Bleeding

Question 1

What part of the nervous system monitors blood flow and adjusts accordingly?

Answer 1

Autonomic nervous system

Question 2

How long can the kidneys survive inadequate perfusion before permanent damage occurs?

Answer 2

45 minutes

Question 3

How long can the brain and spinal cord survive inadequate perfusion before permanent damage occurs?

Answer 3

4-6 minutes

Question 4

When does the cardiac cycle start and end?

Answer 4

Begins with onset of muscle contraction and ends with the beginning of the next contraction.

Question 5

Preload

Answer 5

Amount of blood returned to the heart to be pumped out.

Question 6

Afterloard

Answer 6

Pressure in the aorta or peripheral vascular resistance

(PVR), against which the left ventricle must pump blood.

Question 7

What governs afterload?

Answer 7

Arterial BP

Question 8

BP is represented by “

Answer 8

CO x PVR

Question 9

Mean arterial pressure

Answer 9

Measurement of arterial pressure in the vessels that perfuse the organs and indicate changes b/n CO and PVR

Question 10

Equation for MAP

Answer 10

Diastolic pressure + 1/3 pulse pressure

Question 11

Pulse pressure

Answer 11

Calculated by subtracting diastolic BP from systolic BP

Question 12

Cardiac output

Answer 12

Amount of blood pumped through the circulatory system in 1 minute

Question 13

CO equation

Answer 13

SV x PR

Question 14

Relationship between preload, afterload, and SV.

Answer 14

Preload directly affects afterload which in turn affects the SV.

A higher afterload reduces SV.

Question 15

Frank-Sterling mechanism

Answer 15

If the heart is stretched the muscle will contract more forecully.

Question 16

What occurs when the heart muscles are stretched?

Answer 16

The heart will contract more forcefully in order to prevent blood from backing up in veins.

Question 17

Why does the ejection fraction remain the same if the heart muscles are stretched?

Answer 17

Even though the amount of blood being forced through the heart increases, the same amount of blood that was pumped out of the heart is the amount when it returns to the heart. The amount of blood remains the same whether it returning or leaving the heart.

Question 18

Signs of shock

Answer 18

AMS
Tachycardia
Cold, moist skin
Shallow, rapid breathing
Abnormal cap refill
Weak, rapid pulse
Dull eyes
Weakness, fainting, or dizziness
Thirst
N/V

Question 19

Class I hemmorrhage

Answer 19

Blood loss : <750 mL
% blood loss : 15%
HR : minimally elevated or nl
Systolic BP : w/in nl limits
Capillary refill : w/in nl limits
Pulse : w/in nl limits
Respiratory rate : 14-20
CNS/mental status : slightly anxious
Skin condition : cool, pink
Urine output : >30
Fluid replacement : crystalloid

Question 20

Class II hemorrhage

Answer 20

Blood loss : 750-1,500 mL
% blood loss : 15-30
HR : 100-120
Systolic BP : minimal or no change
Pulse : narrow
Capillary refill : may be delayed
Respiratory rate : 20-24
CNS/mental status : mildly anxious
Skin condition : cool, moist
Urine output : 20-30 mL/h
Fluid replacement : crystalloid

Question 21

Class III hemorrhage

Answer 21

Blood loss : 1,500-2,000 mL
% blood loss : 30-40
HR : =>120, thready
Systolic BP : hypotensive
Pulse : narrow
Capillary refill : delayed
Respiratory rate : tachypneic
CNS/mental status : anxious and confused
Skin condition : cool, pale, moist
Urine output : diminished
Fluid replacement : crystalloid and blood

Question 22

Class IV hemorrhage

Answer 22

Blood loss : > 2,000 mL
% blood loss : >40
HR : tachycardia
Systolic BP : hypotensive
Pulse : very narrow
Capillary refill : delayed
Respiratory rate : markedly tachypneic
CNS/mental status : confused and lethargic
Skin condition : cold, pale
Urine output : minimal or none
Fluid replacement : crystalloid and blood

Question 23

When should you remove an impaled object from a wound?

Answer 23

Impaled through the cheek and interferes with airway or the chest and interfered with chest compressions.

Question 24

Bleeding will almost always stop when the pressure of the dressing ____ arterial pressure.

Answer 24

Exceeds

Question 25

What dimensions should a triangular bandage be if you are using it as a tourniquet?

Answer 25

4” wide x 6-8 layers thick

Question 26

How much air should be inflated in an air splint?

Answer 26

50 mm Hg

Question 27

Hemostatic agent

Answer 27

Adheres to the damaged tissue and either dehydrations the blood or undergoes a chemical reaction that stimulates the natural blood-clotting cascade.

Question 28

Treatment for epistaxis

Answer 28

Cold compress over bridge of nose while patient leans forward. Rolled gauze can be placed under upper lip as well.

Question 29

Management of internal hemorrhage

Answer 29

Maintain airway
C-spine if indicated
Administer supplemental oxygen and assist ventilation PRN
Control external hemorrhage
Establish two 18-gauge IVs
Administer 250 mL of nl saline or lactated Ringer solution. Use warm fluids if able.
Keep patient warm
Provide immediate transport
Consider ALS rendezvous for analgesics for pain

Question 30

How does TXA work?

Answer 30

Reduces fibrinolysis by inhibiting the activation of plasminogen to plasmin, which also reduces cloth breakdown.

Question 31

Management of hemorrhagic shock

Answer 31

XABC
Identify and stop any major bleeding.
NPO
Splint extremity fx during transport
Signs of shock - administer supplemental oxygen and keep warm
Establish two 18-gauge IV en route
Administer warm isotonic crystalloid of nl saline in 250 mL increments
Monitor LOC, pulse, and BP