Heamorrhage And Shock

Question 0

Signs of Internal Haemorrhage (6)

Answer 0

> Bright red blood from mouth, rectum, other office
Coffee Ground APPEARENCE of Vomitus
Malaena (black tarry stools)
Haematochezia (passage of red blood through rectum)
Dizziness/syncope on sitting or standing
Orthostatic Hypotension

Question 1

Differentiate Between Venous Bleed and Arterial Bleed

Answer 1

VENOUS: Low pressure, slow and steady, dark/deoxygenated blood
ARTERIAL: High pressure, fast flowing, bright/oxygenated blood

Question 2

What Cardiovascular systems need to be working to maintain adequate tissue perfusion (oxygenation) (3)

Answer 2

> Heart
Lungs
Vasculature

Question 3

Four Stages of Haemorrhagic Shock

Answer 3

> Stage 1
Stage 2
Stage 3
Stage 4

Question 4

S & S Stage 1 Haemorrhagic Shock

Answer 4

> <15% blood loss, few signs

Question 5

S&S Stage 2 Haemorrhagic Shock (5)

Answer 5

> > 15-30% blood loss
Mild Tachycardia
Lethagy, Confusion, Combativeness
Delayed Cap Refill, Cool skin
Normal or Slightly ⬆️ BP
BODY DETECTS ⬇️ circulatory volume = vasoconstriction ⬆️ HR
Vasoconstriction ⬇️ amount of blood to skin = cool, pale, clammy skin

Question 6

S&S Stage 3 Haemorrhagic Shock (5)

Answer 6

> > 30-40% Blood loss
Mod Tachycardia
Confusion, unconsciousness
Delayed Cap Refill, Cold extremities, Cynosis
⬇️ SYST & ⬇️ Diastolic BP
NO LONGER MAINTAIN SYSTEMIC BP = ⬇️ blood flow to vital organs
HYPOXIA BUILDS = Acidosis
⬇️ blood = pooling = micro embolus which become lodges triggering HISTAMINE response = leakage or capillaries & third space shift

Question 7

S&S Stage 4 Haemorrhagic Shock (5)

Answer 7

>40% blood loss
> Bradycardia, Severe Dysrrhythmias
> Coma
> Pale, Cool, Clammy
> Frank Hypotension
High damage to vital organs from hypoxia and acidosis, organ start to fail.

Question 8

Description/Cause Hypovolemia

Answer 8

> Lack circulating volume
> Burns
> Diarrhoea
> Vomiting
> Haemorrhage (internal/external)

Question 9

Description/Causes (4) Cardiogenic

Answer 9

> Inadequate circulation due to failure of pump (heart)
> Cardiac Tamponade
> CCF
> ACPO
> Cardiomyopathy

Question 10

Description/Causes Neurogenic

Answer 10

> Spinal Cord Injury = loss in sympathetic tone

Question 11

Description/Causes Anaphylactic Shock

Answer 11

> Multisystem acute Hypersenitivity reaction to stimuli = release Histamine = third space shift & Bronchoconstriction
Bees Stings
Medications

Question 12

Description/Causes Septic Shock

Answer 12

> Systemic reaction to infection = vasodilation and capillary leakage, formation micro emboli (DIC) multi organ failure
Bacterial

Question 13

Management of Shock

Answer 13

A- establish/maintain open/patent airway
Consider airway adjuncts, or advance if indicated

B- High 02 100%, Ventilate if inadequate

C- Control external bleeding if present, IVC, IVF TO EFFECT, Cardiac monitor

D- BSL>4mmol, Montior GCS (deterioration of pt)

E- Temp, Locate areas of Bleeding/injuries

Pain RELIFE, ongoing monitoring, ECG, SpO2

Question 14

Method to Control External Bleeding (4)

Answer 14

> Direct Pressure hand, elastic bandage
Elevate limb above heart
Pressure Points proximal to injury over bony site
CAT Torniquet LAST RESORT

Question 15

S&S Cardiogenic Shock

Answer 15

> JVD,

> Arrtythmias

Question 16

S&S Neurogenic Shock

Answer 16

> Warm/Flushed Skin below level of injury

> Pariprism

Question 17

S&S Anaphylactic Shock

Answer 17

> Localised Oedema

> Bronchoconstriction

Question 18

S&S Septic Shock

Answer 18

> Pyrexia, Warm, Sweaty