PCP Expansion - Bleeding Control Flashcards
What are the four types of shock?
- Distributive shock
- Cardiogenic shock
- Hypovolemic shock
- Obstructive shock
What is distributive shock a result of?
- Septic shock
- Neurogenic shock
- Anaphylactic shock
- Endocrine shock
- Toxic shock syndrome
- Systemic inflammatory response syndrome
- End-stage liver disease
What is cardiogenic shock a result of?
- Myocardial infarction
- Atrial or ventricular dysrhythmias
- Valvular or ventricular septal rupture
What is hypovolemic shock a result of?
Hypovolemic shock is largely due to hemorrhagic and non-hemorrhagic fluid losses.
What is obstructive shock a result of?
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Constrictive pericarditis
- Restrictive cardiomyopathy
How much blood is lost in Class I hemorrhage?
Class I hemorrhage involves a blood volume loss of up to 15%.
What physiological changes would be expected in Class I hemorrhage?
- Normal or minimally elevated HR
- No change in blood pressure, pulse pressure, or respiratory rate
How much blood is lost in Class II hemorrhage?
Class II hemorrhage occurs when there is a 15-30% blood volume loss
What physiological changes would be expected in Class II hemorrhage?
- Tachycardia (HR 100-120)
- Tachypnea (RR 20-24)
- Decreased pulse pressure
- Systolic blood pressure changes may be minimal, if at all
- skin may be cool and clammy, and capillary refill may be delayed
How much blood is lost in Class III hemorrhage?
Class III hemorrhage involves a 30-40% blood volume loss
How much blood is lost in Class IV hemorrhage?
Class IV hemorrhage involves > 40% blood volume loss
What physiological changes would be expected in Class IV hemorrhage?
- Significant hypotension (SBP < 90 mmHg)
- Severely altered mental status or loss of consciousness
- Narrowed pulse pressure is (≤ 25 mmHg)
- Tachycardia (HR >120)
- Urine output is minimal or absent
- Skin is cold and pale
- Capillary refill is delayed
What physiological changes would be expected in Class III hemorrhage?
- Any hypotension (SBP < 90 mmHg) or drop in blood pressure greater than 20-30% of the measurement at initial presentation is cause for concern.)
- Changes in mental status
- Tachycardia (HR >120)
- Tachypnea (RR markedly elevated)
- Capillary refill is delayed
- Diminished urine output
Remember:
While diminished anxiety or pain may contribute to such a drop, the clinician must assume it is due to hemorrhage until proven otherwise.
What classe(s) of blood loss are considered minimal?
Class I
What classe(s) of blood loss are considered moderate?
Class II
What classe(s) of blood loss are considered severe?
- Class III
- Class IV
What are the four classes of shock?
- Class I (Initial)
- Class II (Compensatory)
- Class III (Progressive)
- Class IV (Irreversible)
What percentage of tourniquets are suspected to cause some form of neurovascular damage?
7%
True or false; BCEHS endorses removing tourniquets if bleeding stops
False
True or false; BCEHS endorses topical application of TXA
False
What are the four main types of mechanisms in action for topical procoagulants
- Factor concentrators
- Procoagulants
- Mucoadhesive agents
- Cauterizing agents
Describe factor concentrators
Factor concentrators remove water from the blood and mechanically concentrate the clotting factors at the injury site.
Describe procoagulants
Procoagulants supplement coagulation factors and activate the coagulation cascade.
Describe mucoadhesive agents
Mucoadhesive agents provide a physical barrier to blood flow by swelling when exposed to water, trapping and cross-linking blood components.
Describe cauterizing agents
Cauterizing agents (not pictured here) use a chemical reaction to create intense heat that is intended to cauterize the damaged vessels, decreasing bleeding.
