Vol.4-Ch.3 "Hemorrhage and Shock" Flashcards
Young adult males make up what % of total trauma and trauma deaths?
75%
What is the most common form of shock?
Hemorrhagic (a form of hypovolemic)
What are the 3 basic components of the circulatory system?
- heart
- blood vessels
- blood
What is the afterload as pertaining to the circulatory system?
the resistance to blood flow out of the heart
What is the effective pulse range? what should it be at approximately at rest?
50-180 but should be around 70 at rest
What is normal cardiac output per minute (in Liters)
5 L/min.
Do arteries or arterioles have a better control over changing their diameter to control how much blood flows into the perspective tissues or organs?
Arterioles have more control over their lumen size
What is the major determinate for peripheral vascular resistance?
How do you calculate it peripheral vascular resistance?
Arterioles and their ability to drastically change lumen size.
Mean arterial pressure (MAP) is the measurment of peripheral vascular resistance and its formula is:
MAP = (Diastolic pressure + diastolic pressure +
systolic pressure) / 3
At what mmHg is MAP before blood gets to the capillaries and what is it is as blood gets to the other side and starts to enter the venous system?
MAP starts at about 80mmHg and goes down to about 18 mmHg as blood starts to enter the venous system
What % of blood is held in the arteries/arterioles?
What % of blood is held in the capillaries?
What % of blood is held in the veins?
Arteries/arterioles = 13% of total blood volume
Capillaries = 7% of total blood volume
Veins/Venules = 64% of total blood volume
Which pressure pushes fluids out of the capillary?
Which pressure pushes fluids in to the capillary?
What is the movement of fluids in and out of the capillaries called?
Hydrostatic Pressure pushes intracapillary fluid into the interstitial space
Oncotic Pressure pulls fluids back into the capillary
Net Filtration
Plasma accounts for what % of volume in the blood?
Erythrocytes accounts for what % of volume in the blood?
plasma = 55% and is mostly water
erythrocytes = 45% (hematocrit = % of RBCs in blood)
(Platelets are next most frequent blood cell type)
What describes the relationship between the ability of hemoglobin to bind and release oxygen at varying partial pressures?
Oxyhemoglobin Dissociation Curve
Describe the flow rate and color expected with arterial, venous, and capillary hemorrhaging?
Arterial - spurts or flows rapidly and is bright red
Venous - flows slower than arterial but faster than
capillary oozing and is dark red
Capillary - oozes and is bright red
What are the 3 stages of hemostasis (clotting)
- Vascular phase
- platelet phase
- coagulation phase
What happens in the vascular phase of hemostasis?
first phase
Vessel wall contracts (therefore, vessel withdraws into the wound, thicken wall, and reduce lumen size)
Ultimately reducing the rate and volume of blood through the vessel and out the wound
What happens in the platelet phase of hemostasis? (second phase)
platelets and vessel walls become adherent and as platelets begin to stick to collagen (a protein exposed by the damaged vessel). As platelets aggregate (or collect and adhere) a blood clot is formed but also also unstable.
What happens in the coagulation phase of hemostasis? (third phase)
A cascade of events that ultimately result in the formation of Fibrin or fibrin strands that adhere and form a type of mesh net that catches RBCs and forms a more durable clot than the platelet phase.
This can take around 7-10 minutes as opposed to the first two that happen almost immediately
What are some factors that can aid (1) or inhibit (4) the clotting process?
Aid: - quick immobilization or splinting so that tissues
move less
Inhibit: - movement of the wound site
- aggressive fluid therapy (dilutes blood if there
is not any blood infusion to replace RBCs for
O2, platelets for clotting, etc and it raises
blood pressure)
- Low body temp (slows clotting process)
- Medications (blood thinners)
What drug plays a major role in the management of trauma and hemorrhagic shock? What does it do?
Tranexamic Acid (TXA)
It is a Antifibrinolytic so it inhibits fibrinolysis (the breakdown of fibrin)
What is coagulopathy?
A condition in which the blood’s ability to clot is impaired
Epistaxis = ?
Nosebleed
Hemoptysis = ?
Coughing up blood
Hematemesis = ?
Blood in vomit
Hematochezia = ?
Blood in poop
Melena = ?
Black and tarry poop
Fluid accounts for ____% of total body weight?
Cells contain _____% of total body fluid?
Interstitial spaces contain _____% of total body fluids?
