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EMT Test 4 > Bleeding & Shock > Flashcards

Bleeding & Shock Flashcards

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1
Q

Arteries

A

Systemic
• Carry oxygen-rich blood away from the heart
• Comprised of thick, muscular walls that enable dilation and constriction
Pulmonary
• Pulmonary artery

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2
Q

Veins

A
  • Carry oxygen-depleted blood rich in carbon dioxide back to the heart
  • Contain one-way valves to prevent back flow of blood
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3
Q

Capillaries

A

• Microscopic blood vessels
• Vital exchange site: oxygen, nutrients passed through
capillary walls in exchange for
carbon dioxide from cells - occurs in the alveoli - circulatory system rich in CO2 (during exchange)

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4
Q

Functions of Blood

A
  • Transportation of gases
  • Nutrition
  • Excretion
  • Protection
  • Regulation
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5
Q

Perfusion

A

Adequate circulations of blood throughout body

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6
Q

Hypoperfusion (Shock)

A

Inadequate circulations of blood to tissues and organs

Pump Problem - cardiogenic
Content - hypovolemic, dehydration, bleeding
Container Problem - Sepis, Anaphylaxis, neurogenic

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7
Q

Two Types of Bleeding

A
  • External
  • Internal -

main area you can loose enough blood to die in thorax, abdomen, pelvis, femur fracture

how much blood do I have to loose to have a problem

20% rule (circulating blood volume)

1200ml (6000ml x 20%)

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8
Q

External Bleeding What does it look like:
Arteries:
Veins:
Capillaries:

A

Arteries: Spurting Blood, Pulsating Flow, Bright Red Color

Veins: Steady, slow flow, Dark Red Color

Capillaries: Steady Even Flow

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9
Q

Arterial External Bleeding is?

A

Oxygen Rich
Rapid and profuse
Spurting with heartbeat
Most difficult to control

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10
Q

Venous External Bleeding is?

A

Rich in carbon dioxide & waste
Steady flow
Easier to control
low pressure system

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11
Q

Capillary External bleeding is?

A

Slow and Oozing
Easily controlled
Stops Spontaneously

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12
Q

Think About It: Bleeding

A

• How severe is the bleeding? Is it exsanguinating hemorrhage? If so, how does that affect the priorities of treatment?

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13
Q

Patient Assessment - Primary Assessment

A 
Standard Precautions
Open Airway
Monitor Respirations
Ventilate if Necessary
Control Bleeding
Skin: Color, Temp, Condition, Check Pulses
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14
Q

Methods to Control External Bleeding

A

Direct Pressure
Elevate
Pressure Dressing
Tourniquet

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15
Q

Direct Pressure - How to

A
  • Apply firm pressure to wound with gloved hand and gauze bandage
  • Hold pressure until bleeding is controlled
  • If necessary, add dressings when lower ones are saturated
  • Never remove bandages—even when bleeding is controlled
  • When controlled, check for pulse distal to wound - PMS
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16
Q

Elevate

A
  • Elevate injured extremity above level of the heart while applying direct pressure
  • Do not elevate if musculoskeletal injury is suspected
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17
Q

Pressure Dressing

A

• Place several gauze pads on wound
• Hold dressings in place with self-adhering roller bandage wrapped tightly over
dressings and above and below wound site
• Create enough pressure to control bleeding

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18
Q

Hemostatic Agents

A
  • Commonly, dressing containing substance that absorbs and traps red blood cells
  • Can be wadded up and inserted into wound
  • May be a powder poured directly into the wound
  • Manual pressure is always necessary
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19
Q

Tourniquet

A
  • Use if bleeding is uncontrollable via direct pressure
  • Use only on extremity injuries
  • Once applied, do not remove or loosen
  • Attach notation to patient alerting other providers tourniquet has been applied
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20
Q

Think About It: Bleeding

A

• Is the current method of bleeding control working? Do you need to move on to a more aggressive step? How would you
evaluate this?

