Lecture 3: Bleeding management Flashcards
When do you see serious results after blood loss?
Serious results after 1L loss
15% loss = moderate shock
30% loss = severe or fatal shock
what is the total blood volume in the body
5-6 L
What are the elements of blood composition
mostly plasma
RBC (Erythrocytes)
WBC (Leukocytes)
Platelets
What are the steps of hemostasis?
Blood vessel spasm
formation of platelet plug
blood clotting (coagualtion)
What is vasoconstriction?
Vessel will spasm/constrict to prevent blood flow to that area
how long does it take for hemostasis to occur
6-10 minutes
What is the goal of hemostasis?
to coagulate/stop the blood
What are the circumstances in which someone will have no clotting
1) Haemophiliacs (clotting does not happen fast/or at all
2) Aspirin (need medical clearance to play since it will take longer to clot)
3) Large vessel lacerated (depends on size and location of laceration)
4) Large space lacerated
Can people who don’t clot pay sports
Depends on the situation
Explain external bleeding vs internal bleeding and what do they have in common>
External:
Obvious, blood coming out, risk of infection
internal: hidden, blood contained in cavity, will see tenderness, swelling, discoloration, feel warmth)
BoTH: weakness, shock, death= both equally dangerous
What is considered life threatening extrenal bleeding
1) bleeding in a victim who is now unconcious
2) bandages/ clothing soaked in blood
3) blood pooling on the ground/wont stop coming out of wound
4) loss of part of arm/leg
5) blood spurting out (artery)
What are the factors to consider when talking about external bleeding
Flow (Speed)
vein=oozing
artery=spurting
Color
artery=bright red
Type of vessel
› Arterial
› Venous
› Capillary
Where are the 3 places external bleeding results from
1) arteries (spurting, pulsating, bright red)
2) veins (steady slow flow, dark blood)
3) capillary (slow even flow)
What are the types of patients/athletes that bleed more?
- athletes after exercise
- hypertensive individuals
- hemophiliac
- anti-coagulants
What is more prone to injuries, solid or hollow organs s
solid
What are the solid organs
Liver Spleen Pancreas Kidneys Ovaries Adrenal
What are the hollow organs
Gallbladder Stomach Small intestine Large intestine Bladder Bile ducts Ureters
What is the FIRST thing to do when controlling external bleeding?
Protect yourself
› Latex gloves (possibly double bag!!)
› Pocket face mask with one way valve
› Eye protection in massive trauma
Explain direct pressure
maintain sufficient pressure, first layer is non adherant sterile gauze, never remove first layer, check for pulse
True or false: tourniquet is a last resort
TRUE
What is the purpose of a tourniquet
for uncontrolled arterial bleeding where
direct pressure is not being effective
LIFE OVER LIMB
What is a vey important aspect when securing the tournique>
WRITE THE TIME IT WAS PLACED
True or false; you cannot put tourniquet over clothes
False. you can put it over clotes (not preffered) but cannot place over items in clothes)
Where should you never place a tourniquet
OVER A JOINT
How tight should a tourniquet be?
Tight enough to cut circulation (cannot fit fingers under the strap)
If a person if bleeding non stop, what must you keep in the back of your mind
SUPPLY O2 for POSSIBLE SHOCK (hypoxia)
What are the 7 skin injuries and be able to explain them
Punctures (impaled)
Skin bruises (acucmulation of blood within skin)
Lacerations (irregular tear)
Incisions (clean cut)
Blisters (fluid under skin)
Avulsions (complete seperation of skin)
Abrasions (scraping away layers of skin)
How do you treat an abraision
1) clean the wound (Check for debris)
2) disinfect thje wound (steril saline, water, benzo)
3) polysporin
4) bandaid
5) dressings and slippage prevention
When you have a blister, should you pop it?
