Bleeding And Shock

Question 1

Shock

Answer 1

Life threatening condition( hypoperfusion) body is unable to circulatate oxygen rich blood to the cells

Question 2

Compensated shock

Answer 2

The maintenance of perfusion in the blood during shock due to the body trying to maintain homeostasis

Question 3

Decompensated shock

Answer 3

The last stage of shock where the compensation mechanism( increased heart rate, vasoconstriction, increased respiratory rate) are unable to maintain adequate perfusion to the brain and vital organs

Question 4

Hypovolemic shock

Answer 4

Resulting from excessive loss of fluids or blood

Question 5

Hemostatic

Answer 5

A substance used to stop bleeding like powders, gauze, dressing or bandages

Question 6

Hemostasis

Answer 6

The cessation of bleeding

Question 7

Hypoperfusion

Answer 7

The body’s inability to circulate blood to the body to supply it with oxygen and nutrients

Question 8

Clotting physiology

Answer 8

Physiology
• Blood clots form to help prevent leaking when you break the surface of the skin

The constriction reduces blood flow to the injured blood vessel, which helps to limit blood loss. The injured blood vessel will constrict, the platelets present in the blood that is passing through that vessel will start to stick to the collagen fibers that are part of the blood vessel wall. Fibrin threads entwine the platelet plug forming a mesh-like framework for a clot.

• The framework traps red blood cells that flow toward it, forming a clot. Because red blood cells are tangled in the meshwork, clots appear to be red. As the red blood cells trapped on the outside dry out, the color turns a brownish red, and a scab is formed than the fibrin net is formed

Question 9

Non compressible hemorrhages

Answer 9

Cannot be compressed with direct pressure
Includes the chest and abdominal cavity

Signs and symptoms:
Ab rigidity and tenderness 
Bruising ( ecchymosis) 
Coughing up blood ( hemoptysis) 
Rectal bleeding 
Bloody vomit( hematemesis)

Question 10

How much can an adult bleed into each side of the Chest

Answer 10

1500 ml

Question 11

Hemorrhages of the abdominal cavity

Answer 11

A typical adult can hemorrhage up to 10 liters in the abdominal cavity even though body only has about 6 liters of blood circulating

Question 12

Compressible hemorrhages

Answer 12

Can be compressed with direct pressure, wound packing, and pressure bandage

Includes arms legs maxilla groin and neck and superficial wounds to the head and torso

Adult can bleed up to 1 liter into the thigh

Question 13

Arterial bleed

Answer 13

Profuse bleed, very hard to control and is typically bright red

Question 14

Venous bleed

Answer 14

Bleeding from the vein is easy to control

Maroon or dark red color

Question 15

Capillary bleed

Answer 15

Slow oozing flow from the caps

Question 16

Methods to control bleeding

Answer 16

Direct pressure 
Elevation 
Pressure dressing 
Tourniquet
Hemostatic

Question 17

Direct pressure

Answer 17

Applying compressive force directly over the injured area maintaining this for 3-5 minute until bleeding subsided

Question 18

Elevation

Answer 18

Assist direct pressure by the use of gravity.
Blood circulates slower when a wound is elevated above the heart
Blood pressure also lowers

Question 19

Pressure bandage

Answer 19

May be used alone for superficial to moderate injuries
• May be used with hemostatic agents or gauze packing for large or deep wounds
• This allows the agents to work better

Question 20

types of pressure bandage

Answer 20

ace wraps and elastic bandages
Emergency Trauma Bandage and H bandage
Most come with 2 silver colored metal clips
• These clips cannot be trusted to ensure pressure in maintained
• While applying the wrap, both ends should be remain free in order to tie them together in a square knot

Question 21

Hemostatic Agent

Answer 21

Quick Clot combat gauze.
These dressings have chemical properties that stimulate clotting when placed in wounds.
expose injured area
place gauze directly in wound onto bleeding vessel
apply direct pressure for 3 minutes
secure the dressing with tape

Question 22

The four P’s

Answer 22

peel

push pile pressure

Question 23

principles of wound packing

Answer 23

hemostatic agent is recommended for arterial bleed

wounds involved with veins or arteries

Question 24

wound depth

Answer 24

moderate to severe depth may require hemostatic agent and gauze packing
superficial wound: pressure bandage

Question 25

When Hemorrhage has been identified on a casualty

Answer 25

expose the wound 
maintain direct pressure 
apply a pressure dressing 
reassess the wound 
record

Question 26

What are tourniquets used for

Answer 26

used to control major hemorrhage by compressing tissues around blood vessels

Question 27

types of tourniquets

Answer 27

combat application tourniquet or real tourniquet used for one time use. (black)
A trainer tourniquet is used all the time for training purposes(blue)

Question 28

deliberate tourniquet

Answer 28

expose wound
place tourniquet 2-3 inches
pull free end of the handle through the buckle
pull self adhering bandage as tight as possible
twist the windlass until the bleeding stops
lock the windlass in place with the clip
secure the windlass with the windlass strap
assess the distal pulse
place a T and the time on the casualty
secure the CAT with tape

Question 29

hasty tourniquet

Answer 29

high and tight and over the clothing

Question 30

Internal Bleeding

Answer 30

Internal bleeding can result in severe blood loss with resultant shock (hypoperfusion) and subsequent death
• Suspicion and severity of internal bleeding should be based on the mechanism of injury (MOI)
• Although not usually visible, internal bleeding can result in serious blood loss, up to 10 liters even though the circulatory system only has 6 liters
• A casualty with internal bleeding can develop shock before you realize the extent of their injuries
• In most cases, internal bleeding is caused by trauma
• Blood loss in the peritoneal cavity, regardless of the source will contribute to hypovolemic shock
• A casualty’s entire circulating volume can be lost into the abdomen