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21
Q

Other Ways to Stop Bleeding

A
  • Splinting
  • Cold application
  • Pneumatic anti-shock garment (PASG)
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22
Q

Special Bleeding Situations Head Injury

A

• Head injury
– From increased intracranial pressure, not direct trauma
– Stopping bleeding only increases intracranial pressure

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23
Q

Special Bleeding Situations Nose Bleeds (Epistaxis)

A 
– Have patient sit and lean forward
– Apply direct pressure to fleshy
portion of nostrils
– Keep patient calm and quiet
– Do not let patient lean back
– If patient becomes unconscious, place patient in recovery position and be prepared to suction
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24
Q

Internal Bleeding

A
  • Damage to internal organs and large blood vessels can result in loss of a large quantity of blood in short time
  • Blood loss commonly cannot be seen
  • Severe blood loss can even result from injuries to extremities
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25
Q

Blunt Trauma is..

A 
• Leading cause of internal bleeding
– Falls
– Motor vehicle crashes
– Automobile–pedestrian collisions
– Blast injuries
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26
Q

Penetrating Trauma

A

• Common penetrating injuries
– Gunshot wounds
– Stab wounds
– Impaled objects

27
Q

Signs of Internal Bleeding

A
  • Injuries to surface of body
  • Bruising, swelling, or pain over vital organs
  • Painful, swollen, or deformed extremities
  • Bleeding from mouth, rectum, or vagina
  • Tender, rigid, or distended abdomen
  • Vomiting coffee-ground or bright-red material
28
Q

Pediatric Considerations Bleeding

A

• Infants and children—efficient
compensating mechanisms maintain blood pressure until half of volume is depleted
• Potential for shock must be recognized and treated before tell-tale signs appear

29
Q

Cultural Considerations: Bleeding

A

• Places on body to look to assess circulation via skin color
– Fingernails and lips
– Conjunctiva in eyes
– Palms of hands; soles of feet

30
Q

Treatment of Internal Bleeding

A

Administer Oxygen
Maintain ABC’c
Control External Bleeding
Rapid Transport to Appropriate Medical Facility

31
Q

Shock

A

Inability to supply cells with oxygen

Inadquate removal of waster products from cells

32
Q

Causes of Shock

A

• Failure of any component of circulatory
system
– Heart: loses ability to pump
– Blood vessels: dilate, making too large a “container” to fill
– Blood: loses volume from bleeding

Pump
Content
Container

33
Q

Severity of Shock Compensated

A

Compensated - Body shunts blood where needed

34
Q

Severity of Shock Decompensated

A

Decompensated - Blood pressure falls as body can’t handle loss of blood

35
Q

Severity of Shock Irreversible

A

Cell damage occurring, causing rapid death

36
Q

During Shock

A
  • Pulse increases to maintain cardiac output
  • Blood vessels constrict, causing pale, clammy skin
  • Respiration rate increases
  • Blood is shunted away from the GI organs causing nausea
  • Decreasing blood pressure is a late sign of shock
37
Q

Types of Shock

A
  • Hypovolemic
  • Cardiogenic
  • Neurogenic
38
Q

Hypovolemic Shock

A
  • Results from a decreased volume of circulating blood and plasma
  • Called hemorrhagic shock if caused by uncontrolled bleeding (internal or external)
  • Can be caused by burns or crush injuries
39
Q

Cardiogenic Shock

A
  • Seen in patients suffering myocardial infarction
  • Results from inadequate perfusion to heart, decreasing strength of contractions
  • Heart’s electrical system may malfunction causing heartbeat that is too slow, too fast, or irregular
40
Q

Neurogenic Shock

A
  • Results from inability to control dilation of blood vessels because of nerve paralysis
  • No blood loss, but vessels dilated so much that blood volume can’t fill them
  • Rarely seen in the field
41
Q

Signs and Symptoms of Shock

A
  • Altered mental status
  • Pale, cool, clammy skin
  • Nausea and vomiting
  • Vital sign changes
42
Q

Care for Shock

A
  • Aggressive airway maintenance
  • Administer high-concentration oxygen
  • Attempt to stop cause of shock
  • Apply and inflate PASG if approved
  • Splint any suspected bone or joint injuries
  • Prevent loss of body heat
  • Deliver patient to appropriate medical facility within “golden hour”
  • Speak calmly and reassure throughout assessment and care
43
Q

