Chap 25

Question 1

Different parts of a vessel

Answer 1

External elastic membrane
Smooth muscle
Internal elastic membrane 
Lumen
Endothelium

Valve- only in veins
Capillaries- just has endothelium

Question 2

Functions of blood

Answer 2

Transports gases
Nutrition
Excretion
Protection
Regulation

Question 3

hemorrhage

Answer 3

Bleeding, especially severe bleeding

Hemorrhage is the major cause of shock in trauma

Question 4

Arterial bleeding

Answer 4

Bleeding from an artery, which is characterized by bright red blood that is rapid, profuse and difficult to control

Spurting Blood
Pulsating flow
Bright red color

Question 5

Venous bleeding

Answer 5

Bleeding from a vein, which is characterized by dark red or maroon blood and a steady, easy to control flow

Steady, slow flow
Dark red color

Question 6

Capillaries

Answer 6

Small vessels that are under far less pressure and can be easily controlled. Superficial wounds to the surface of the skin

Bleeding is under very low pressure and produces only a slow ooze from the wound. Typically ceases with out any intervention

Sometimes occurs over large areas so risk of infection is high

Slow, even flow

Question 7

Junctional hemorrhage

Answer 7

Occurs where the appendages of the body connect to the trunk. In these locations large arteries and veins tend to be less well protected and particularly vulnerable to traumatic forces. The neck both armpits and both sides of the groin are sites were massive bleading is likely

Question 8

Affects of hypothermia on blood

Answer 8

Affects ability to clot decreases. The colder a patient gets, the more likely coagulopathy or impaired ability to clot. Hypoperfused slowly lose their ability to generate heat through metabolism and their ability to conserve heat through blood flow

Question 9

Compressible

Answer 9

For the most part, external hemorrhage is “compressible”, that is it can be controlled by compressing the tissue around the wound or the vessel that is bleeding or both.

Question 10

Late signs of shock

Answer 10

Thirst, dilated pupils, and cyanosis around the lips and nail beds

Question 11

Anaphylactic and neurogenic shock

Answer 11

Skin is typically warm, flushed and dry because the circulatory system has lost the ability to constrict blood vessels in the skin

Question 12

Major methods of controlling external bleeding

Answer 12

Direct pressure
Elevation of a limb
Hemostatic agent
Tourniquet

Question 13

Pressure dressing

Answer 13

A bulky dressing held in position with a tightly wrapped bandage, which applies pressure to help control bleeding

Question 14

Elevation

Answer 14

Gravity helps reduce the blood pressure in the extremity, slowing bleeding. Don’t use this method if you suspect possible muscle skeletal injuries, impales objects in extremity or spine injury as the movement of broken bone ends or penetrating objects can further damage the tissue

Question 15

Hemostatic agents

Answer 15

Substances applied as powders, dressings, glaze or bandages to open wounds to stop bleeding

Question 16

Placement of tourniquet

Answer 16

2 inches above bleed

Question 17

Make shift tourniquets

Answer 17

Two inches wide

Several layers thick

Question 18

Bystanders tourniquets

Answer 18

If the EMT determines that the bleeding is not severe and other means would control it, medical direction may be contacted about removing the tourniquet

If you find that the tourniquet spoiled by a layperson has not stopped the bleeding, immediately apply direct pressure and remove it.

Question 19

Splinting for bleeding control

Answer 19

Air splint may he used to control internal and external as long as no suspected bone injury. Air splints are most effective for venous and capillary bleeding but not usually effective for high pressure bleeding caused by artery bleeds unless arterial pressure has decreased below that of the splint

Question 20

Cold applications

Answer 20

Cold minimizes swelling, reduce pain and reduces the bleeding by constricting the blood vessels.

Don’t apply directly to skin. don’t leave in place longer than 20 minutes

Question 21

Head injury

Answer 21

Traumatic injuries resulting in a fractured skull may cause bleeding or loss of cerebrospinal fluid (CSF) from the ears or nose. Head injury results in increased pressure within the skull, which forces fluid out of the cranial cavity. You should not attempt to stop this bleeding or fluid loss as doing so may increase the pressure in the skull. Do not apply pressure to the ears or nose. Allow he drainage to flow freely using a gauze pad to collect it

Question 22

Nosebleeds

Answer 22

(epistaxis)

Tiny capillaries in nose may burst because of increased blood pressure, sinus infection, or digital trauma (nose picking).

Steps

1. Patient sit down and lean forward
2. Apply or instruct patient to apply direct pressure to the fleshy portion around the nostrils
3. Keep patient calm and quiet
4. Don’t let the patient lean back. This allows the blood to flow down the esophagus to the stomach causing nausea and vomiting
5. If patient goes unconscious, place in the recovery position

Question 23

Mechanisms for blunt trauma

Answer 23

Falls
Motor vehicle or motorcycles crashes
Auto-pedestrian collisions
Blast injuries

Question 24

Mechanisms for penetrating trauma

Answer 24

Gunshots
stab wounds
impaled objects

Question 25

Compensated shock

Answer 25

The body senses the decrease in profusion and attempts to compensate for it. the body is able to compensate the work and patient maintains his blood pressure.

Constriction of the peripheral circulation(to redirect blood to the vital core organs) results in pale, cool skin and in infants and children, increased capillary refill time

Question 26

Decompensated shock

Answer 26

Point when the body can no longer compensate for the low blood volume or lack of perfusion. Late signs of shock, such as falling blood pressure, develop.

Question 27

Hemorrhagic shock

Answer 27

shock resulting from blood loss

Hypovolemic shock may also be caused by burns or crush injuries where plasma is lost or by severe dehydration

Question 28

Fight or flight

Answer 28

When pressure receptors in the aorta and carotid artery sense decreased flow, they stimulate the release of epinephrine and norepinephrine into the bloodstream. This causes blood vessels to constrict, especially in the skin, kidneys and gastrointestinal tract. When blood vessels in the skin constrict, the skin becomes cool and pale. Sweat glands empty their contents, causing the sweaty skin so commonly seen in this situation. When blood vessels in the kidney constrict, the kidneys produce less urine, thereby preventing the loss of more fluid. Constriction of blood vessels in the GI tract causes the stomach to try to empty its contents leading to nausea and vomiting.

Question 29

Neurogenic shock

Answer 29

result from the uncontrolled dilation of blood vessels from nerve paralysis caused by spinal cord injuries. Although there is no actual blood loss, the dilation of the blood vessels increases the circulatory systems capacity to the point where the available blood can no longer adequately fill it

Sepsis (also called blood poisoning) and anaphylactic reaction also results in vasodilation that may cause shock

Question 30

Platinum 10 minutes

Answer 30

The goal for on scene time when caring for a trauma or shock patient has been stated as a maximum of 10 minutes.

Question 31

Acidosis (lactic acid)

Answer 31

a condition that occurs when cells receive insufficient oxygen and generate acidic waste products that accumulate in the blood.

Question 32

Layers of vessels starting from the outside

Answer 32

External elastic membrane
Smooth muscle
Internal elastic membrane
Lumen
Endothelium
Valve- just veins

Question 33

What’s narrowing of blood pressure

Answer 33

As the difference between the systolic and diastolic pressure decrease, it shows signs of shock