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Paramedic Care Volume 5 - Trauma > Chapter 4 - Hemorrhage and Shock > Flashcards

Chapter 4 - Hemorrhage and Shock Flashcards

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1
Q

Which nervous system most specifically slows the heart rate?

A

pg 62

Parasympathetic nervous system

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2
Q

What affects the stroke volume of the heart?

A

pg 62

Preload

Afterload

Cardiac contractility

Ventricular wall stretching

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3
Q

The heart maintains an efficient pumping function through a rate range of ___ to ___ bpm.

A

pg 62

50-180 beats per minute

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4
Q

The normal cardiac output is about

A

pg 62

5 Liters

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5
Q

The blood vessel layer that determines the artery’s maximum diameter is the

A

pg 62

tunica adventitia.

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6
Q

Approximately what volume of blood is contained within the venous system?

A

pg 63

64 percent

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7
Q

Venous constriction is able to return about what volume of blood to the active circulation?

A

pg 63

1,000 mL

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8
Q

The percentage of the blood that consists of red blood cells is referred to as

A

pg 63

plasma.

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9
Q

The blood cells responsible for clotting and blood vessel repair are the

A

pg 63

platelets.

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10
Q

What types of hemorrhage is characterized by bright red blood?

A

pg 64

Capillary bleeding & Arterial bleeding

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11
Q

What type of hemorrhage is characterized by dark red blood?

A

pg 64

Venous bleeding

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12
Q

Which of the following is NOT a stage in the clotting process?

A. Intrinsic phase
B. Vascular phase
C. Platelet phase
D. Coagulation phase
E. All of the above

A

pg 64

A. Intrinsic phase

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13
Q

Which is the phase of clotting where blood cells are trapped in fibrin
strands?

A

pg 64

Coagulation phase

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14
Q

The clotting process normally takes about what length of time

A

Pg 64

7 to 10 minutes

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15
Q

T/F - Cleanly and transversely cut blood vessels tend to bleed very heavily.

A

pg 64

False

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16
Q

What factors are likely to adversely affect the clotting process?

A

pg 65

Aggressive fluid resuscitation

Drugs such as aspirin

Hypothermia

Movement at the site of injury

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17
Q

T/ F- Bleeding from capillary or venous wounds is easy to halt because the pressure driving the
hemorrhage is limited.

A

pg 66

True

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18
Q

Fractures of the femur can account for a blood loss up to

A

pg 67

1,500 ml

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19
Q

Intravascular fluid accounts for what percentage of the total body water?

A

pg 69

7 percent

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20
Q

In which class of hemorrhage does the patient first display thirst?

A

pg 69

Class II

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21
Q

In which class of hemorrhage does the patient first display air hunger?

A

pg 69

Class III

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22
Q

What populations react differently to blood loss than the normal, healthy adult?

A

Pg 69

Pregnant women

Children

Athletes

The elderly

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23
Q

The late-pregnancy female is likely to have a blood volume

A

pg 69

much greater than normal.

(increases by nearly 50%)

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24
Q

Obese patients are likely to have a blood volume

A

pg 70

much less than normal.

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25
Q

Elderly patients are more adversely affected by blood loss due to

A

pg 70

reduced pain perception.

chronic cardiovascular inefficiency.

lower fluid reserves.

medications.

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26
Q

The aerobic component of the cell’s utilization of glucose to obtain energy is called

A

pg 70

the Kreb’s cycle.

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27
Q

What are characteristics of interstitial fluid?

A

pg 71

It is rich in carbon dioxide.

It has a lowered pH.

It is separated from the blood by capillary walls.

It has the lowest oxygen concentration in the body.

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28
Q

T/ F - Blood fills the vascular space EXCEPT in shock states.

A

pg 71

False

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29
Q

What are physiological results of parasympathetic nervous system stimulation?

A

pg 71

Decreased heart rate

Decreased peripheral vascular resistance

Decreased blood pressure

Decreased respiratory rate

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30
Q

Which of the following is a catecholamine?

A

pg 73

Epinephrine

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31
Q

Which hormone induces an increase in peripheral vascular
resistance and causes the kidneys to retain water?

A

pg 73

Antidiuretic hormone

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32
Q

Erythropoietin accelerates the production of

A

pg 75

red blood cells.

33
Q

The column of coagulated erythrocytes caused by capillary stagnation is called

A

pg 75

rouleaux.

34
Q

Which list places the stages of shock in the correct order of their occurrence?

A

pg 75

Compensated, decompensated, irreversible

35
Q

Which stage of shock ends with a precipitous drop in blood pressure?

A

pg 75

Compensated

36
Q

Which of the following does NOT occur during the compensated stage of shock?

A. Increasing pulse rate
B. Decreasing pulse strength
C. Decreasing systolic blood pressure
D. Skin becomes cool and clammy
E. The patient experiences thirst and weakness

A

pg 75

C. Decreasing systolic blood pressure

37
Q

T/F - Once the patient becomes profoundly unconscious and loses his vital signs, he moves into
irreversible shock.

A

pg 76

False

38
Q

All of the following can cause hypovolemic shock, EXCEPT

A. bums.

B. ascites.

C. pancreatitis.

D. gastritis.

E. cardiac dysrhythmias.

A

pg 77

cardiac dysrhythmias.

39
Q

Under which of the shock type would anaphylactic shock fall?

A

pg 78

Distributive shock

40
Q

Under which shock type would spinal injury fall?

A

pg 79

Neurogenic

41
Q

T/F - The sooner the signs and symptoms of shock appear in your patient, the greater the
hemorrhage rate and the likelihood that the patient will move into the later stages of shock.

