Bleeding (chapter 24)

Question 1

Perfusion

Answer 1

Circulation of blood which is ADEQUATE to meet the needs of the organ or tissue

Question 2

Constant supply needed in the _______

Answer 2

The lungs and the kidneys never rest and require adequate perfusion at all times.

Question 3

Control center of the blood supply

Answer 3

The AUTONOMIC nervous system monitors the blood flow and makes adjustments as needed. (ex: shunting, increase heart rate etc.)

Question 4

Shock

Answer 4

HYPOperfusion, inadequate perfusion to organs or tissues.

Question 5

Tissue Damage Times

Answer 5

Without adequate perfusion damage occurs within __min
Brain/Spinal Cord 4-6 min
Kidneys 45 min
Skeletal muscles 120 min
GI track (limited but not absent flow for multiple hours)

Question 6

Hemorrhage

Answer 6

Bleeding
External : visible, crosses the skin
Internal: not visible, based on signs symptoms
(Has to be found and fixed by surgeon)

Question 7

External bleeding

Answer 7

Capillary: shallow, superficial. dark oozing blood slow but steady
Venous: darker red, moves more freely than capillary but able to be controlled. Flash you get during IV start.
Arterial: bright red, spurts along with the pulse.

Question 8

Internal Bleeding

Answer 8

High energy MOI
Blunt or penetrating trauma
Don’t forget NOI
Some illnesses can create internal bleeding;
ulcers, ruptured ectopic pregnancies, aneurysms

Question 9

contusion

Answer 9

bruise

Question 10

ecchymosis

Answer 10

discoloration of skin associated with a closed wound, bruising

Question 11

hematoma

Answer 11

mass gathering of blood inside the soft tissue under the skin,

Question 12

hematuria

Answer 12

pissing blood

hema: blood
uria: urine

Question 13

hematemesis

Answer 13

vomiting blood.
When it looks like used coffee grounds its a sign of an Upper GI tract bleed. Dark coffee appearance because the GI tract has already started working on it, trying to attack it/digest it.

Question 14

hemoptysis

Answer 14

coughing up blood

will be bright red

Question 15

melena

Answer 15

pooping out digested blood

black tarry, foul smelling

Question 16

hematochezia

Answer 16

bloody poops

BRIGHT red blood, color indicates bleeding near the exit of the colon

Question 17

EARLY signs of hypovolemic shock

Answer 17

change in mental status
(anxiety, restlessness, combative)

weakness, fainting, dizziness when standing

changes in skin color (pallor)

PROMPT transport!

Question 18

LATE signs of hypovolemic shock

Answer 18

(suggestive of internal bleeding)

tachycardia (heart rate over 100bpm) 
weak, dizzy, fainting at REST
thirst 
nausea and vomiting 
cold, clammy, moist skin 
shallow rapid breathing (trying to blow off carbon)
dilated, slow to respond pupils 
capillary refills taking LONGER than 2 seconds 
weak, thready pulse
altered level of consciousness
*PROMPT transport!*

Question 19

Blood pressure during shock/internal bleeding

Answer 19

blood pressure can be UNRELIABLE indicator during early stages of shock. Body tries to maintain as long as possible, medications can mask early BP changes.

Question 20

Acute blood loss

Answer 20

Body CAN’T tolerate an acute blood loss of 20% volume

Question 21

Average blood volume

Answer 21

Typical adults holds 70mL of blood per kilogram of weight.

Blood loss of greater than 1 liter of blood will cayse changes in vital signs. How fast matters too
(increased HR, increased Resp, decreased BP)

Question 22

increase index of suspicion if you see ____.

Answer 22

significant MIO 
(ESPECIALLY blunt to abdomen or chest)
poor general appearance 
s/s of shock 
significant blood loss
rapid blood loss
uncontrolled bleeding