CH 29 Bleeding and Shock Flashcards
H-1) If blood is not circulated adequately through the body's capillaries, cells become starved for oxygen and nutrients, and overloaded with carbon dioxide and waste products. This condition is known as: A. cardiac compromise. B. hypoperfusion. C. circulatory depression. D. hypotension.
B. hypoperfusion
Under some conditions, blood does not circulate adequately through all the body’s capillaries. The chief result of inadequate circulation is a state of profound depression of cell perfusion, called shock (or hypoperfusion). The cells become starved for oxygen (hypoxia) and nutrients, and become overloaded with carbon dioxide and other waste products.
H-2) How does the vascular system control temperature regulation?
A. By dilating blood vessels in the periphery of the body to conserve heat
B. By expanding or narrowing the blood vessels
C. By increasing blood flow to the thermoregulatory center in the brain
D. By gathering heat from the surface of the body and delivering it to the core
B. By expanding or narrowing the blood vessels
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The body’s mechanism to conserve heat is to expand (dilate) or narrow (constrict) the blood vessels. Dilation of the blood vessels contributes to heat dissipation, whereas constriction of the blood vessels preserves core temperature by decreasing heat dissipation.
H-3) Gas exchange of oxygen for carbon dioxide occurs at the cellular level of the body between: A. capillaries and veins. B. capillaries and body cells. C. arteries and body cells. D. arteries and capillaries.
B. capillaries and body cells
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Where capillaries meet body cells is where the exchange of oxygen for carbon dioxide occurs.
H-4) Hemorrhagic shock is due to: A. dehydration. B. spinal trauma. C. sepsis. D. blood loss.
D. blood loss
H-5) Of the following adjustments to the vascular system, which will contribute the most to increased perfusion to the core? A. Decreased vascular diameter B. Increased blood volume C. Decreased heart rate D. Increased oxygen consumption
A. Decreased vascular diameter
Laws of hemodynamics demonstrate that a reduction in vascular diameter has the greatest influence on perfusion. Conversely, increasing the diameter would cause a reduction in perfusion, as is seen with septic and anaphylactic shock.
H-6) Which of the following is a defense mechanism that the body uses to defend against shock? A. Increased heart rate B. Vasodilation C. Decreased respirations D. Decreased heart rate
A. Increased heart rate
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To combat shock, the body will typically increase the heart rate and force of contraction.
H-7) All shock involves: A. inadequate tissue perfusion. B. hypertension. C. heart failure. D. sepsis.
A. inadequate tissue perfusion
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All shock involves inadequate tissue perfusion
H-8) When the body responds to shock, what physiological effects would you expect to occur? A. Bradypnea B. Peripheral vasoconstriction C. Peripheral vasodilation D. Bradycardia
B. Peripheral vasoconstriction
The body starts to “shunt” the blood from the extremities to the core of the body to protect the main organs of life (Lungs, Heart, Brain, Liver, Spleen, etc.)
H-9) Which patient is in the initial stages of shock?
A. 45-year-old motor vehicle crash victim with pale, cool, skin and tachycardia
B. 16-year-old female with a possible traumatic brain injury presenting with altered mental status and low blood pressure
C. 36-year-old fall victim with absent peripheral pulses
D. 52-year-old assault victim with bilaterally dilated pupils and cyanosis
A. 45-year-old motor vehicle crash victim with pale, cool, skin and tachycardia.
nitial presentation of shock symptoms include pale, cool, clammy skin; tachycardia; and tachypnea. As shock progresses, vital signs will deteriorate, with low blood pressure, thirst, dilated pupils, and cyanosis as late signs.
H-10) Your patient is a 49-year-old female with complaints of shortness of breath and generalized weakness. On examination, you note that she has extensive crackles in her lungs, swelling of her feet and ankles, and difficulty in breathing when lying down. This is troublesome for her because she gets lightheaded when sitting up, because of her low blood pressure. You would classify her shock as: A. neurogenic shock. B. anaphylactic shock. C. septic shock. D. cardiogenic shock.
