Hemorrhage And Shock Flashcards
The transition between normal function and death is called ____.
Shock
How does a capillary hemorrhage present?
Generally oozes from the wound, normally an abrasion, and clots quickly on its own.
What color is blood in a capillary hemorrhage?
Bright red
The loss of the body’s most important and dynamic medium, blood, is called ____.
Hemorrhage
How does venous hemorrhage present?
Flows quickly but generally stops in a few minutes
Dark in color
Bleeding associated with arterial hemorrhage flows _____ and ____ from the wound.
Rapidly
Spurts
Blood from arterial blood is what color?
Bright red
What occurs when a blood vessel is torn and begins to lose blood, it’s ______ muscle contracts.
Smooth
The _____ phases the clotting process is the step in which smooth blood vessel muscle contracts, reducing the vessel lumen and the flow of blood through it.
Vascular
When a blood vessels smooth interior lining is disrupted, it causes?
Turbulent blood flow
The turbulent blood flow within the blood vessel attracts ______.
Platelets
What occurs in the platelet phase of the clotting process?
Platelets stick to collagen on the vessels injured inner surface and to other tissue in the area. They aggregate other platelets
To _____ is to cluster or come together.
Aggregate
What is the third and final step of the clotting process?
Coagulation
_____ are fibers which entrap red blood cells and form a stronger, more durable clot.
Fibrin
Coagulation normally takes _____ to _____ minutes.
7-10
If a blood vessel is cut transversely, the muscles of the vessel wall ____.
Contract
If a blood vessel is lacerated longitudinally, the smooth muscle contraction _______.
Pulls the vessel open
In a longitudinal laceration, bleeding is?
Heavy and continued
What kind of injury produces heavy continued bleeding?
Crushing trauma
If severe hemorrhage continues post laceration, _____ reduces the blood pressure at the hemorrhage site.
Hypotension
Systemic hypotension may be beneficial in controlling?
Serious internal hemorrhage
What are the factors which hinder the clotting process?
- Movement of the wound site
- Aggressive fluid therapy
- Low body temperature
- Medications such as aspirin, heparin, Coumadin
____ modifies the enzymes on the surface of platelets that cause them to aggregate the injury.
Aspirin
_____ hemorrhage presents with blood oozing, flowing, or spurting from the wound.
External
Bleeding from capillary and venous wounds is easy to halt because the _____ is limited.
Pressure
Bleeding from an arterial wound is _____.
Forceful
To stop bleeding from an arterial wound, pressure must?
Exceed the arterial pressure
When a tourniquet is placed, the limbs arterial and venous pressures _____ as well as the rate of hemorrhage.
Rise
Employ a tourniquet only to?
Half persistent hemorrhage
What metabolites accumulate in the stagnant blood during the absence of perfusion present when using a tourniquet?
Lactic acid
Potassium
Other anaerobic metabolisms
The hemorrhages which occur within the tissue or fascia are?
Self-limiting because the pressure within the tissue or fascia controls blood loss
What are the best indicators of significant internal hemorrhage?
Mechanisms of injury
Local signs and symptoms of injury
Early signs and symptoms of blood loss and shock
____ is bleeding from the nose resulting from injury, disease, or environmental factors; a nosebleed.
Epistaxis
Esophageal varies are?
Enlarged and tortuous esophageal veins
What are the common outward signs that indicate hemorrhage in lungs and respiratory?
Hemoptysis
If blood is evacuated early in esophageal varces the blood is ____ in color.
Bright red
Bowel hemorrhage may present as?
Bleeding from the rectum
Black and tarry stool(Melena)
What are the characteristics of acute hemorrhage?
Rapid shock
Quickly recognizable
Chronic hemorrhage is ____ volume, _______, and leads to?
Limited in
Continues over time
Anemia
In anemia, the patient experiences _______ and ____.
Fatigue
Lethargy
Cells contain about ____ percent of total fluid volume.
62
Interstitial space holds ______ percent blood volume.
26
_____ precent of fluid resides in the vascular space.
7
Stage 1 hemorrhage is a blood loss of up to ____ percent of circulating blood.
15
In stage 1 hemorrhage, what do vitals do?
Blood pressure, pulse, respiratory rate, urine output remain constant
A patient experiencing stage 1 hemorrhage may present with?
Nervousness
Marginally cool skin
Slight pallor
Stage 2 hemorrhage occurs as ____ to _____ precent of blood volume is lost.
15-25
What occurs to the vitals in a patient experiencing stage 2 hemorrhage?
Tachycardia
Pulse strength diminishes
In stage _____ hemorrhage, peripheral resistance is ______.
