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EMT > Bleeding & Shock > Flashcards

Bleeding & Shock Flashcards

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1
Q

Bleeding control is performed during which assessment?

A

Primary Assessment

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2
Q

Variables for severity of bleed

A
  • Amount of blood loss
  • Rate of loss
  • Other injuries/pre-existing conditions
  • Age
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3
Q

Percentage of 200ml of Blood loss in an adult vs. infant

A 
Adult = 4%
Infant = 25%
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4
Q

Types of bleeding

A
  • Arterial bleeding
  • Venous bleeding
  • Capillary bleeding
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5
Q

Arterial bleeding

A
  • Bright red squirting blood from wound
  • Squirting coincides with the contraction of the heart
  • More difficult to control because of the higher pressure
  • As BP decreases so will the squirting
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6
Q

Venous Bleeding

A
  • Dark red blood with a steady flow
  • May be profuse, but it is easier to control
  • Lower pressures
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7
Q

Capillary Bleeding

A
  • Dark slow oozing flow
  • Easiest to control
  • May spontaneously clot on it’s own
  • Large enough area can be prone for infection (Road Rash)
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8
Q

Bleeding Control techniques

A
  • Direct pressure
  • Tourniquets
  • Elevation
  • Splinting
  • Hemostatic Agents
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9
Q

Direct pressure

A
  • 1st method for bleeding control
  • Will handle most of the wounds an EMT sees
  • Gauze applied on wound
  • Pressure dressing (Kerlix/Coban)
  • Helps allow the clotting process to take hold
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10
Q

Tourniquets

A
  • If bleeding is not controlled with direct pressure/bandage
  • Follow manufacturer’s instructions
  • Place High and tight
  • Must tighten until bleeding stops, no pulse past tourniquet
  • Label time and location of TK
  • 2 TK can be used
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11
Q

Why splinting is important?

A

Broken bones if left un-splinted the potential of laceration Increases

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12
Q

Splinting should only be done on scene if pt is?

A

Stable

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13
Q

Hemostatic Agents

A
  • Designed to improve clotting

- Extremity Use only

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14
Q

Types of Hemostatic Agents

A
  • Fibrinogen
  • Thrombin
  • Chitosan
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15
Q

Isolated nose bleed aka?

A

Epistaxis

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16
Q

Nose bleed Rx

A

Have pt lean slightly forward & place direct pressure with ice pack on the bridge of the nose

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17
Q

Impaled Objects

A
  • Leave in place! Unless object is compromising the airway or breathing
  • Pad and stabilize around the object
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18
Q

Internal bleeding considerations

A
  • MOI
  • NOI
  • Vitals
  • BP
  • Skin signs
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19
Q

Pneumatic antishock garment (PASG) aka MAST indications

A
  • Pelvic Fracture with BP greater than 90mmHg
  • Internal ABDM bleed
  • Retroperitoneal bleed with hypotension
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20
Q

PASG contraindications

A
  • Penetrating thoracic trauma
  • Splinting of Lower extremity fracture
  • Eviscerated ABDM Organs
  • Impaled object in ABDM
  • Pregnant
  • Cardiopulmonary Arrest
  • CHF
  • Pulmonary Edema
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21
Q

Soft Tissue Injuries

A
  • Contusion
  • Hematoma
  • Crush Injury
  • Abrasions
  • Lacerations
  • Avulsions
  • Amputations
  • Penetration/Puncture
  • Bites
  • Clamping Injury
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22
Q

Contusion

A
  • A Bruise
  • Blood Vessels in the dermis are damaged
  • Localized Swelling/Pain
  • Discoloration
23
Q

Hematoma

A
  • Similar to contusion
  • Larger blood vessels involved
  • Large lump with bluish discoloration from blood pooling
24
Q

Crush injury

A
  • Can cause severe under lying internal injuries
  • Organs can pop
  • Can be opened or closed
25
Q

Abrasions

A
  • Scraping away the epidermis
  • Oozing capillary bleed
  • Can be serious with greater surface area
  • “Road Rash”
26
Q

Lacerations

A
  • A break in the skin of varying depth
  • Extent of Bleeding depends on vessels hit
  • “linear” clean razor cut
  • “Stellate” irregular jagged cut from blunt objects
27
Q

Avulsions

A
  • Loose flap of skin & underlying soft tissue
  • Still attached would be a “partial”
  • Torn free would be a “total” or “Complete”
  • Bleeding will be dependent on depth and internal structures hit
28
Q

