Exam 4 Flashcards
Carry oxygenated blood away from the heart
Arteries
Have thick, muscular walls that enable dilation and constriction
Arteries
Microscopic blood vessels
Capillaries
Carry deoxygenated blood rich in carbon dioxide
back to the heart
Veins
Contain one-way valves to prevent back flow of blood
Veins
Dilation __ blood flow to skin
Increases
Inadequate perfusion of body’s tissues and organs
Hypoperfusion
Four main causes of shock
Volume problems
Pump problems
Blood vessel tone problems
Obstruction of blood flow
A volume shock problem is known as
Hypovolemia
Blood is lost, what kind of shock
Hypovolemia
Relative Hypovolemia
Plasma is removed from circulatory system
Cause of relative Hypovolemia
Dehydration or burns
Hemorrhagic shock is
Loss of blood
Both absolute and relative hypovolemia are called
Hypovolemic shock
Not enough blood volume in the blood vessels, so
pressure falls
Hypovolemia
Pump problems are usually related to a
Mechanical problem of the heart
In pump problems, blood cannot be moved because
Drop in BP
Pump problems are categorized as
Carcinogenic shock
Root cardiac cause of hypoperfusion
Cardiogenic shock
During blood vessel tone problems… all blood vessels
Dilate at same time and blood can’t fill entire circulatory system
Blood vessel tone problem is known as
Distributive shock
Types of distributive shock
Anaphylactic shock
Neurogenic shock
Septic shock
Massive drop in BP because of systemic dilation
Distribute shock
Spinal cord injury, messages to sympathetic nervous system gets interrupted and blood vessels constrict
Neurogenic shock
Body infection causes inflammatory response
Septic shock
What happens in septic shock
BV dilate and cap membrane becomes permeable
Blood flow blocked
Obstructive shock
Obstructive shock causes by
Pulmonary embolism, cardiac tamponade, tension pneumothorax
Constricted blood vessels in GI tract result in
Nausea and vomiting
Baroreceptors are located in
Aorta and carotid arteries and sense decreased pressure
Compensation aims to
Restore blood flow
Ways Compensation aims to restore blood flow.
Regulation of volume Vasoconstriction Cardiopulmonary response
Compensatory actions
Narrow pulse pressure, kidneys retain fluid, increased pulse and respiratory rate
In infants and children, Efficient compensating mechanisms maintain blood
pressure until
Half of volume is depleted
In pediatrics, what is a key indicator of shock
Fast heart rates
Compensated shock requires more
Fuel
When muscles run out of fuel for compensation,
compensated shock becomes
decompensated shock
Indicators of decompensation
Drop in BP
Mental status changed
Slow heart rate and respiratory rate
lead to organ-system
damage and death over time
Prolonged vasoconstriction
As organs fail…
Irreversible shock begins
Irreversible shock and death results in
Apnea and cardiac arrest
What kind of shock?
Wheezing=
Tension pneumothorax=
Anaphylaxis
Obstructive shock
When assessing for shock, if distal pulses they are
Low Bp, narrowed pulse
Distributive shock causes what color skin
Flushing or rash
Identify shock by
Trends in vitals
Signs of shock: order
Pulse increases Blood vessels constrict Respiratory rate increases Nausea Decreasing BP
Deadly triad of trauma
Acidosis, hypothermia, coagulopathy
Decreases body PH, dangerous in hemorrhage shock
Acidosis
Bleeding control, rapid transport: what kind of shock
Hypovolemic
Request ALS, support blood pressure: what shock
Cardiogenic shock
Give epi, what shock
Distributive
Septic shock requires
Rapid transport, time sensitive disorder
Occurs outside of body after force penetrates skin and
lacerates or destroys underlying blood vessels
External bleeding
Bright red color, spurting with heartbeat, oxygen rich : what kind of bleeding
Arterial bleeding
Darker in color, less pressure, volume of blood can create life threatening hemorrhage: What kind of bleeding
Venous bleeding
Occurs where appendages of the body connect to the
trunk.
