Chapter 30 - Bleeding

Question 1

How is hemostatis achieved after a cut has caused a bleed?

Answer 1

Hemostasis proceeds through three steps:
(1st) vasoconstriction, followed by
(2) platelet aggregation, and finally
(3) fibrinogen weaving into the clot and forming fibrin to hold the clot together, controlling bleeding.

pg 1587

Question 2

What is the trauma triad of death?

Answer 2

Hypothermia,
coagulopathy,
and acidosis

pg 1587

Question 3

Class I Shock (Blood Loss)

Answer 3

Blood Loss <750 (15%)
HR WNL
BP WNL
RR WNL

Fluid Replacement - Crystalloid

Question 4

Class II Shock (Blood Loss)

Answer 4

Blood Loss 750-1500 (15-30%)
HR 100-120
BP WNL
Pulse Pressure Narrowing
RR 20-24

Fluid Replacement - Crystalloid

Question 5

Class III Shock (Blood Loss)

Answer 5

Blood Loss 1500-2000 (30-40%)
HR >120
BP Signficant Drop
Pulse Pressure Narrowing
RR Elevated

Confused Anxious

Fluid Replacement - Crystalloid/Blood

Question 6

Class IV Shock (Blood Loss)

Answer 6

Blood Loss >2000 (>40%)
HR TACHY
BP Signficant Drop
Pulse Pressure Very Narrowing
RR Elevated

Confused Lethargic

Fluid Replacement - Crystalloid/Blood

Question 7

If you suspect internal hemorrhage, begin management by

1. 2.

Answer 7

1. Keeping the patient warm
2. Administer supplemental oxygen by a nonrebreathing mask at 15 L/min en route to the ED.

Pgs. 1591-92

Question 8

Why do children compensate better than adults?

Answer 8

Children compensate by vasoconstriction better than adults do.

This factor tends to allow them to maintain a compensatory state and good blood pressure for a longer period, until the point when their vital signs collapse abruptly

pg 1593

Question 9

Are air splints useful for venous or arterial bleeds?

Answer 9

Venous. They are not appropriate for arterial bleeds.

pg 1599