Bleeding & Shock Chapter Review

A

• Almost all external bleeding can be controlled by direct pressure and elevation. If these don’t work, apply tourniquet if bleeding is on an extremity.
• Emergency care for internal bleeding is based on prevention and treatment of shock.
• Early signs of shock: restlessness, anxiety, pale skin, rapid pulse and respirations.
• If shock is uncontrolled, patient’s blood pressure falls (late sign of shock).
• Signs and symptoms may not be evident early; treatment based on MOI may be lifesaving.
• Treat shock by airway maintenance; administration of high-concentration oxygen; controlling bleeding; and keeping
the patient warm. One of most important treatments is early recognition of shock and immediate transport.

44
Q

Remember: Bleeding & Shock

A

• The circulatory system is designed to ensure adequate perfusion of body
tissues.
• The classification of hemorrhage is directly related to the type of vessel ruptured and
the pressure within that vessel.
• Treatment of external hemorrhage includes progression through the following steps: direct pressure, elevation, tourniquet application, use of hemostatic agents.
• Internal bleeding is impossible to evaluate. The most appropriate treatment must be
rapid transport to an appropriate facility.

45
Q

Remember: Bleeding & Shock

A
  • Shock develops if the heart fails, blood volume is lost, or blood vessels dilate, resulting in inadequate perfusion.
  • Signs of shock reflect the body’s attempts at compensating for inadequate perfusion.
  • The most significant treatment for the shock patient is early recognition and prompt transport to a hospital where the patient will receive definitive care.
46
Q

Questions to Consider: Bleeding & Shock

A
  • What can I use for a tourniquet that will control bleeding but not damage tissue?
  • When treating a patient with shock, what should I do at the scene and what should I do en route to the hospital?
47
Q

Questions to Consider: Bleeding & Shock

A

• Is a patient with pale, cool skin,
tachycardia, and rapid, shallow respirations in shock or just under stress?
How will continuing assessment help in making that decision?

48
Q

Critical Thinking
• A patient has been involved in a motor vehicle collision. There is considerable damage to the vehicle. The steering column and wheel are badly deformed.
The patient complains of a “sore chest.” You note no external bleeding.

A

• The patient’s vital signs are pulse 116, respirations 20, blood pressure 106/70. How would you proceed to assess and care for this patient?

49
Q

Be Able to trace a drop of blood through the body including the valves of the heart

A

.

50
Q

an adult patient with a blood volume of 7 will start to see symptoms of shock after how much blood loss

A

.

51
Q

test questions on what does blood loss look like

bright red
Dark red color
steady even flow

which type of blood loss is characterized by……

A

.

52
Q

Always check the pulse distal to the injury, PMS

A

.

53
Q

can use an BP cuff as a tourniquet

A

look this up in the book - pg 627

54
Q

Nosebleed

A

lean the patient back
swallow blood they are going to vomit
blood they get in the mouth spit it out

55
Q

recovery position

A

place pt on left side

56
Q

can loose a two liters of blood with bilateral femur fracture.

A

.

57
Q

blunt trauma pt in cardiac arrest don’t survive

penetrating trauma a little bit better

lost circulating blood volume

A

.

58
Q

internal

A

look of for mechanism
bruising
over liver is it rigid or hurt

59
Q

kids compensate much better than adults - they maintain for a longer period of time - and then drop off a cliff

A

.

60
Q

Three phases of shock

A

compensated - increases HR, Blood vessels get smaller -
HR 130, cool clammy skin, BP 120/80

decompensated - blood pressure starts to fall - not a good sign prehospital - HR, Skin, abdomen

irreversible

61
Q

know symptoms of shock in kids

633

A

.

62
Q

know compensated, decompensated, irreversible

last vital sign to fail in shock in BP

A

.

63
Q

hypovolemic - content - blood vomiting, diarrhea, shot dehydration

cardiogenic - pump

nuerogenic - container
septic
anaypy
psychogenic

A

.

64
Q

care for shock

A

.

EMT Test 4 (11 decks)

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