- Large arteries and veins are not well protected
– Injury is likely to cause massive bleeding
Junctional hemorrhage
Caused by superficial wounds to surface of skin
Capillary bleeding
Identifying type of bleeding is
Irrelevant
Slow and oozing bleed
Capillary bleeding
Affects body’s ability to clot
Hypothermia
Identify and control massive hemorrhage within
first
seconds of primary assessment
Control nonmassive bleeding only after
assessing and treating prior elements
Methods or controlling external bleeding
- Direct pressure
– Hemostatic agents
– Wound packing (don’t take dressings off)
– Tourniquet use on extremities (last)
– Specialized compression devices for junctional
bleeding
Control of bleeding is essential to preventing
Shock
Hold pressure until bleeding is controlled and check after
5-10 minutes
Coughing up blood
Hemoptysis
Once bleeding is controlled…
bandage a dressing firmly
in place to form a pressure dressing
Presents natural cavities that promote profuse bleeding
Junctional areas
Direct pressure should be augmented by
Would packing
In wound packing, fill void spaces with
Hemostatic gauze
Pressure dressing steps
▪ Place several gauze pads on wound. ▪ Hold dressings in place with self-adhering bandage wrapped tightly over dressings and above and below wound site.
Designed to enhance direct pressure’s ability to control
bleeding
Hemostatic agents
Best suited for wound packing
Hemostatic agents
- Use if bleeding is uncontrollable by direct pressure.
– Use only on extremity injuries.
– Always apply between the wound and the heart.
Tourniquet
Designed specifically to control hemorrhage in
junctional areas of axilla and groin
Junctional tourniquets
Elevate injured area how
Above level of heart
Do not elevate if
musculoskeletal injury, impaled
objects in extremity, or spine injury
Minimizes swelling, constricts blood vessels, and
reduces pain
Cold application
From increased intracranial pressure, not direct
trauma to ears or nose
Head injury
Stopping bleeding of head injury increases
Intercranial pressure
Allow head injury to
Drain freely
epistaxis
Nosebleed
Begin hemorrhage control with
Direct pressure
Blood loss commonly not seen in
Internal bleeding
Indication of what with these symptoms…
– Injuries to surface of body
– Bruising, swelling, or tenderness over vital organs
– Painful, swollen, or deformed extremities
– Bleeding from mouth, rectum, or vagina
Internal bleeding
Tender abdomen, coffee grounds are signs of
Internal abdomen
Internal injuries with no pathway from the outside to the injured site
Closed wound
Examples of closed wounds
Contusions, hematomas, closed crush injuries, rupture of hollow organ or solid organ injury, internal puncture
In a confusion what layers are damaged
Epidermis but not dermis
More tissue damage, larger blood vessels affected in a
Hematoma, rather than a contusion
– Force transmitted from exterior to internal structures
– Crush or rupture internal organs
Closed crush injury
If bruise on head and neck, check for
Blood in holes
Bruise on trunk can cause
Coughing up blood, puncture lung, listen to lung sounds
Bruise on abdomen indicates
Injury to organs
What layers damages in abrasion
Epidermis
Perforating puncture wound has
Entrance and exit wound
Open crush injures
Extremity caught between heavy items
Mix of open and closed injures
Blast injuries
Blast injures: primary injuries
Secondary
Tertiary
Quaternary
1: high pressure and winds
2: projectile hitting patient (blast wave)
3: patient throw by blast (fracture, abrasion)
4: exposure to chemicals and burns
With open wounds patient care included
Expose wound, clean wound, control bleeding, care for shock
Always check __ with abrasions and lacerations
CMS
With penetrating search for an
Exit wound
With treating impaled objects…
Don’t remove object, expose area, direct pressure, apply layers of bulky dressing
With impaled objects, place bulky dressing
On opposite sides of object
Keep the cravets wide when treating impaled object, how long?
No less than 4 inches in width once folded
If object impaled in the cheek…
Position patient for drainage, motion airway, dress outside of wound
Apply what kind of protection with impaled eye
Rigid
What gauze used for puncture wound in eye
3 inch gauze or folded 4x4 on vertical axis
What is the only object you can take out if impaled
Cheek, if you see both sides
If avulsed parts of skin are completely torn away…
save in sterile dressing and keep moist with sterile saline.
