Chapter 25 bleeding and shock

Question 1

Trauma fact

Answer 1

Trauma is the leading cause of death for persons between the ages of one and 44. Approximately 180,000 deaths and many of them were preventable

Question 2

Structure of arteries, capillaries, and veins

Answer 2

1. Artery
   - made up of External elastic membrane, smooth muscle, internal elastic membrane, endothelium, lumen
   - artery has a thick muscular wall that enables it to dilate and constrict
2. Capillaries
   - made up of Endothelium
   - 1 cell thick, extremely thin walls
3. Veins
   - Made up of external elastic membrane, smooth muscle, internal elastic membrane, endothelium, aluminum, and one-way valve
   - veins are not as thick as arteries
   - veins also have a one-way valve
   - Blood in vein is under much less pressure than blood an artery

Question 3

Hemorrhage

Answer 3

Also known as severe bleeding

Question 4

Three types of external bleeding

Answer 4

Arterial bleeding
- spurting blood, pulsating flow, bright red color
Venous bleeding
- Steady flow, slow flow, dark red color
Capillary bleeding
- Slow – even flow

Question 5

Arterial bleeding

Answer 5

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

• Spurting blood, pulsating flow, bright red color

Question 6

Venous bleeding

Answer 6

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

• steady, slow flow, dark red color, Sheer volume of blood carried by some veins is enough to create an immediate life-threatening hemorrhage

Question 7

Junctional hemorrhage

Answer 7

Occurs where the appendages of the body connect to the trunk

• examples Dash neck, both armpits, and both sides of the groin

Question 8

Capillary bleeding

Answer 8

Bleeding from capillaries, which is characterized by a slow, oozing flow of blood

• typically ceases without any intervention at all
• risk of infection is high

Question 9

Signs of shock - in order of appearance 1-4

Answer 9

1. Altered mental status
2. Pale, cool, and clammy skin - diaphoretic
3. Nausea and vomiting
4. Vital sign changes
   - First to change is pulse then respirations, lastly blood pressure, narrowing of pulse

• late signs of shock that you may counter include thirst, dilated pupils, and in some cases cyanosis around the lips and nail beds

Question 10

Major methods of controlling external bleeding are

Answer 10

– direct pressure
– elevation of a limb
– Hemostatic agent
– tourniquet

Other methods include
– splinting and cold application

Question 11

Pressure dressing

Answer 11

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

• take care of that the pressure dressing you are applying does not cut off blood flow and become a tourniquet
• Always check distal pulses

Question 12

Hemostatic Agents

Answer 12

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

• Important to remember that Hemostatic agent aid direct pressure but do not replace it, always apply pressure
• you should not push dressings or bandaging materials into an internal wound or penetrating trauma to the abdomen or chest

Question 13

Tourniquet

Answer 13

A device used for bleeding control that constricts blood flow to and from an extremity

• place tourniquet approximately 2 inches above the bleeding wound, on a single bone limb
• “high or die”
• Turnock it can also be made from ambulance equipment such as a “Cravat”
  
  • should be at least 2 inches wide and several layers thick
• Can also use a blood pressure cuff
• You may arrive to a scene that well-meaning bystanders have already applied a Tourniquet to injury, If EMT determines bleeding is not severe medical direction may be contacted about removing Tourniquet
• if applying a second Tourniquet Always apply above or proximal to the first one

Question 14

Inflatable splints

Answer 14

Maybe used to control internal and External bleeding from an extremity

Useful if there are several wounds to the extremity or one that extends over the length of the extremity

Most effective for Venous and capillary bleeding

Not usually effective for the high-pressure bleeding caused by an injured artery

Question 15

Cold application

Answer 15

The cold minimize the swelling and reduces the bleeding by constricting the blood vessels

Never apply ice or cold packs directly to skin, always wrap ice or a cold pack in a cloth or towel, do not leave it in place for longer than 20 minutes at a time

Question 16

Special situations involving bleeding

Answer 16

•Head:

• Traumatic injuries resulting in fractured skull may cause bleeding or loss of cerebrospinal fluids CSF from ears or nose
• Do not attempt to stop bleeding or fluid loss, doing so may increase the pressure in the school
• Do not apply pressure to the ears or nose allow the drainage to flow freely using a gauze pad to collect it

•Nosebleeds: also called Epistaxis
- May be caused by trauma
- May also be caused from increased blood pressure or hypertension from tiny capillaries in the nose bursting 
– Sinus infection
– Digital trauma/nose picking 

•To stop nose bleeds:
- Have patience sit down and lean forward
– apply or instruct patient to apply direct pressure too fleshy portion around nostrils
- Keep patient calm and quiet
– do not let the patient lean back this can allow blood to flow down esophagus to stomach resulting in nausea and vomiting
– if patient becomes unconscious placed patient in the recovery position and be prepared to provide suction

Question 17

What cells and tissues are the most sensitive to inadequate perfusion?

Answer 17

The cells and tissues of the Brain, Spinal cord, and Kidneys are the most…

Question 18

Pediatric note for blood lost

Answer 18

Such efficient compensating mechanisms that they can pg672

Question 19

Nosebleeds are also called?

* treatment and care

Answer 19

Also known as Epistaxis

1. Have patient sit down and lean forward
2. Apply direct pressure to fleshy portion around nose
3. keep patient calm and quiet
4. Do not let patient lean back - this can allow blood to flow down esophagus
5. if patient becomes unconscious place patient in recovery position and be prepared to suction

Question 20

Leading cause of internal bleeding?

Answer 20

Blunt trauma