NO it is acting as protection of skin underneath
how do you treat a blister
1) clean the wound (Check for debris)
2) disinfect thje wound by IRRIGATION
3) polysporin
4) bandaid with tuff skin for adhesive
5) dressings and slippage prevention
What is something besides polysporin to keep an injury wet>
vaseline
How do you treat a laceratin
If not too depp
1) control the bleeding
2) clean wound (look for debris)
3) disinfect
4) approximate skin and add steri strips (with lubricant)
5) wrap with dressings
HOw do you apply steri strips
Approximate skin, apply in the middoe first
make your way outwards by switch direction of application each time
What are the 4 types of ways of closing an open laceration
1) sutures
2) staples
3) steri strips
4) glue
How would you treat an avulsion
1) stop the bleeding
2) DO NOT REMOVE FLAP clean wound by irragation
3) disinfect
4) wrap and send to the hospital
How do you treat a clean cut?
If not too depp
1) control the bleeding
2) clean wound (look for debris)
3) disinfect
4) approximate skin and add steri strips (with lubricant)
5) wrap with dressings
How do you treat a puncture?
DO NOT REMOVE THE OBJECT
STOP BLEEDING AND SECURE WITH A LOG CABIN
send to hospital for removal
WHAT ARE THE CLASSIC SIGNS OF WOUND INFECTION
Increased pain around the wound bed Redness or warmth Fever /chills or other flu-like symptoms Pus draining from the wound bed Increasing odor from the wound Increased firmness of skin or swelling around the wound bed
What are the secondary signs of wound infection
Increasing drainage from the wound bed Delayed wound healing Discoloration of the wound bed with it turning darker in color Foul odor Increased fragility of the wound bed Wound breakdown /enlargement
What are the 4 goals of wound care
Facilitate hemostasis
Decrease tissue loss
Promote wound healing
Minimize scar formation
What are the 4 types of CLOSED WOUNDS
Ecchymosis
Hematoma
Effusion
Edema
What is ecchymosis, what does it look like and what is the MOI
medical term for the common bruise
a discoloration of the skin
MOI: impact, resulting from bleeding underneath
What is the progression of colours of ecchymosis
red or purple (oxygen rich blood has newly pooled underneath the skin)
black or blue (1-2 DAYS, lose oxygen
yellow
brown (begins to fade at this point)
allows you to see how old a bruise it
What are the causes of a bruise
- Accidents or bumps
- Microscopic tears in the blood vessels under the skin in athletic people
- Bleeding disorders — unexplained bleeding that occurs without reason
- Thinner skin due to aging
What are the symptoms of a bruise?
-Dark blue or purple patch of skin that appears within a few hours after injury
-Tenderness on or around the affected
area
-internal organes and bones can also suffer damage
What is hemotoma
Collection/pooling of blood outside a blood vessell
What are the 2 MOI of a hemotoma?
Direct impact blunt trauma (muscle contracted= supercicial, relaxed= deep)
indirect post muscle tear-rupture
Causes of hemotoma
Trauma is the primary cause of a hematoma (high contact sports)
Orthopedic injuries such as fractures
Hematomas may also be caused by:
› Aneurysm
› Certain medications
› Viral infections (chicken pox)
What are the different classifications of hematoma
Deep intramuscular superficial intramuscular (more serious) inter-muscular mixed (intra and inter)
What are the symptoms of hemotoma
Inflammation Redness Tenderness Warmth Pain Swelling
What is edema and where does it occur
Accumulation of fluid in interstitial space,
when capillaries leak fluid: the fluid builds
up in surrounding tissues, leading to
swelling.
outside a joint
What are the signs of edema?
-Swelling or puffiness of the tissue directly under the skin (legs or arms)
-Stretched or shiny skin
-Skin that retains a dimple (pits), after being
pressed for several seconds
-Increased abdominal size
What is joint effusion?
- Commonly referred to as “water on the…”
- Accumulation of fluid in or around a joint
- *Don’t confuse with edema
What are the causes of joint effusion?