A

pg 78

True

42
Q

Which of the following suggests shock?

A. A pulse rate above 100 in the adult
B. A pulse rate above 140 in the school-age child
C. A pulse rate above 160 in the preschooler
D. A pulse rate above 180 in the infant
E. All of the above

A

Pg 79

E. All of the above

43
Q

When using a pulse oximeter, you should use oxygen and ventilation to keep the reading
above which oxygen saturation value?

A

pg 80

95%

44
Q

T/F - In the normotensive patient, the jugular veins should be full when the patient is in the supine position.

A

pg 80

True

45
Q

During assessment you note that the patient’s lower extremities and lower abdomen are warm
and pink while the upper extremities, thorax, and upper abdomen are cool and clammy. This
presentation is consistent with which type of shock?

A

pg 81

Neurogenic

46
Q

Fractures of the pelvis can account for a blood loss in excess of

A

pg 81

of 2,000 mL.

47
Q

A black, tarry stool is called

A

pg 81

melena.

48
Q

A positive tilt test demonstrating orthostatic hypotension is positive when

A

pg 81

the blood pressure falls by at least 20 mmHg.

the pulse rate rises by at least 20 beats per minute.

49
Q

For the patient in compensated shock, you should perform a reassessment

A

pg 81

every 5 minutes.

after every major intervention.

after noting any change in signs or symptoms.

50
Q

List techniques used to help control hemorrhage?

A

pg 82

Direct pressure

Limb splinting

Elevation

Pressure points

51
Q

When applying a tourniquet, you should inflate the blood pressure cuff

A

pg 83

20 to 30 mmHg above the systolic blood pressure.

52
Q

Which of the following may be an indication to employ overdrive respiration?

Severe rib fractures

Head injury

Flail chest

Diaphragmatic respirations

All of the above

A

pg 84

All of the above

53
Q

Which of these fluid replacement choices would be most desirable for the patient who is losing
blood through internal bleeding?

A

pg 85

Whole Blood

54
Q

Most of the solutions used in prehospital care for infusion are

A

pg 85

hypertonic colloids.

55
Q

Which of the following characteristics of a catheter will ensure that fluids run rapidly through it?

A

pg 85

Short length, large lumen

56
Q

In the patient who has internal bleeding and hypovolemia, the objective of fluid resuscitation
is to maintain a systolic blood pressure

A

pg 86

of 80 mmHg

57
Q

What affects the cardiac output of the heart?

A

pg 62

Preload

Heart rate

Afterload

Cardiac contractility

58
Q

Approximately what volume of the body’s blood is contained within the capillaries?

A

pg 62

7 percent

59
Q

The red blood cells account for what percentage of the total blood volume?

A

pg 63

45 percent

60
Q

Which of the following types of hemorrhage is characterized by slow-oozing bright red blood?

A

pg 64

Capillary bleeding

61
Q

Which of the following is the phase of clotting in which smooth muscle contracts

A

pg 64

Vascular phase

62
Q

T/F - Blood vessels that are lacerated longitudinally generally do not bleed very severely or for very
long.

A

pg 64

False

63
Q

What factors are likely to adversely affect the clotting process

A

pg 65

Aggressive fluid resuscitation

Hypothermia

Movement at the site of injury

Drugs such as aspirin

64
Q

Fractures of the tibia or humerus can account for a blood loss of

A

pg 67

500 to 750 mL.

65
Q

In which stage of hemorrhage does the patient first display ineffective respiration?

A

pg 69

Class IV

66
Q

What are factors of sympathetic nervous system stimulation?

A

pg 71

Increased heart rate

Skeletal muscle vasodilation

Increased peripheral vascular resistance

Increased cardiac contractility

67
Q

Which of the following is a catecholamine?

A. Glucagon
B. Insulin
C. Norepinephrine
D. Adrenocorticotropic hormone
E. Erythropoietin

A

pg 73

Norepinephrine

68
Q

Which of the following is a potent system vasoconstrictor?

A

pg 74

Angiotensin II

69
Q

The opening of postcapillary sphincters and the resulting release of potassium, acids, and hypoxic
blood is called

A

pg 75

washout.

70
Q

During which stage of shock is it difficult to determine if the patient is suffering from the effects
of hypovolemia?

A

pg 75

Compensated

71
Q

Which of the following does NOT first occur during the decompensated stage of shock?

A. Pulses become unpalpable.
B. Respirations slow or cease.
C. Blood pressure decreases precipitously.
D. The skin becomes cool and clammy.
E. The patient becomes unconscious.

A

pg 76

D. The skin becomes cool and clammy.

72
Q

Under which shock type would septic shock fall?

A

pg 77

Distributive Shock

73
Q

Under what shock type would pericardial tamponade fall?

A

pg 77

Cardiogenic

74
Q

T/F - The color, temperature, and general appearance of the skin can indicate shock before there are
changes in the blood pressure.

A

pg 79

True

75
Q

A fast and weak pulse may be the first indication of developing shock in the trauma patient.

A

pg 79

True

76
Q

Large hematomas can account for a blood loss of

A

pg 80

up to 500 ml.

77
Q

Frank blood in the stool is called

A

pg 81

hematochezia.

78
Q

Which of the following will permit the least fluid flow through a catheter?

A

pg 85

Long length, small lumen

79
Q

The preferred solution for the patient who is losing blood is

A

pg 85

whole blood.

Paramedic Care Volume 5 - Trauma (11 decks)

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