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2018 VU Trauma > Hemorrhage and Haemodynamics > Flashcards

Hemorrhage and Haemodynamics Flashcards

1
Q

What is haemodynamic?

A
  • The physiology of blood flow and the forces involved in circulation
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2
Q

How is Haemodynamic measured?

A
  • HR, BP, perfusion
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3
Q

What is the two-part process of perfusion?

A
  • Oxygen and nutrients go in and waste comes out
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4
Q

What is oxygenation?

A
  • Oxygen reaching a tissue or cell
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5
Q

What three components of the body need to be functional and working adequately for the body to perfuse?

A
  • Lungs, heart and Vessels
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6
Q

Lung Perfusion

A
  • Adequate O2 reaching alveoli

- Adequate oxygenation and ability to diffuse across the alveoli membrane

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7
Q

What are all vasculature lined with?

A
  • Smooth endothelial cells
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8
Q

What mechanisms are a feature of vessels bigger than capillaries?

A
  • They have elastic layers, tunicae, these regulate pressure
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9
Q

What determines the nature of flow through the body?

A
  • The difference in pressure at two ends of a vessel.
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10
Q

Define Haemorrhage.

A 
-	Disruption or leakage from the circulatory system, it can be broken down into three subtypes.
o	External
o	Internal (concealed)
	Bleeding into tissue or organs, but not visible
o	Internal (revealed)
	Becomes visible through passage or orophas of the body.
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11
Q

What types of external haemorrhage may occur?

A
  • Arterial
    o Will be seen as pulses, and spurts of bright red blood, denoting that it is oxygenated
  • Venous
    o Will be a steady flow from the wound and will present with a dark red colour, denoting that it is deoxygenated.
  • Capillary
    o Small volume of blood and will ooze out
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12
Q

What determines how serious a haemorrhage is?

A

the amount of the vasculature is disrupted and the amount of blood loss.

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13
Q

What body cavity will an internal haemorrhage from illness, disease or rupture tend to occur in?

A
  • Chest
  • Abdomen
  • Pelvis
  • Retroperitoneal
  • Skull
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14
Q

What is the natural control of bleeding?

A
  • Haemostasis, the prevention of blood loss.
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15
Q

What are platelets function in the clotting mechanism?

A
  • Forming a temporary plug that helps seal breaks or ruptures that have occurred in blood vessels.
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16
Q

What is the clotting process?

A
  • A injury occurs, LAC, Blunt injury etc.
  • Vascular spasm occurs
    o This is to reduce the level of blood lost through the hole
  • Platelet plug formation
    o Clotting cascade occurs
  • Blood coagulation
    o The formation of scabs and scars
17
Q

Platelet plug formation

A
  • Platelets adhere to the collagen under the epithelium
  • Platelets become enlarge and irregular
  • Platelets become sticky and attracts other platelets forming a temporary plug
18
Q

Blood coagulation

A
  • Blood coagulation is a complex process, it not only involves platelets but also substances that secrete vessel walls and blood proteins that initiate clotting.
19
Q

What pathways are involved in the clotting process?

A
  • Extrinsic and intrinsic pathways
20
Q

Explain the Extrinsic pathway

A
  • The extrinsic pathway takes effect within seconds of damage occurring.
  • It is initiated with liquid blood contacting damaged tissue.
  • It starts with damage to the vessel wall and surrounding tissue
21
Q

Explain the Intrinsic pathway

A
  • The intrinsic process is initiated by liquid blood contacting a foreign surface, i.e. something that is not a part of the body, occurs minutes after the wound has occurred.
22
Q

What are the stages of the common pathway?

A 
-	Stage one
o	Formation of prothrombin activator
-	Stage two
o	Conversion of prothrombin
-	Stage three
o	Conversion of soluble fibrinogen
23
Q

How does the formation of Pro thrombin activator occur?

A
  • The process occurs differently in the intrinsic and extrinsic pathways.
  • Involves the activation of 4 other factors.
24
Q

What is factor 1?

A
  • Fibrinogen
25
Q

What is factor 2>

A
  • Prothrombin
26
Q

What is Factor 3?

A
  • Tissue thromboplastin
27
Q

What is Factor 4?

28
Q

What is Factor 5?

A
  • Proaccelerin labile factor: AC-globulin
29
Q

What is factor 8?

A
  • Antihemophilic factor

- Antihemophilic Factor A

30
Q

What is Factor 10?

A
  • Stuart Factor, Stuart-power factor.
31
Q

How does clot retraction and Dissolution work?

A
  • As the cloth retracts, it pulls the edges of the broken blood vessel together, opening the blood vessel and increasing the blood flow.
32
Q

What is Fibrinolysis?

A
  • The break down of the clot so that the vessels don’t become blocked.
    o Occurs through the breakdown of fibrin.
33
Q

What forms of drugs have an effect on clotting?

A
  • Platelet inhibitors
    o Aspirin – Stops production of thromboxane A, required in platelet plug formation.
     Prevents the clot growing larger.
  • Anticoagulants
    o Warfarin – Interferes with Vitamin K dependent clotting factors, for example, prothrombin (factor 2).
  • Streptokinase – convert plasminogen into active plasmin
    o Clot dissolving
34
Q

What patient pathologies may affect the clotting process?

A
  • Excessive bleeding.
  • Liver disease
    o Preventing the synthesis of clotting factors
  • Vitamin K deficiency
    o Required for clotting factor synthesis
  • Haemophilia
    o Commonly due to deficiency of factor VIII (Antihemophilic factor), Haemophilia A
  • Thrombocytopenia
    o Abnormally low levels of circulating platelets
  • Von Willebrand’s disease
    o Compound defect involving both platelet function and clotting factor deficiency.
  • Thromboembolic conditions
    o Unwanted clots are formed
  • Disseminated intravascular coagulation DIC
    o Spontaneous clots form as a failure of multiple systems.
     These create blocked blood flow and may create severe bleeding.
35
Q

What types of internal haemorrhage can be considered?

A
  • Haematemesis
  • Haemoptysis
    o Associated with tuberculosis or cancer
  • Haematuria
    o Related to trauma of urinary tract and kidney stones
  • Vaginal bleeds
    o Spontaneous abortion, intrapartum haemorrhage
  • Rectal bleeds
    o heemraads
  • Melaena
    o Dark and highly offensive smell Stools. Indicative of ulcer/tumour. Small and upper GIT bleeds.
36
Q

How might a patient with an internal haemorrhage present?

A
  • Light headed
  • Nausea or vomiting
  • Rapid, weak, thready pulse
  • Rapid respirations
  • Pale, cold, and clammy
  • Thirsty
37
Q

What are exceptions of bad cavity bleeds?

A
  • Menstruation
  • Haemorrhoids
  • Some epistaxis
38
Q

What is the treatment of Epistaxis?

A
  • Firm pressure to the soft part of the nose for 10 minutes
  • Sit upright, head forward
  • Don’t blow the nose
    o This will disturb the clotting process
  • Cold compress on the back of the neck
  • If bleed continues for > 10 minutes transport

2018 VU Trauma (23 decks)

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