2
Increased
In stage 2 hemorrhage, systolic blood pressure ______.
Stays the same
Patients with stage 2 hemorrhage present with?
Cool, clammy skin, restlessness, and thirst
Thirst presents with stage 2 hemorrhage due to?
Fluid leaving the intracellular and interstitial spaces and the osmotic pressure of blood changes
Respiratory rate in stage 2 hemorrhage _____.
Increases
Stage 3 hemorrhage occurs when blood loss reaches ____ to ______ percent of blood volume.
25-35
In which stage of hemorrhage do signs of shock appear?
3
What are vitals doing in stage 3 hemorrhage?
Rapid tachycardia
Blood pressure begins to fall
Pulse is barely palpable
A patient experiencing stage 3 hemorrhage presents with?
Anxiety, restlessness, thirst, decreased level of responsiveness, pale, cool, diaphoretic
Stage 4 hemorrhage occurs with a blood loss greater than ____ precent of body’s total blood supply.
35
In stage 4 hemorrhage, the patients vital signs are?
Pulse is barely palpable in central arteries
Respirations are very rapid, shallow, and ineffective
How do patients experiencing stage 4 hemorrhage present?
Patient is lethargic, confused
Skin is cool, clammy, pale
Urinary output decreases
What patient may lose rather large volumes of blood before progressing through the various stages of hemorrhage?
Pregnant patients
The _____ patient has a blood volume close to ____ precent of ideal body weight, but not actual body weight.
Obese
7
Blood volumes in infants and children approximate ____ to _____ percent of body weight.
8-9
Compensatory mechanisms in infants and children are?
Neither well developed nor effective
Signs of blood loss and shock in elderly patients may be masked by?
Reduced perceptions of pain and by lowered levels of mental acuity due to disease
Which injury results in the most severe amount of blood loss?
Fractured pelvis
What are the early signs and symptoms of internal hemorrhage?
- pain, tenderness, swelling
- bleeding from mouth, rectum, vagina
- vomiting of bright red blood
- tender, rigid, distended abdomen
What are the signs and symptoms of late internal hemorrhage?
- Anxiety
- weakness
- thirst
- Melena
- rapid, weak, pulse
_____ is the passage of stools containing red blood.
Hematochezia
What indicates a positive tilt test?
Drop in systolic BP of 20
Increase of pulse 20
When the patient is moved from a supine to sitting position
A tilt test is suggestive of?
Hypovolemia
During the primary assessment, when should you care for serious hemorrhage?
Only after any airway and breathing problems are corrected
Cover any open neck wound with what type of dressing?
Occlusive
____ is the transitional stage between normal life and death.
Shock
What occurs in the heart which blood loss?
Stroke volume drops
Immediate drop in systolic blood pressure
What does the medulla oblongata do during blood loss?
Increases peripheral vascular resistance and heart rate
_____ pressure is the pressure of liquids in equilibrium; the pressure exerted by or within liquids.
Hydrostatic
____ is the group of red blood cells that are stuck together.
Rouleaux
A ____ is the release of accumulated lactic acid, carbon dioxide, potassium, and Rouleaux into venous circulation.
Washout
_____ shock is a hemodynamic shock insult to the body in which the body responds effectively.
Compensated
In compensated shock, symptoms are ________.
Limited. Systems function normally
In ____ shock, signs and symptoms are pronounced.
De compensated
Entry into decompensated shock is indicated by?
Drop in systolic blood pressure
____ is the final stage of shock in which organs and cells are so damaged that recover us impossible.
Irreversible
A rapid secondary assessment is performed on a patient with?
a significant MOI or signs of shock or serious injury
The primary principal of shock care is to?
Ensure the best possible chance for tissue oxygenation and carbon-dioxide off load
_________ is positive pressure ventilation supplied to a breathing patient.
Overdrive respiration
The most practical choice for prehospital fluid resuscitation is _______ solution.
Lactated ringers
When blood is lost, angiotension II increases __________ and reduces _____.
Peripheral vascular resistance
Blood flow
During blood loss, _______ reduces the ability of the capillaries to provide oxygen and nutrients to, and remove carbon-dioxide and other waste products from, the cells.
Interstitial edema
During blood loss, he building acidosis from the accumulating lactic acid and carbon dioxide causes?
Relaxation of the post capillary sphincters
The body’s first recognizable response to serious blood loss is probably an increase in?
Pulse rate
The first sign of shock is?
A narrowing pulse pressure and weakening pulse strength
What are the late signs of shock?
Tachypnea
Air hunger
Tachycardia suggests?
