Bleeding and Shock

Question 1

External Hemorrhage

Answer 1

A break in the skin. Capillaries ooze, veins flow, arteries spurt. Apply direct pressure.

Question 2

Internal Hemorrhage

Answer 2

Not always obvious. Usually caused by blunt trauma. Rapid transport, immobilization of area and treatment of shock.

Question 3

Trauma Triad of Death

Answer 3

Increased mortality rate in trauma patients who have:

Hypothermia, coagulopathy (can’t clot), and acidosis.

Question 4

Cardiogenic Shock

Answer 4

Heart’s reduced ability to pump blood effectively. Myocardial infarctions, myocarditis, pulmonary embolism, arrhythmias.

Question 5

Obstructive Shock

Answer 5

Blockage in the heart’s blood vessels affecting blood flow. Tension Pneumothorax, pericardial tamponade.

Question 6

Hypovolemic Shock

Answer 6

Loss of blood volume. Can be Endogenous or Exogenous (Internal bleeding or external bleeding)

Question 7

Distributive Shock (3 kinds)

Answer 7

Septic, Neurogenic, Anaphylactic

Question 8

Septic Shock

Answer 8

Widespread infection. Inflammatory-immune response causes increased permeability of the capillaries and vasodilation.

Question 9

Neurogenic Shock

Answer 9

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.

Question 10

Anaphylactic Shock

Answer 10

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.

Question 11

Angioedema (IV)

Answer 11

Fluid building up in the subcutaneous area as a reaction to an allergen. Not usually dangerous, unless it affects airway.

Question 12

3 Levels of Shock

Answer 12

Compensated (alert), decompensated (altered LOC), irreversible.

Question 13

Stage 1+2 Hemorrhage

Answer 13

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)

Question 14

Stage 3 Hemorrhage

Answer 14

30-40% blood loss
BP down
Pulse >120
RR high
Confused

Question 15

Stage 4 Hemorrhage

Answer 15

40+% blood loss
BP extremely low
Pulse >140
RR >40
Confused and lethargic

Question 16

Compensated Shock

Answer 16

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.

Question 17

Decompensated Shock

Answer 17

The classic shock. When the body can’t compensate anymore - BP drops, tachypnea, tachycardia but weak, cold skin/extremities, possibly altered LOC.

Question 18

Permissive Hypotension

Answer 18

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.

Question 19

Baroreceptors

Answer 19

Detects changes in BP and sends out signals to increase or decrease BP as needed. Located in the aorta and carotid arteries.

Question 20

Chemoreceptors

Answer 20

Detects change in pH and sends signals to the medulla to adjust with buffers. Located in the aorta and carotid arteries.