Circulation and Control of Hemorrhage

Question 1

What are the major assessment parameters for circulation and hemorrhage?

Answer 1

level of consciousness, skin color, and pulse

Question 2

What can the use of AVPU reveal?

Answer 2

patient’s level of consciousness and help determine if the initial assessment may proceed as ABC or reprioritize ABC to address hemorrhage

Question 3

When assessing for circulation what is one of the first things you want to evaluate?

Answer 3

hemorrhage in the abdomen and pelvis or anyone with sustained blunt trauma

Question 4

What do you inspect for circulation?

Answer 4

• uncontrolled bleeding

- skin color

Question 5

What do you auscultate for in circulation?

Answer 5

• muffled heart sounds

Question 6

What do muffled heart sounds indicate?

Answer 6

pericardial tamponade

Question 7

What do you palpate for in circulation?

Answer 7

• presence of carotid/femoral pulses (rate, rhythm, strength)
• skin temp/moisture (cool/diaphoretic or warm/dry)

Question 8

What do you do if pulses are absent?

Answer 8

• initiate life support
• assess for signs of uncontrolled internal bleeding
• penetrating wound to the heart
• pericardial tamponade
• rupture of great vessels
• abdominal hemorrhage

Question 9

What are common sites for hemorrhage?

Answer 9

• chest
• abdomen
• pelvis
• long bones
• external bleeding from wounds/amputation

Question 10

What do you inspect if pulses are present?

Answer 10

• external bleeding

- skin color

Question 11

What do you palpate for if pulses are present?

Answer 11

• central pulses

- skin temp and moisture

Question 12

What does a strong, regular, and normal pulse rate indicate?

Answer 12

normovolemia

Question 13

What does a rapid, thready pulse indicate?

Answer 13

hypovolemia

Question 14

What does an irregular pulse indicate?

Answer 14

cardiac dysfunction

Question 15

What do you do if pulses are present but circulation is ineffective?

Answer 15

• assess for signs of uncontrolled bleeding

- consider common sites for hemorrhage (chest, abdomen, pelvis)

Question 16

What interventions do you do for circulation?

Answer 16

• control/treat bleeding
• cannulate two veins
• intervene in life-threatening situations

Question 17

How do you control/treat uncontrolled bleeding?

Answer 17

• apply direct pressure
• apply pressure over arterial sites
• pelvic binder for unstable pelvic fx
• tourniquet
• take blood pressure (base line, trending)

Question 18

Why would you want to cannulate two veins?

Answer 18

• type and crossmatch blood
• infusions of warmed isotonic crystalloid solution
• blood administration tubing and NS to facilitate for possible blood administration
• administer blood/blood products
• use rapid infusion devices per protocol

Question 19

What should you do if you are not able to place an IV?

Answer 19

consider IO or central venous access

Question 20

What are some interventions you can do for life-threatening situations?

Answer 20

• prepare/assist with thoracotomy
• prepare/assist with pericardial needle aspiration to relieve cardiac tamponade
• prepare pt transfer to operating suite

Question 21

What could elevated blood pressure do?

Answer 21

dislodge blod clots and promote further bleeding

Question 22

What is suggested for fluid resuscitation?

Answer 22

• component therapy - RBC, plasma, platelets