Hypovolemia
What type of CO2 levels reflect cardiac arrest, shock, pulmonary embolism, or incomplete airway obstruction?
Decreased
_____ ETCO2 levels reflect hypoventilation, respiratory depression, or hyperthermia.
Increased
ETCO2 readings above 40mmHg suggest the need for?
Increased ventilatory support
ETCO2 readings below 30 mmHg suggest the need for
hyperventilation, respiratory depression, or hyperthermia
An abnormally low alveolar CO2 level may produce _______.
Severe Cerebral Vasoconstriction
Two techniques to improve ventilatory efficiency are?
End-expiratory pressure
Continuous positive airway pressure
_____ uses special ventilation equipment that increases pressure during both inspiration and expiration.
Cpap
If there is any sign of tension pneumothorax, provide pleural decompression where?
Second intercostal space, Midclavicular line or at the fifth intercostal space
Or midaxillary line
The field treatment of choice for significant blood loss in trauma cases is ________.
Blood transfusion
Why should a patient with tension pneumothorax be monitored after decompression?
It is common for the catheter to clog and the tension pneumothorax to reappear
What should be done for a pneumothorax with a clogged decompression?
Insert another needle close to the first to relive any subsequent buildup of pressure
What is the most practical fluid for prehospital administration?
Isotonic crystalloid aka Lactated ringers solution or normal saline
Hypertonic crystalloid solutions can mobilize ______ and _____ fluid volumes to replace lost blood volume.
Interstitial
Cellular
Hypertonic crystalloid solutions are not able to carry?
Either the oxygen or the clotting factors essential for hemorrhage control
What is the biggest advantage of hypertonic solutions?
Low volume and weight
What are polyhemoglobins?
These solutions are either animal or human hemoglobin that has been processed to exclude antigens and microorganisms that would cause disease or adverse reaction in the recipient.
What are the positive attributes of polyhemoglobins?
Prolonged shelf life
Inexpensive
Can effectively carry oxygen from the lungs to the tissues
Fluid flow is proportional to the _____ power of the internal diameter.
4th
The longer the catheter, the ______ the resistance to flow.
Greater
The ideal catheter for the shock patient is?
1.5 inch or shorter
If you are unable to elevate the fluid bag, position it _________, in a ____ or in a ________ inflated to _____ or ______ mmHg.
Under the patient
Pressure infused
Blood pressure cuff
100 or 200
That is the goal systolic for a head injury patient with a GCS of 8 or less?
At or above 90mmHg
_____ decreases the skins ability to act as part of the body’s temperature control.
Cutaneous vasoconstriction
The _____ nervous system efficiently compensates for low volume.
Sympathetic
________ is not included in the initial signs of compensated shock accompanying external hemorrhage.
Unconsciousness
In a patient with no suspected trauma, and signs and symptoms of shock, you can perform the tilt test. The test is performed to determine:
Orthostatic hypotension
The arterial blood pressure is monitored by receptors in the aortic arch and carotid sinuses. These receptors are the?
Baroreceptors
Baroreceptors send signals to the ____ to help maintain blood pressure that assures adequate perfusion.
Medulla oblongata
When the body is working to counteract the effects of hemorrhage and cardiovascular insufficiency, it constricts arterioles and increases the heart rate and contractility. The most rapid hormonal response occurs with the release of:
Catecholamines
A patient with vital signs indicating a falling blood pressure and bradycardia as well as cool, clammy skin is most likely in:
Decompensated shock
A patient with suspected serious internal hemorrhage should be transported to?
Trauma facility
Your patient is determined to be in Decompensated shock. Fluid therapy is indicated. The most practical fluid for prehospital administration is:
Lactated ringers
A patient develops shock secondary to Hypovolemia. You understand that the reduced flow of oxygen to the cells leads to a buildup of lactic acid and other by-products. You further understand that ______ metabolism causes this process to work.
Anaerobic
What is Ficks Principle?
Getting oxygen into lungs, into body, into cells, and back out
Stroke volume is?
Amount ejected in one contraction of heart
Cardiac output is?
Amount of output per minute
How is cardiac output found?
Heart rate times stroke volume
Peripheral vascular resistance is ____.
After load
After load is?
A measure of friction between the vessel walls and fluid
What is the main factor affecting the resistance of blood flow?
Vessel diameter
Under normal conditions, over _____ of blood volume is in the venous system
60%
Oxygen exchange takes place in the ____.
Capillary
Radial pulse is at least _____ systolic.
80
Femoral pulse is at least _____ systolic.
70
Carotid pulse is at least _____ systolic.
60
