Chapter 28: Bleeding and Soft Trauma Flashcards
severity of blood loss depends on several variables:
- amount of blood loss
- rate of blood loss
- other injuries/existing conditions
- patient’s existing medical problems
- patient’s age
how much blood loss is considered significant and can lead to shock?
15% of the blood volume or more
arterial bleeding
bright red spurting blood from a wound, can be difficult to control due to higher pressure, can also present as a steady flow, can need constant, hard direct pressure for 20 minutes or more
venous bleeding
dark red blood, flows steadily and briskly from a wound, easier to control with direct pressure
capillary bleeding
slowly oozing blood that is dark/intermediate red, typically easily controlled
protocol from ACSCT (evidence based) to control bleeding
- apply direct pressure to wound
- if not enough resources are available for one person to constantly hold pressure, apply a pressure dressing
- if the direct pressure or pressure dressing is ineffective in stopping the hemorrhage and the wound is to an extemity, apply a tourniquet
- if direct pressure is ineffective in stopping hemorrhage to an area of a body where a tourniquet can’t be applied, apply a hemostatic agent and continue to apply direct pressure
- if it is impractical to apply direct pressure or pressure dressings due to the number of patients at the scene with severe bleeding, go directly yo a tourniquet
steps to apply a tourniquet
- wrap the tourniquet around the extremity at a point just proximal to the bleeding but as distal on the extremity and as close to the injury as possible
- tighten the tourniquet until the hemorrhage ceases and secure the device in place
- write the time of tourniquet application on tape and secure it to the tourniquet
- if bleeding continues, tighten the tourniquet
- notify the receiving medical facility that a tourniquet has be applied
emergency medical care for severe external bleeding
- take necessary standard precautions
- apply direct pressure (pressure dressing if you cannot)
- if direct pressure fails on an extremity, apply a tourniquet
- provide care for shock by administering a high concentration of O2 or via PPV
- keep patient warm, transport immediately
- immobilize injured extremities
possible causes of bleeding from nose, ears, mouth
- skull injury
- facial trauma
- digital trauma (nose picking)
- sinusitis and other upper respiratory tract infections
- hypertension
- clotting disorders
- esophageal disease
epistaxis
nosebleed
emergency care for nosebleed
- have the patient sit straight up and tip head slightly forward
- use thumb and forefinger to firmly pinch soft part of nose shut
3.apply ice pack to nose/cheeks - continue pinching nose for 10 minutes (do not release to check)
- tell patient not to blow nose for at least 12 hours after bleeding has stopped
hematoma
contained collection of blood
emergency medical care for internal bleeding
- take standard precautions
- maintain open airway and adequate breathing
- administer high concentration of oxygen (nonrebreather mask, 15lpm)
- control external bleeding with direct pressure or pressure dressing, tourniquet if needed
- provide immediate transport
- provide care for shock
factors that increase bleeding
- movement
- low body temperature
- medications (anticoagulants, NSAIDs)
- intravenous fluids
- removal of dressings or bandages
hemorrhagic shock
shock due to fluid loss from bleeding
emergency medical care for hemorrhagic shock
- take standard precautions
- maintain an open airway, apply oxygen or PPV
- control any external bleeding
- place the patient in a supine position
- splint suspected bone or joint injuries
- use a blanket to cover any patient suspected of suffering hemorrhagic shock
- transport patient immediately
closed injury
a wound in which there is no break in the continuity if the skin. Contusions, hematomas, crush injuries
contusion
bruise, injury to the tissue and blood vessels contained within the dermis, causes localized pain and swelling at injury site
ecchymosis
black and blue discoloration
hematoma
similar to a contusion, usually involves damage to a larger blood vessel and a larger amount of tissue, a large lump with bluish discoloration caused by blood pooling beneath skin
crush injury
one in which force great enough to cause injury has been applied to the body, severe blunt trauma/crushing force can cause serious damage to underlying soft tissue and cause hemorrhagic shock
emergency medical care for larger contusions, hematomas, and crush injuries
- take standard precautions
- ensure open airway and adequate breathing and oxygenation
- treat for shock if necessary
- splint suspected fractures
open injury
wound where the continuity of the skin is broken. Abrasions, lacerations, avulsions, amputations, penetrations/punctures, crush injuries
abrasion
caused by scraping, rubbing, shearing away the epidermis
laceration
break in the skin of varying depth, can be linear (regular) or stellate (irregular)
avulsion
a loos flap of skin and underlying soft tissue that has been torn loose (partial avulsion) or completely off (total/complete avulsion)
amputation
a disruption in the continuity of an extremity or other body part
penetration/puncture
the result of a sharp pointed object being pushed or driven into the soft tissues
crush injuries
can cause open injuries
dog bites
common in hands, arms, legs, can cause infection, cellulitis, septicemia, or rabies/tetanus (rare)
human bites
can cause hepatitis (liver inflammation)
clamping injury
occurs when a body part is caught or strangled by some piece of machinery, tool, or other object/equipment, usually involves a finger or hand
emergency medical care for open injuries
- take standard precautions
- ensure open airway, adequate breathing and oxygenation
- expose wound
- control bleeding with direct pressure
- prevent further contamination
- dress and bandage wound
- keep patient calm and quiet
- treat for hemorrhagic shock
- transport
chest injury treatment
- use an occlusive dressing to prevent air from entering the chest cavity throughout the wound (seal with tape on 3 sides
- if there is no suspected spinal injury the patient can assume a position of comfort
abdominal injury treatment
- do not touch abdominal injuries or try to replace exposed organs
- cover exposed organs
- flex patients hips and knees if they are uninjured and if spinal injury is not suspected
evisceration
the abdominal organs protrude through the wound
impaled object treatment
- manually secure the object
- expose wound area
- control bleeding
- use a bulky dressing to help stabilize object
amputations treatment
- remove any gross contamination by flushing the part with sterile water or saline
- wrap the part in a dry sterile gauze dressing
- wrap or bag the amputated part in plastic
- keep the amputated part cool
- transport the part with the patient if possible
large open neck injuries treatment
- place a gloved hand over wound to control bleeding
- apply an occlusive dressing, taped on all 4 sides
- cover occlusive dressing with regular dressing
- apply only enough pressure to control the bleeding
- after bleeding is controlled, apply a pressure dressing
- if there is a suspected spinal injury, provide appropriate spine motion restriction
air embolism
air bubble
dressing
covers an open wound to aid in the control of bleeding and to prevent further damage or contamination
sterile
free of any organisms that can cause infection
gauze pad
made of layered gauze, various sizes
self-adhering dressing
adheres to itself when overlapped, various sizes, can be used as a roller bandage
universal or multi-trauma dressing
bulky dressing, 10x36 inches, used on large areas such as abdominal wounds
occlusive dressing
creates an airtight seal
bandage
used to secure a dressing in place
self-adhering bandage
adheres to itself when overlapped, can be used as a dressing or as a roller bandage
gauze rolls
various sizes, rolled meshed gauze
triangular bandage
can be used as a bandage to secure dressings
air splint
can be used to hold dressings in place on an extremity
how to apply a pressure dressing
- cover wound with several sterile gauze dressings or a sterile bulky dressing
- apply direct pressure
- bandage firmly
- if blood soaks through, remove and apply direct fingertip pressure
general principles of dressing and bandaging
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