D. cardiogenic shock.
The patient’s signs and symptoms suggest congestive heart failure, indicating cardiogenic shock, because the pumping mechanism has been compromised.
H-11) Which of the following would most likely lead to hypovolemic shock? A. Open fracture of the hand B. Subdural hematoma C. Crush injury to the foot D. Crush injury to the abdomen
D. Crush injury to the abdomen
Hypovolemic shock is most often caused by significant blood loss due to trauma or internal hemorrhage from a medical cause (such as an AAA, GI bleed, or crush injuries to major body cavities, such as the chest or abdomen). Hypovolemic shock may also result from third-space losses such as fluid shifts into various body compartments, as in severe pancreatitis, or fluid loss from protracted vomiting.
H-12) Which of the following forms of shock is associated with volume loss? A. Hypovolemic shock B. Septic shock C. Cardiogenic shock D. Neurogenic shock
A. Hypovolemic shock
Hypovolemic shock results from a loss of fluid, whether acutely – as in hemorrhagic shock – or over a period of time, as in dehydration. The other forms of shock are pipe problems. The amount of fluid is available, but the pipes’ ability to perfuse the body is compromised.
H-13) Your 55-year-old female patient is suffering from a rupturing abdominal aortic aneurysm, and is entering into the decompensating stage of shock. What finding would not be an indicator of decompensated shock in this patient? A. Cyanosis B. Dilated pupils C. Increased heart rate D. Falling blood pressure
C. Increased heart rate
Because an increased heart rate would be a sign of early, compensating shock, it would not be an indicator of decompensated shock.
H-14) You are assessing a 53-year-old male with severe blood loss from a wound that is covered with a pressure bandage. Bleeding appears to have stopped. The patient's pulse and respiration are elevated, but blood pressure is falling. The patient's skin around the lips shows signs of cyanosis, and the patient's pupils are dilated. What is a sign that the patient has entered decompensated shock? A. Cyanotic skin B. Severe blood loss C. Elevated pulse D. Elevated respiration
A. Cyanotic skin
Cyanosis around the lips and nail beds is one of the signs of late shock, which would indicate the onset of decompensated shock. Severe blood loss alone does not indicate decompensated shock. An elevated pulse and respiration would be consistent with compensated shock.
H-15) You are caring for a 28-year-old male patient who was involved in a motor vehicle crash. He has sustained a closed head injury and blunt-force trauma to his chest and abdomen, and is unconscious and in shock. In what position should you transport him?
A. In a sitting position, because of his closed head trauma
B. In a reverse Trendelenburg position, because of the patient’s head trauma and pulmonary injury
C. In a left lateral position, to allow for vomiting and to prevent aspiration
D. In a supine position with sufficient spinal immobilization
D. In a supine position with sufficient spinal immobilization
H-16) You are treating a 64-year-old female patient complaining of weakness and abdominal pain. You find the patient pale, cool, and diaphoretic, leaning against the wall adjacent to her toilet. You note the presence of bright, red blood in the toilet. Based on these findings, what treatment option will improve the body’s ability to clot?
A. Cover the patient in a blanket to prevent hypothermia.
B. Request advanced life support assistance, so that intravenous fluids can be infused to replace lost blood volume.
C. Place the patient on high-flow oxygen via nonrebreather.
D. Transport the patient to the most appropriate facility as soon as possible.
A. Cover the patient in a blanket to prevent hypothermia.
In addition to depleting the body’s energy stores, hypothermia may reduce the body’s ability to clot. Keeping the patient warm may prevent heat loss, which contributes to hypothermia.
H-17) A bulky dressing that is held in place by a tightly wrapped bandage and is used to control bleeding is called a: A. hemostatic dressing. B. tourniquet. C. cravat bandage. D. pressure dressing.