Infection
Injury
Arthritis
What are common joint effusion places
Knee (most common) Ankle Elbow Shoulder Hip
What can internal bleeding be caused by?
traumatic injury:
- severe force
- contact sports
- non compound fractures (fracture that does not pierce skin)
non traumatic injuries;
Aneurism
Ruptured ectopic pregnancy
Ulceration
What could the possible injuries be for blood coming out of ears, eyes, mouth , rectum urethra
ears: head injury, csf fluid, ruptured ear drum
eyes: head injury
mouth: lung or stomach
rectum: digestive tract
urethra: kidneys and urinary
What are the possible signs for internal bleeding
-Rigid abdominal cavity
-Pain, tenderness, discoloration
(ecchymosis), swelling
(edema/hematoma/hemarthrosis)\
-Dizziness
- Increased thirst
-Restlessness and anxiety
-Weak and helpless feeling
What are possible signs and symptoms of internal bleeding (more vital related)
- Shallow and rapid breathing
- Cold & clammy skin
- Weak and rapid pulse
- Capillary refill > 2 seconds
- Dull eyes, enlarged pupils, blurred vision
What are the treatments for possible internal bleeding?
- Stop bleeding if possible
- Lie down/elevate legs (not FOR head/chest injury)
- Loosen restrictive clothing
- Be prepared for vomit
- Airway maintenance
- Administer oxygen
- Prevent heat loss (blanket/off ice asap!)
- Give nothing by mouth
- Record vitals
What is the medical name for a nose bleed and what is it caused by
epistaxis caused by rupture of capilaries (random or by trauma)
What are teh 2 classifications of epistaxis?
Anterior:
blood comes out through nostrils
posterior:
blood flows back into throat caused by possible airway issue
What is the treatment for epistaxis?>
Pinch nose
Head flexion
Sitting and rest
True or false: it is good to rub/blow nose with a nose bleed?>
FALSE
What are the effects of of hemmorage>
decrease BLOOD VOLUME decrease OXYGEN TRANSPORT decrease BLOOD PRESSURE increase HEART RATE TO COMPENSATE FOR low BP =HYPOVOLEMIC SHOCK
What is the review systemic approach to bleeding contol?
1) PREVENT FURTHER INJURY
2. CONTROL BLEEDING
3. ASSESSMENT/CLASSIFY
4. CLEAN+DISINFECTA
5. CLOSE-UP/BANDAGE
6. DECISION MAKING
What is the tolerance of heart and lungs and brain to ischemia
4-6 min
What is the tolerance of digestive tract, liver and kidneys to ischema
45-90 mins
What is the tolerance of bones, tissues and muscles to ischemia?
4-6 hours
When do you use wound packing?
When bleeding does not stop from direct pressure, tourniquet not availalbe, places like neck, shoulder and grouin
what do you pack a wound with?
bleeding control (hemostatic) gauze
plain gauze
a clean cloth
true or false: you do not need to apply pressure after wound packing?
false
What are the steps of wound packign
1) Open the clothing over the bleeding wound.
2. Wipe away any pooled blood.
3. Pack (stuff) the wound with bleeding control gauze, leaving a tip out
4. Apply steady pressure with both hands directly on top of the bleeding wound, push down as hard as you can and hold pressure to stop bleeding.
What are the steps of applying a commercial tourniquet?
1) Wrap the tourniquet around the bleeding arm or leg about 2 to 3 inches above the bleeding site (be sure NOT to place the tourniquet onto a joint—go above the joint if necessary).
2. Pull the free end of the tourniquet to make it as tight as possible and secure the free end
3) twist windlass until no more bleeding or distal pulse
4. Secure the windlass to keep the tourniquet tight.
5. Note the time the tourniquet was applied.
What can you use if you dont have a commercial tourniquet?
BP cuff
traingular bandage with a pen
SHould you cover a tourniquet?
NO
What are teh steps for applying a homemade tourniquet?
1) Maintain direct pressure
2) Place tourniquet 2-3 inches proximal bleed site on uninjured tissue.
3) wrap the triangylar bandage around the extremity twice and tie a knot on upper surface
4) Place a short stick (or similar object) on the half- knot
and Tie a 2nd square knot
5) Twist the stick to tighten tourniquet, creating “windlass effect”, until bleeding is controlled and no more pulse
6) secure pen with another knot and write the time