Intravascular space contain _____% of total body fluids?
Fluid accounts for 60% of total body weight?
Cells contain 62% of total body fluid?
Interstitial spaces contain 26% of total body fluids?
Intravascular space contain 7% of total body fluids?
What 3 things are important to identify when you have a hemorrhaging Pt?
- Time elapsed since injury
- Class of hemorrhaging
- Rate of which shock is worsening
Describe stage 1 hemorrhages
- 15% or less blood loss
- may be nervous with slightly pale cool skin w/ slight pallor
Describe stage 2 hemorrhages
- 15-30% blood loss
- Pt thirsty, anxious, restless, cool/clammy skin
- increased respiratory rate
Describe stage 3 hemorrhages
- 30-40% blood loss
- dyspnea, “air hunger”, severe thirst, anxiety, restless
- survival unlikely without rapid intervention
Describe stage 4 hemorrhages
- 40% or more blood loss
- barely palpable pulse, ineffective respirations, lethargic, confused, closely unresponsive
- survival unlikely
What occurs in compensated shock? (5)
- pulse rate increases
- pulse strength decreases (narrowing of pressures)
- skin is cool and clammy
- progressing anxiety, restlessness, and combativeness
- thirst, weakness, eventual air hunger
(narrowing of pulse pressures is usually first sign; this stage ends when BP drops suddenly and drastically)
What occurs in decompensated shock? (4)
- unpalpable pulse
- blood pressure drops drastically
- Pt becomes unconscious
- respirations slow or stop
What happens in irreversible shock?
This is caused by cells and tissues dying because they have not been perfused to due to decompensation of shock. This cell death will eventually lead to organ failure and eventually death of PT.
The cross from decomp to irreversible is not able to be seen by signs and symptoms, but obviously the longer they are decomp the more damage is being done and the closer to death the Pt becomes
What are the 5 types of shock?
- hypovolemic
- cardiogenic
- neurogenic
- anaphylactic
- septic
Erythema = ?
skin reddening
When would you perform a rapid trauma assessment vs a focused assesment?
A rapid trauma assessment (head to toe) would be performed on a Pt that has sign of serious trauma pts (this will be on ambulance unless Pt is stable) and so long as you can move past the ABCs.
A focused assessment would be for stable Pts that do not show signs of a serious trauma or blood loss (sometimes it is still a good idea to perform a rapid trauma assessment before this just to be sure you didn’t miss anything)
Syncope = ?
fainting or loss of consciousness
What are 3 anatomical sites where firm digital pressure have to be performed with extreme percision?
- the head on an open head wound (apply pressure to ridges of scalp at wound site
- the eyes
- the neck (you could stop flow to adjacent healthy vessel)
What are 4 ways to control hemorrhaging?
- Direct pressure (the best option and usually works)
- Elevation and Pressure points (the down sides are
that elevation moves the injured limb and once
pressure is applied on an arterial pressure point it
must be maintained) - Hemostatic agents (dust or powder form ; can be
made from crustacean shells, volcanic rock, or
starch based powder from plants) - Tourniquets
What is the most practical fluid for prehospital administration in shock patients?
An Isotonic crystalloid like normal saline (Lactate Ringer’s)
What is the ultimate goal of fluid resuscitation?
To restore organ perfusion and stabilize vitals (NOT regain blood pressure or make vitals better, just not worse)
(if given too much fluids it dilutes the blood and makes clotting harder and can even dislodge clots b/c of raised BP)
How much fluid does a Pt in shock and hemorrhaging normally need?
1-2L (20ml/kg for kids)
What 3 ways can a Pt respond to fluid resuscitation?
Describe each one.
- Rapid Responder - responds quickly to first bolus and will stabilize. (Usually only loss of 20% or less of blood)
- Transient Responder - Respond well to the first bolus but after it ends they continue to deteriorate, suggesting on going fluid loss or bleeding (Usually loss of 20-40% of blood)
- Minimal/No Response - No response to fluid admin and usually caused by uncontrollable hemorrhaging
What bore catheter should you use to restore fluids and if a pulse is not palpable how much fluids do you want to admin unrestricted to what BP to try to see at least in order to get a palpable pulse?
14-16 large bore catheters, 1.5in or shorter, with a non-flow-restrictive saline lock. (shorter the better cause long needles have high flow restriction)
If no pulse or BP lower than 80mmHg ; push 250-500mL unrestricted