D. pressure dressing.
H-18) You arrive on scene to an 8-year-old male patient who fell while skating. He is responsive but is lying down on the pavement. As you assess the patient, you notice abrasions with self-controlled bleeding located on both his knees. Based on your assessment, what type of external bleeding is this? A. Arterial B. Non-significant C. Venous D. Capillary
D. Capillary
Slowly oozing blood that is a dark or intermediate color of red usually indicates damaged capillaries. In most cases, capillary bleeding is easily controlled. This type of bleeding often clots spontaneously.
H-19) Your 14-year-old male patient has fallen off his bike and scraped his arm. The bleeding is dark red and oozing slowly. This type of bleeding is usually from damaged: A. arteries. B. veins. C. capillaries. D. venules.
C. capillaries
Slowly oozing blood that is a dark or intermediate color of red usually indicates damaged capillaries. In most cases, capillary bleeding is easily controlled. This type of bleeding often clots spontaneously. However, if a large body surface is involved, bleeding may be profuse, and the threat of infection is great.
H-20) You are treating a 43-year-old female who was hunting with a pistol. When she sat down in the outhouse, her gun went off and created a large hole in her right femur, which is now severely spurting blood. What is the most appropriate method of bleeding control for this injury if direct pressure fails? A. Direct pressure and elevation B. Looking for a pressure point to apply C. Application of ice on the wound D. Application of a tourniquet
D. Application of a tourniquet
When a patient has a severe extremity injury, as in this case in which the blood is spurting from an artery, the most effective bleeding control method will be a tourniquet.
H-21) If you find a major bleed during your initial assessment of the patient, you should:
A. immediately apply direct pressure to the site with your gloved hand.
B. apply a blood pressure cuff above the site and inflate it until the bleeding stops.
C. immediately hold the injury above heart level and compress the appropriate pressure point.
D. complete your initial assessment, then control the bleeding with a pressure bandage.
A. immediately apply direct pressure to the site with your gloved hand.
Life-threatening conditions should be corrected first. Major bleeds must be stopped immediately before you move on to the rest of the primary assessment.
H-22) You are on scene for a 31-year-old female with bleeding from the medial aspect of her right upper arm. Emergency medical responders on scene applied a tourniquet. As you inspect the wound, you decide that a tourniquet is unnecessary. What are the proper steps for removing the tourniquet?
A. Once a tourniquet has been placed, you should remove it within 30 minutes.
B. Elevate the extremity and remove the tourniquet quickly.
C. Lower the extremity and remove the tourniquet slowly.
D. Once a tourniquet has been placed, you should not remove it unless approved by medical direction.
D. Once a tourniquet has been placed, you should not remove it unless approved by medical direction
H-23) In applying a tourniquet, which of the following is the proper technique?
A. Place the tourniquet at least 2 inches above the bleeding wound.
B. If no commercial tourniquet device is available, the EMT can use ropes or wires to create an improvised tourniquet.
C. Cover the injury and the tourniquet site to prevent overexposure to the environment.
D. Ensure that the patient has a pulse and sensory and motor function distal to the site after application of the tourniquet.
A. Place the tourniquet at least 2 inches above the bleeding wound.
H-24) Emergency medical care for internal bleeding includes:
A. placing the patient with head and torso elevated, to better perfuse the brain.
B. rapid transport for patients with signs and symptoms of shock.
C. applying supplemental oxygen by nasal cannula only, so that the circulatory system is not overwhelmed.
D. applying direct manual pressure to the areas of internal bleeding.
B. rapid transport for patients with signs and symptoms of shock.
The goal of all emergency medical care for internal bleeding is to recognize its presence quickly, maintain the body’s perfusion, treat for shock, and provide rapid transport to an appropriate medical facility.
H-25) Which of the following provides the greatest chance of survival for a critical trauma patient? A. High-flow oxygen B. ALS response C. Surgery D. IV fluids
C. Surgery
Surgery is the only definitive treatment for many trauma patients.
PT-1) A substance that will stop bleeding is called a: A. pressure dressing. B. compression device. C. tourniquet. D. hemostatic agent.
