Chapter 26: Bleeding

Question 1

How long can the brain, spinal cord, lungs, kidneys, and skeletal muscles last without blood?

Answer 1

Brain and spinal cord: 4-6 minutes
Lungs: 15-20 minutes
Kidneys: 45 minutes
Skeletal muscle: 2 hours

Question 2

Vital signs associated with significant bleeding:

Answer 2

Increased heart rate, increased respiratory rate, decreased blood pressure.

Question 3

Characteristics of external bleeding:

Answer 3

Significant MOI, poor/calm appearance, s/s shock, significant blood loss, rapid blood loss, uncontrollable bleeding

Question 4

What factors designate severe bleeding?

Answer 4

Amount of blood loss, rate of blood loss, other injuries or existing conditions, patient’s existing medical problems, patient’s age,

Question 5

What can cause a failure to clot?

Answer 5

Movement, disease, medications, removal of bandage, external environment, body temperature, severe injury

Question 6

What are signs of internal bleeding?

Answer 6

Pain, swelling, distension, dyspnea, tachycardia, hypotension, hematoma, bruising, bleeding from body openings, hematemesis, melena, guarding, broken ribs, hypoperfusion.

Question 7

What are the steps for controlling bleeding for a patient who has severe bleeding from an extremity?

Answer 7

Occlusive dressing, direct pressure, splint, tourniquet

Question 8

What are the indications for use of a tourniquet?

Answer 8

TBA

Question 9

What percent of blood loss will the body tolerate?

Answer 9

20%

Question 10

What may cause internal bleeding?

Answer 10

High energy MOI whether blunt or penetrating trauma
Stomach ulcer, lacerated liver, ruptured spleen, broken bones, colon bleeding, ruptured ectopic pregnancy, aneurysms

Question 11

What should be considered in a secondary assessment?

Answer 11

Ask about blood thinners, monitor vital signs, Full body scan: raccoon eyes, battle signs, blood/fluid from ears, abdominal quadrants, PMS in all extremities

Question 12

What is the treatment for bleeding?

Answer 12

Control bleeding, high flow oxygen via NRB if needed, keep warm, ASAP transport

Question 13

What are the aspects of direct pressure?

Answer 13

Gloved hand over sterile dressings, never remove impaled objects, hold uninterrupted for 5 minutes

Question 14

What may bleeding from nose, ears, and or mouth indicate?

Answer 14

Skull or facial fractures, sinusitis, infection, use & abuse of nose drops, dried or cracked nasal mucosa, high blood pressure, coagulation disorders, digital trauma

Question 15

What is epistaxis?

Answer 15

Nosebleed, common emergency, shock possible, blood swallowed –> nausea & vomiting,
Control: Pinching nostrils & sniffing position

Question 16

What is the treatment for bleeding from nose, ears, and or mouth?

Answer 16

Do not attempt to stop blood flow, loosely cover with sterile gauze pad, apply light compression with a dressing

Question 17

What might left or right shoulder referred pain when abdomen experiences a blunt trauma indicate respectively?

Answer 17

Left: Spleen injury
Right: Liver