
Feel all four quadrants for tenderness or rigidity
In the extremities, record ___
Pulse, motor, and sensory function
In an adult patient, a systolic BP less than ___ with a ___ and ___ are signs of hypoperfusion that require immediate attention
- 100 mm Hg
- Weak, rapid pulse
- Cool, moist skin that is pale or gray
Children will compensate well for blood loss and then ___
Crash quickly
Whenever you suspect significant bleeding, either external or internal, and signs of shock are present, provide ___
High-flow oxygen
Methods to control bleeding
- Direct pressure
- Pressure dressings and/or splints
- Tourniquets
- Junctional tourniquet
- Hemostatic dressing
- Wound packing
Never remove an object protruding from a wound, unless ___
It is in the cheek and blocking the patient’s airway
Apply bulky dressings to stabilize the impaled object in place, and apply pressure as best you can for at least ___
5 minutes without interruption
Once you have applied a dressing to control bleeding, create a pressure dressing to maintain the pressure by ___
Firmly wrapping a sterile, self-adhering roller bandage around the entire wound
Use ___ for small wounds and ___ for larger wounds
- 4 x 4-inch sterile gauze pads
- Sterile universal dressings
If direct pressure fails to immediately stop hemorrhage, then ___
Apply a tourniquet above the level of the bleeding
If tourniquet is not possible because the wound is too proximal, then consider a ___
Junctional tourniquet or wound packing with a hemostatic dressing if available
Dressing impregnated with a chemical compound that slows or stops bleeding by promoting clot formation
Hemostatic dressing
If the tourniquet does not immediately control bleeding ___
Apply a second one adjacent to the first
Never use ___ for a tourniquet
Wire, rope, al belt, or other narrow material that could cut into the skin
If it is possible to do so without causing a delay, consider placing ___ under the tourniquet as you apply it
Padding
Allows for proximal compression of life-threatening bleeding in areas where a standard tourniquet application is not possible
Junctional tourniquet
Junction of the torso with the arms
Axillary area
Inguinal area
Legs
Some junctional tourniquets may also be used as a ___ for suspected unstable pelvic fractures
Pelvic binder
Known as soft splints or pressure splints
Air splints
Can help control internal or external bleeding associated with severe extremity injuries, such as fractures
Air splints
Type of splint that may be indicated for a suspected closed unstable pelvic fracture
Pelvic binder
Helps to control internal bleeding from an open-book pelvic fracture
Pelvic binder
A life-threatening fracture of the pelvis caused by a force that displaces one or both sides of the pelvis laterally and posteriorly
Open-book pelvic fracture
Trochanters
Hips
How to apply a pelvic binder
- Slide the binder under the supine patient with the device centered over the trochanters
- Secure and tighten device
Pediatric patients who weigh less than ___ may be too small for an adult pelvic binder
50 lbs
After you have applied a splint, be sure to___
Monitor pulse and motor and sensory function in the distal extremity
Bleeding around the face always presents a risk for ___
Airway obstructions or aspiration
Conditions that can result in bleeding from the nose, ears, and/or mouth
- Fracture of the base of the skull
- Facial injuries
- Sinusitis, infections, nose drop use and abuse, dried or cracked nasal mucosa, intranasal use of street drugs, or other abnormalities
- High BP
- Coagulation disorders
- Digital trauma
- Cancer
Nosebleed
Epistaxis
The tissue dividing the nostrils
Septum
Head position when treating a nosebleed
Leaning forward, head tilted forward
Apply direct pressure to a nosebleed for at least ___
15 minutes
Other method to stop a nosebleed
Place a rolled gauze bandage between the upper lip and the gum and apply pressure by stretching the upper lip tightly against the bandage and pushing it up into and against the nose
Bleeding from the nose or ears following a head injury may indicate a ___. In these cases, do not ___
- Skull fracture
- Attempt to stop the blood flow
If blood or drainage contains cerebrospinal fluid, you will see a ___
Characteristic staining of the dressing much like a target or halo shape
If you suspect a skull fracture, ___
Loosely cover the bleeding site to collect the blood and help keep contaminants away from the site. Apply light compression by wrapping the dressing loosely around the head