D. hemostatic agent
PT-2) You are treating a 29-year-old motorcycle crash victim who appears pale, cool, and diaphoretic. You suspect he sustained a traumatic brain injury based on decreased pupillary response. Based on these findings and the mechanism of injury, which of the following is the most appropriate method to manage this patient?
A. Limit on-scene time and promptly transport the patient to the hospital.
B. Perform a detailed secondary assessment on the patient prior to transportation.
C. Assess and catalog all major and minor injuries prior to transporting the patient to the hospital.
D. Splint all orthopedic injuries found prior to transporting the patient to the hospital.
A. Limit on-scene time and promptly transport the patient to the hospital.
PT-3) You have been called to a nursing home, where you find an 88-year-old female patient who is confused and combative. The staff states that this is not her normal behavior but that she has been bedridden from a previous stroke. They also report that she has had a recent urinary tract infection from an indwelling catheter. You note that her skin is flushed and warm, her pulse is 108, and her blood pressure is 80/44. You should suspect: A. hypovolemic shock. B. septic shock. C. anaphylactic shock. D. neurogenic shock.
B. septic shock
PT-4) What could be a sign that a patient is experiencing internal bleeding into the abdomen? A. Tenderness B. Contraction C. Erythema D. Cyanosis
A. Tenderness
PT-5) You suspect that your patient has a GI bleed. She presents with tachycardia, hypotension, and pale skin. What stage of shock is she most likely in? A. Compensated shock B. Decompensated shock C. Early shock D. Hypovolemic shock
B. Decompensated shock
PT-6) Which of the following is a function of the blood? A. Metabolism B. Production of red blood cells C. Hormone production D. Transportation of gases
D. Transportation of gases
PT-7) You are treating a patient who was dizzy and fell, sustaining a laceration to the forehead. Aside from determining the cause of the dizziness and dealing with the bleeding with direct pressure and bandaging, should you assess the patient for internal bleeding? Why?
A. Yes, because of the fall
B. No, because the fall only inflicted a laceration
C. No, because there are no signs of shock
D. Yes, because of the laceration
A. Yes, because of the fall
PT-8) You are managing a 27-year-old female with severe hemorrhage from her right ankle after a motor vehicle collision. You are unable to stop the hemorrhage with direct pressure. What intervention should you try next?
A. Apply a tourniquet proximal to the wound on the patient’s femur.
B. Place the patient on high-flow oxygen.
C. Apply a bulky sterile dressing.
D. Apply a pressure dressing.
A. Apply a tourniquet proximal to the wound on the patient’s femur.
PT-9) Waste can build up in the body when: A. excretion increases. B. the blood volume reduces. C. perfusion decreases. D. the heart rate decreases.
C. perfusion decreases.
PT-10) In all forms of shock, what is the greatest consequence to the body?
A. Decreased blood flow to the tissue
B. Inadequate delivery of oxygen to the cells
C. Decreased removal of waste from the tissue
D. Inadequate delivery of nutrients to the tissue
B. Inadequate delivery of oxygen to the cells
PT-11) If a patient in shock is able to maintain perfusion, then this is: A. compensated shock. B. decompensated shock. C. physiological shock. D. irreversible shock.
A. compensated shock.
PT-12) You respond to the scene of a 27-year-old female who was working on her car when she "snagged her hand on a sharp edge." She has napkins around her hand covering the wound. You uncover it and note that the bleeding is slow and dark red in color. Direct pressure easily stops the bleeding. Based on this information, what is the source of her bleeding? A. Radial artery B. Capillary bleed C. Brachial artery D. Cephalic vein
D. Cephalic vein
PT-13) Your patient has been severely injured in a fight. He is now lying supine, with gurgling respirations and visible blood in the throat. Which of the following should you do first? A. Suction the airway B. Apply oxygen C. Initiate PPV with oxygen D. Fully immobilize the patient
A. Suction the airway
