Bleeding and Shock Flashcards
External Hemorrhage
A break in the skin. Capillaries ooze, veins flow, arteries spurt. Apply direct pressure.
Internal Hemorrhage
Not always obvious. Usually caused by blunt trauma. Rapid transport, immobilization of area and treatment of shock.
Trauma Triad of Death
Increased mortality rate in trauma patients who have:
Hypothermia, coagulopathy (can’t clot), and acidosis.
Cardiogenic Shock
Heart’s reduced ability to pump blood effectively. Myocardial infarctions, myocarditis, pulmonary embolism, arrhythmias.
Obstructive Shock
Blockage in the heart’s blood vessels affecting blood flow. Tension Pneumothorax, pericardial tamponade.
Hypovolemic Shock
Loss of blood volume. Can be Endogenous or Exogenous (Internal bleeding or external bleeding)
Distributive Shock (3 kinds)
Septic, Neurogenic, Anaphylactic
Septic Shock
Widespread infection. Inflammatory-immune response causes increased permeability of the capillaries and vasodilation.
Neurogenic Shock
Injury to the spine, resulting in loss of control - vasodilation. No loss of blood, but organs are not being perfused. Bradycardia and lack of sweat below the injury point is a symptom.
Anaphylactic Shock
Upon sensitization to allergen, histamine and vasodilators are released. Bronchoconstriction and leaking of interstitial fluids lead to swelling and wheezing sounds commonly associated with severe allergic attacks.
Angioedema (IV)
Fluid building up in the subcutaneous area as a reaction to an allergen. Not usually dangerous, unless it affects airway.
3 Levels of Shock
Compensated (alert), decompensated (altered LOC), irreversible.
Stage 1+2 Hemorrhage
15% blood loss ; 15-30% blood loss
BP normal ; BP normal
Pulse >100 ; Pulse >100
RR normal ; RR elevated
Alert but anxious (slight to mild)
Stage 3 Hemorrhage
30-40% blood loss
BP down
Pulse >120
RR high
Confused
Stage 4 Hemorrhage
40+% blood loss
BP extremely low
Pulse >140
RR >40
Confused and lethargic
Compensated Shock
Vitals will seem more normal. Tachycardia, less urination, thirst, anxiety, decreased CO (ex: 105/90). Baroreceptors pick up lowered BP and begins compensatory stage to keep organs perfused.
Decompensated Shock
The classic shock. When the body can’t compensate anymore - BP drops, tachypnea, tachycardia but weak, cold skin/extremities, possibly altered LOC.
Permissive Hypotension
In some hemorrhage patients, administering boluses of fluid just up to 80/90 systolic is beneficial (when the distal pulses return) because higher blood pressure could aggravate bleeding or dislodge clots trying to form.
Baroreceptors
Detects changes in BP and sends out signals to increase or decrease BP as needed. Located in the aorta and carotid arteries.
Chemoreceptors
Detects change in pH and sends signals to the medulla to adjust with buffers. Located in the aorta and carotid arteries.