Wrap an amputation site in
Sterile dressing and secure with self adhesive bandage
Classifying burns
– Agent and source
– Depth
– Severity
Solid organ can result in
Significant blood loss
– Involves only epidermis
– Reddening with minor swelling
Superficial burn (1st degree)
Closed chest and abdominal wounds bear a high risk for
Underlying organ system damage and internal bleeding
– Epidermis burned through, dermis damaged – Deep, intense pain – Noticeable reddening – Blisters and mottling
Partial thickness burn (2nd degree)
– All layers of skin burned – Blackened areas or dry and white patches
Full thickness burn (3rd degree)
JVD and tracheal deviation are key differences in a
Tension pneumothorax vs pneumothorax
The rules of nine is used when
Determining severity of burns
In rules or nine, adult body is divided into __ areas, each representing __ of body surface
11, 9%
With the rule of palm, palm and fingers equal about __ of body surface area
1
What rule is Easier to apply to smaller or localized burns
Rule of palm
Infants and children have a greater…
Relationship of body surface area to total body size, greater fluid and heat loss from burned skin
Ceran wrap can be a type of
Occlusive dressing
With a chemical burn, apply a
Sterile dressing
Most radiation burns will present like
Thermal injures
See patient with a radiological burn only after they have been
decontaminated
After __ mL of blood loss, results in __
1000, hypovolemic shock
Any material applied to wound to control bleeding and prevent contamination
Dressing
Any material used to hold dressing in place
Bandage
Available for profuse bleeding, large wound
Universal dressing
Used to control bleeding
Pressure dressing
Used to form an airtight seal
Occlusive
With bandaging, do not cover
Tips of fingers or toes
To apply a self-adhering roller bandage, secure it with
several overlapping wraps.
Children under __ and adults over __ most severe age for burns
5, 55
Open or closed in reference to a
soft-tissue injury
must be evaluated with consideration to
underlying anatomy and mechanism of injury.
Closed injuries
key concern when treating a patient with
a burn or an electrical injury.
Safety
Adherence of lung tissue to chest wall due to serous fluid and a constant negative pressure, allows…
Lungs to expand and contract with movement of chest wall/diaphragm
Intercostals flex and expand chest outward in
Inhalation
Active process that uses negative pressure to draw air into the lungs
Inhalation
Passive process that uses positive pressure to push air out of the lungs
Exhalation
Superior border of abdomen
Diaphragm
Stomach located in
Gallbladder located in
Spleen located in
Liver located in
LUQ
RUQ
LUQ
RUQ
Solid organs
Spleen, liver, pancreas, kidneys
Hollow organs
Stomach, gallbladder, large and small intestine, bladder, ovaries and uterus
What type of organs tolerate trauma well
Hollow
Abdominal cavity is __ depending on location of .
Dynamic, diaphragm
There’s always __ in abdomen
A large volume of blood
Immediate concern with chest trauma
Disruption of breathing
Largest threat of chest trauma patient
Internal bleeding
What trauma doesn’t penetrate the chest wall
Blunt
Can fracture ribs, sternum, and costal (rib) cartilages
Blunt trauma
MOI that violates the integrity of the chest wall
Penetrating trauma
Bullets, knives, pieces of metal or glass, steel rods, pipes, other objects – Can damage internal organs and impair respiration
Penetrating trauma
Occurs when severe blunt trauma causes the chest to rapidly compress
Compression and shearing injuries
Shearing can damage the
Aorta and vena cava
Chest injuries are classified as
Open or closed
What type of chest injury is caused by a blunt mechanism
Closed
What blunt chest injury is most common in geriatrics and youth sports
Rib fractures
Reduces lung expansion
Hypo ventilation
Fracture of two or more consecutive ribs in two or more places
Flail chest
Flail chest leads to
Inadequate breathing and hypo ventilation.
Movement of flail segment is opposite to movement of the remainder of the chest cavities.
Paradoxical motion
Symptoms of rib fracture
Pain increases when breathing, tender, respiratory distress, self splinting
