Bleeding Shock Soft Tissue Injuries

Question 1

what is a wound?

Answer 1

an injury, usually involving division of tissue or rupture of the integument (skin) or mucous membrane, due to external violence or some mechanical agency rather than disease

Question 2

List and describe the five main types of wounds

Answer 2

CLIPS:

C Contusion - A Bruise
L Laceration - A Tear Like Wound
I Incision - A Clean Scalpel Cut
P Puncture - An object piercing the
skin and creating a hole
S Special - Ballistic Wound

Question 3

Types of injuries

Answer 3

B Bruising
E Evisceration
A Abrasion
P Puncture (penetrating/perforation)
A Avulsion
I Incision
L Laceration

Question 4

What is evisceration?

Answer 4

Injury in which organs protrude from the abdominal cavity through a wound in the abdominal wall

Question 5

What are perforations?

Answer 5

Entry and Exit wounds present

Caused by gunshot, blast injuries etc

Complete head to toe examination if suspected

All injuries must be treated and bleeding controlled

Question 6

What are avulsions?

Answer 6

Injury in which flaps of skin or tissue are torn loose or pulled completely off

Question 7

What is an incision wound?

Answer 7

Usually caused by a sharp edged object
e.g. a knife or razor
Clean cut wound
Bleeds heavily and freely
Heals quickly

Question 8

What is a haematoma?

Answer 8

an injury/trauma damages your veins and arteries

Question 9

What is a haemmorhage?

Answer 9

bleeding

Question 10

What are the types of bleeding?

Answer 10

Arterial Bleeding
Venous bleeding
Capillary Bleeding

Question 11

What is arterial bleeding?

Answer 11

characterized by spurts with each beat of the heart, is bright red in colour.

Question 12

What is venous bleeding?

Answer 12

characterized by a steady flow and the blood is dark, almost maroon in shade.

Question 13

What is capillary bleeding?

Answer 13

characterized by slow & oozing in nature, this type of bleeding usually has a higher risk of infection.

Question 14

What is shock?

Answer 14

• Failure of the cardiovascular system to adequately supply the body with oxygenated blood
• Bleeding is one of the most common causes
• State of collapse and failure of the cardiovascular system
• Blood circulation slows and eventually ceases

Question 15

What happens if blood flow stops or slows significantly?

Answer 15

• Waste elimination ceases.
• Oxygen delivery would also be disrupted.
• Anaerobic metabolism begins

Question 16

What is hypovolaemic shock?

Answer 16

an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body

Question 17

What is haemostasis?

Answer 17

HOWTHE BODY STOPS BLEEDING
- When vessels are lacerated
- Open ends of the vessel begin to narrow
- Platelets aggregate at the site
- Bleeding will not stop if a clot does not form
- Direct contact with body tissues and fluids or the external environment commonly triggers the blood’s clotting factors

Question 18

What are the three successive phases of shock?

Answer 18

• Compensated
• Decompensated
• Irreversible

Question 19

What is the compensated phase of shock?

Answer 19

Earliest stage
Body can still compensate for blood loss
Level of responsiveness is best indicator of tissue perfusion
Blood pressure is maintained

Blood loss in hypovolaemic shock can be estimated at 15% to 30%
Narrowing of the pulse pressure occurs
Positive orthostatic tilt test result
Treatment will typically result in recovery

Question 20

What is the decompensated phase of shock?

Answer 20

• Blood pressure is falling
• Blood volume drops by more than 30%
• Compensatory measures begin to fail
• Signs and symptoms are more obvious
• Cardiac output falls dramatically
• Treatment will sometimes result in recovery

Question 21

What is irreversible shock?

Answer 21

Arterial blood pressure is abnormally low
Rapid deterioration
Life-threatening reductions in cardiac output, blood pressure and tissue perfusion
Cells begin to die
Vital organ damage cannot be repaired

Question 22

what is the care management for a patient with external bleeding?

Answer 22

Scene Safety
BSI
PEEPS
Posture; Elevate; Examine; Pressure; Shock
O2 Therapy
ALS
Transport

Question 23

What is a haemostatic dressing?

Answer 23

dressing with chemicals that help stop bleeding

Question 24

Where is a tourniquet applied?

Answer 24

2-3 inches above the wound

Question 25

What are the 4 pressure points?

TO STOP BLEEDING

Answer 25

• Brachial artery
• Radial artery
• Femoral artery
• Popliteal artery (back of knee)

Question 26

What are the causes of non-traumatic internal bleeding?

Answer 26

Cases of GI bleeding from the upper or lower GI tract
Ruptured ectopic pregnancies
Ruptured aneurysms

Question 27

What is the term for bleeding from the lungs?

Answer 27

Haemoptysis

Bright red and frothy coughed up through the trachea and airways

HE MOPS BITCH

Question 28

What is the term for internal stomach bleeding?

Answer 28

(Haematemesis)

Dark coffee colour is vomited up. can range from frank blood to coffee ground in appearance

Question 29

How does internal bleeding in the kidneys present?

Answer 29

Stains the urine into a smokey grey colour, can range from staining the urine to frank blood

Question 30

How does internal bleeding in the large intestine present?

Answer 30

Passed by bowel as black tarry substance

Question 31

what is malaena?

Answer 31

the production of dark sticky faeces containing partly digested blood, as a result of internal bleeding or the swallowing of blood

Question 32

What is CSF?

Answer 32

internal brain bleed
blood escapes through the eyes/ears/nose

Question 33

What are the signs and symptoms of bleeding?

Answer 33

Pulse – Rapid and weak
Respirations – Rapid and shallow (air hunger)
Pupils – Dilated / blurred vision
Skin – Pallor, cold extremities, cyanosis
Blood Pressure – Late sign BP Drops

Question 34

What is the treatment for an internal haemorhage?

Answer 34

treat for shock
Administer high-flow supplemental oxygen
Assist ventilation if needed
Splint broken bones or joint injuries
Place blankets under and over the patient
Consider giving analgesia if required
Monitor the serial vital signs

LOAD AND GO

Question 35

what is a crush injury?

Answer 35

body part stuck between two solid objects?

Question 36

what happens to the body after it has been crushed for 4+hrs?

Answer 36

Arterial blood flow is compromised

Muscles are crushed beyond repair

Tissue necrosis (Rhabdomyolysis)

Influx of water, sodium chloride and calcium

Freeing the limb

“Smiling death”

Renal failure

Life-threatening arrhythmias

Question 37

what are the 6 P’s of compartment syndrome?

Answer 37

Pain

Paraesthesia (Pins, Needles, Unusual, etc.)

Paresis (loss of movement)

Pressure

Passive stretch pain

Pulselessness

Delayed or nonspecific

If it persists for longer than 8 hours

Question 38

what reasons would an EMT remove an impaled object?

Answer 38

if the object interferes with airway control

If the object interferes with chest compression

Impaled on an immovable object