EC Chp 25 Bleeding and Shock Flashcards
Understanding Bleeding and Shock
Perfusion (adequate circulation of blood)
the supply of oxygen to and removal of wastes from the body’s cells and tissues as a result of the flow of blood through the capillaries
Hypoperfusion (Shock)
the body’s inability to adequately circulate blood to the body’s cells to supply them with oxygen and nutrients
Blood has several functions what are they?
Transportation of gases
Nutrition circulation to other body cells from intestines
Excretion of wastes
Protection with white blood cells and antiboies
Regulation
Heart, blood vessels and blood are
The 3 main components of the circulatory system
hemorrhage is also known as
severe bleeding
external bleeding is bleeding that happens….
outside of the body visible on the surface of the skin
Arterial bleeding is an example of external bleeding and signs of it are
spurting blood
pulsating flow
bright red
Venous Bleeding is another external bleeding. what Types of signs would you see?
steady, slower flow then arterial and darker red color
Junctional Hemorrhage happens in areas where veins and arteries tend to be less well protected. where are these places?
occurs where the appendages of the body connect to the trunk. Ex: neck, both armpits and sides of groin
when is capillary bleeding at risk of high infection
when the it occurs over large areas
Bleeding can also be accelerated if patients have underlying conditions and take medications for them. these meds are what and used for what?
blood thinners and used for patients with history of stroke or heart problems. Ex. asprin, warfarin, clopidogrel, pradaxa
We also know that hypothermia has what affect on the body
it affects the body’s ability to clot
First step in most cased in bleeding control is to
COMPRESS the wound with DIRECT PRESSURE
with a pressure dressing using several gauze pads and roller bandage you must ensure you…
create enough pressure to control the bleeding
What must you always do after controlling bleeding for an exteremity using a pressure dressing
check for a distal pulse to make sure the dressing has not been applied too tightly
Do NOT use the elevating technique in an injury when…
you suspect a possible musculoskeletal injury
Hemostatic agents are
products as powders, dressings, gauze or bandages designed to stop bleeding.
For large cavity been formed from trauma direct pressure is not typically effective. You can address the issue by
filling the cavity with dressings or unrolled bandages and hemostatic agent as its for wound packing and an agent
When Obvious bleeding and rapid soaking through of dressing are happening even with direct pressure what should you do?
apply a tourniquet! that closes off all blood flow to and from the extremity
Tourniquets are only use on extremity injuries. Where should you place it approximately
approximately 2 inches above the bleeding wound
If a tourniquet is not available you can use…
a cravat, or improvised materials, but should be 2 inches wide and several layers thick.
how tight do you place the tourniquet?
There should be no distal pulse palpable
You need to attach a notation to the patient alerting ALS regarding the tourniquet but you should also indicate what?
the Time it was applied
if you find a “tourniquet” applied by a layperson has not stopped the bleeding. what do you do?
apply direct pressure and remove it, then proceed with your bleeding control as you normally would or apply a second one proximal to the first one
American College of Surgeons recommended that all hemorrhage controls begins with directly pressure. If the bleeding is not controlled then
you should apply a tourniquet.
Two other methods of bleeding control are?
Splinting and Cold Applicaton
Air splints are useful if there are several wounds to the extremity or one that extends over the length of the extremity. they are mot effective for what bleedings?
Venous and Capillary
Cold application does what for bleeding
Minimizes the swelling, reduces the bleeding by constricting the blood vessels.
how long should you leave cold packs for?
no more than 20 min an never apply directly to skin
Head injuries can cause cerebrospinal fluid (CSF) to come out from the ears and nose however it is not from the direct trauma it is actually from
the head injury results in increased pressure within the skull, which forces fluid out of the cranial cavity
nose bleeds are also called Epistaxis and these are typically caused by
hypertension
sinus infection
digital trauma (nose picking)
with Epistaxis you can stop it by?
sitting the patient down and lean forward
apply pressure to the nostril
do NOT let the patient lean back
If a patient becomes unconscious from epistaxis or unable to control their airway you should…
place patient in recovery position on his side and be prepared to provide suction and airway mgt.
what is the leading cause of internal injuries and what are mechanisms of blunt trauma?
blunt trauma
falls, MVC, auto-pedestrian crashes, blast injuries
Signs of internal bleeding
injuries to surface of body bruising, painful, swollen, or deformed extremities bleeding from mouth, rectum, vagina tender, rigid, distended abdomen vomiting coffee grounds like substance dark tarry stools or bright red stool SHOCK
compensated shock is when
the body is developing shock but the body is still able to maintain perfusion
Shock(hypoperfusion) in general is the
the body’s reaction to decreased blood circulation to the organ systems
A late sign of decompensated shock is
falling blood pressure
hypovolemic shock is commonly known as caused by
is caused by uncontrolled bleeding or fluid loss o
Hemorrhagic shock is
shock resulting from blood loss
Cardiogenic shock is
lack of perfusion brought on by the heart’s inadequete pumping action (often due to heart attack
Neurogenic shock is
shock resulting from uncontrolled dilation of blood vessels from nerve paralysis caused by spinal injuries. blood vessels dilate to a point blood can no longer fill it
Although rare to see Neurogenic shock what are some causes?
Sepsis, anaphylactic reaction
what are treatments for Neurogenic shock
Intravenous fluids
Early notification of the hospital
Infants and children present a special problem with shock as they have efficient compensating mechanisms and can maintain a normal BP until how much blood is gone?
1/2 of their blood volume is gone. by the time BP drops they are near death
what is the 1st sign of shock?
altered mental status
what is the 2nd, 3rd, and 4th sign of shock
- Pale cool and clammy skin
- Nausea and vomiting
- vital sign changes
what are the vital sign changes in shock?
1st the pulse will increase to try to pump more blood
2nd Respirations increase to raise oxygen saturation
3rd. BP drops doe to compensation
4th. Pulse oximetry might not be accurate
Other late signs of shock
thirst, dialated pupils and cyanosis
golden hour is described as
the optimal time for the infliction of a traumatic injury until the patient receives definitive treatment in a hospital
the goal for on-scene time when caring for a trauma or shock patient has been stated as a max of
10 minutes (unless lengthy extrication is required
the goal for 10 min at the scene is also called
platinum 10 minutes
some elements of the assessment should be done in route to hospital these include:
detailed exams, treatments, `
preventing a shock/trauma patient from further blood loss and oxygenating can help prevent a condition called
acidosis ; when cells receive insufficient oxygen and generate acidic waste products that accumulate in the blood.
