Circulatory problems Flashcards
Stages of shock (4 stages):
- Up to 15% blood volume loss. The player exhibits:
Pallor of the skin (if this can be detected in an exercising player)
Normal capillary refill – less than two seconds (environment dependent too)
Increase in pulse rate – up to 100 beats per minute
No change in systolic or diastolic blood pressure.
At this stage, the systolic pressure is being maintained by compensatory mechanisms mediated through the autonomic nervous system.
- 15% to 30% blood volume loss. The player exhibits:
Pale, cool, clammy skin (compensated by warm, sweaty player)
Capillary refill extending beyond the normal two seconds
A pulse rate exceeding 100 beats per minute
Increased respiratory rate
Maintenance of normal systolic blood pressure, but an elevated diastolic pressure narrows the pulse pressure.
At this stage, the body is at the limit of its compensation.
- 30% to 40% blood volume loss. The player exhibits:
Anxiety, restlessness and agitation
RR rising, even with player at rest
Pulse rate greater than 120 beats per minute
Systolic blood pressure falling to 100 mmHg or less (altering and or loss of radial pulse).
- Greater than 40% blood loss. The player exhibits:
Moribund appearance
Central cyanosis
Altered level of consciousness
Marked tachycardia with weak pulse
Signs of respiratory distress (RR will compensate as much as possible until it can no longer do so)
Systolic blood pressure of 70 mmHg or less (absent radial pulse).
You’re monitoring two players who are close to returning to play. During a full-contact rehabilitation session, they collide and fall. As they land, there’s forceful contact between the first player’s feet and the second player’s groin. On approach, you immediately identify the presence of a catastrophic bleed.
Regarding the management of this scenario, what needs to be completed?
8 key factors
The bleed needs stemming, the player can exsanguinate in a matter of minutes
Apply direct pressure
Plug the wound if possible
Leave the airway to be dealt with by the other player present
Indirect pressure can be tried when help arrives
This is a medical emergency
Blood will spurt from the wound at the rate of the heartbeat if it is not stemmed
Gauze, a towel or your gloved hand can be used to apply direct pressure
What will help achieve effective management of shock
(Early recognition and management can prevent or limit the effects of shock in a player.
Can you identify which of the following statements would not help achieve effective management of shock?)
Ensuring an open airway
Administering high concentrations of oxygen
Giving nil by mouth
Gaining IV access
Keeping the player at normal temperature
Constantly checking pulse, breathing and level of consciousness
Avoiding unnecessary movement
Raising the legs to maintain blood pressure to vital organs (if injuries permit)
Address other injuries, especially those in the internal cavities
Rapid transfer to ED
When managing a bleeding wound that cannot be controlled by direct pressure, indirect pressure needs to be provided.
Which one of these statements is correct?
You can apply pressure onto designated pressure points with the tips of your fingers or your thumbs. Choose whichever you can exert the most pressure with
During a full A-E assessment, you identify a potentially fractured pelvis – indicating a ‘C’ problem. You decide to apply a pelvic binder. As part of the application process, your colleague concomitantly assesses for pedal and posterior tibial pulses. Both are full and present. After you have closed the legs and applied the pelvic binder at the correct height, you notice both distal pulses have now become absent. You confirm the player has carotid and radial pulses present.
What is your next immediate action?
Do not remove pelvic binder, but document the time distal pulses were lost
After suffering a laceration mid-match, a player is bleeding heavily in the flexor compartment of his right forearm. He leaves the field of play.
What should you do to arrest the bleeding?
Compress the wound using a wad of sterile gauze
In which one of the following circumstances would clinical suspicion arise as to the presence of a catastrophic bleed?
Blood spurting/ pulsating out of the wound, onto the player.
During a match played on a warm evening in late August, you are requested to enter the field of play for one of your players. You suspect, during your ‘C’ assessment, that they are suffering from hypovolaemic shock.
In the pre-hospital care environment, which one of the following is the least reliable clinical indicator?
Assessment of blood pressure
What can be at risk during lower rib fractures?
(Chest injuries may occur in the football setting and can cause problems identified during the structured assessment process. Regarding chest injuries, which one of the following statements is correct?)
Liver and splenic injuries are recognised complications of lower rib fractures
Your player is involved in a high-speed, mid-air collision. She lands on her side and another player lands on top of her.
The landing is forceful, and your player’s mid-section and thigh area takes most of the impact. During your A-E assessment, she presents with hypovolemic shock and clinical signs that suggest a pelvic fracture.
The player is in the supine position. You apply a pelvic binder and high-flow oxygen. Her respiratory rate is 24bpm and both the carotid and radial pulses are present at 130bpm (although the latter is extremely thready).
What is your next immediate action?
Prophylactic cannulation should be performed in the presence of a radial pulse as clinical suspicion this may be lost in due course. Fluid replacement is not currently required in the presence of a palpable radial pulse
‘On the floor and five more’ is the assessment of the presence or suspicion of either external or internal haemorrhage.
Which one of the following statements most likely represents the clinical findings of a player who is suffering symptoms suggestive of the initial signs of a splenic rupture?
Pain on palpation of the upper left quadrant with a thready radial pulse, in the presence of an increasing respiratory rate
What 5 areas do you look at for internal circulatory problems
on the floor and 5 more:
Chest
Abdominals
Rectroperineals
Pelvis
Long bones