Amputations

A
  • Disruption in the continuity of an extremity or other body part
  • Bleeding can be massive
  • Incomplete amputations tend to bleed more than complete amputations.
29
Q

Penetrations/Punctures

A
  • Sharp object being driven into the skin
  • Entry wound may seem small with little bleeding, but injuries below could be massive
  • Severity depends on location, depth, size, & force of object
30
Q

Bites

A
  • Are a combination of penetration/puncture and crush injuries
  • Severity depends on location, force, & size of animal.
31
Q

Clamping Injury

A

-Body part is caught by or strangled by a piece of machinery

32
Q

Penetrating chest trauma

A
  • Treat all wounds from the neck to the naval as sucking chest wounds
  • Anticipate pneumothorax
33
Q

Rx for penetrating chest wound

A

Occlusive dressing or chest seal to stop bleeding

34
Q

4 categories of shock

A
  • Hypovolemic Shock
  • Distributive Shock
  • Cariogenic Shock
  • Obstructive Shock
35
Q

Hypovolemic Shock

A
  • Inadequate volume due to blood or other fluid loss

- Shock Caused by low blood volume

36
Q

Medical problems associated with fluid loss

A
  • Long bouts of Vomiting
  • Diarrhea
  • Fluid Loss associated with burns
37
Q

Distributive Shock

A
  • Decrease in intravascular volume caused by massive systemic vasodilation
  • No actual fluid loss in some cases
  • Volume becomes Inadequate to fill Increased size
38
Q

Distributive Shock S/Sx

A

-Increased capillary permeability
-Fluid leaks out of the capillary beds leading to fluid loss
-Loss in peripheral vascular resistance (PVR)
Leads to Lower Systolic pressures
-Preload is reduced , which reduces cardiac output

39
Q

Cardiogenic Shock

A
  • Heart is ineffective as a pump
  • When the heart has lost 40% or more of the left ventricle through MI the heart will have reduced output (most likely cause)
  • The left ventricle does not have the ability to create the force to eject all the blood from the chamber.
40
Q

What kind of patients are prone to cardiogenic shock?

A

Pt’s with CHF, Infection, & abnormal heart rhythms

41
Q

Obstructive Shock

A

Condition that Obstructs blood flow

42
Q

What does large clots like Pulmonary Embolism do?

A

Reduces preload and lead to decreased cardiac output

43
Q

What does tension pneumothorax and pericardial tamponade do?

A
  • Compress the heart to prevent adequate ventricular filling
  • Reduces cardiac output
  • Lowers systolic blood pressure
44
Q

Body response to shock

A
  • Increased heart rate
  • Increased Force of ventricular contraction
  • Vasoconstriction
  • Release of epinephrine and norepinephrine (Fight or flight)
45
Q

Stages of shock

A
  • Compensatory shock
  • Decompensatory shock
  • Irreversible shock
46
Q

Compensatory Shock

A
  • The body is able to maintain normal BP to vital organs.

- Increasing cardiac output sustains BP for a time

47
Q

Decompensatory Shock or Progressive Shock

A
  • Body’s compensatory systems are failing
  • Cells & Tissues are becoming ischemic from lack of profusion
  • Blood is beginning to pool
48
Q

Irreversible Shock

A
  • the body dies, cell/tissue death and organ shut down

- regardless of Rx Pts outcome will be death

49
Q

S/Sx of compensated shock

A
  • Anxiety
  • Normal BP
  • Tachycardia (100+)
  • Pulse can begin to weaken
  • Slight Increase in RR
  • Skins May be poor
50
Q

S/Sx of Decompensated shock

A
  • ALOC to unresponsive
  • Hypotension, this shows transition to decompensated
  • Marked Tachycardia (130+)
  • Pulse quality weak to absent
  • Skins white and waxy
51
Q

Anaphylactic Shock

A
  • Distributive Shock
  • Capillaries becomes permeable
  • Epinephrine is the Rx
52
Q

Septic Shock

A
  • Massive Infection releases toxins in the blood
  • Distributive Shock
  • Vessels dilate
  • Capillaries leak
  • Possible Fever
53
Q

Neurogenic Shock

A
  • Distributive Shock
  • AKA Vasogenic Shock
  • Caused by spinal cord injury
  • Loss of sympathetic tone cause vessels to dilate
  • No blood loss
  • Preload is decreased dropping BP

EMT (26 decks)

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