Vol.4-Ch.3 "Hemorrhage and Shock"

Question 1

Young adult males make up what % of total trauma and trauma deaths?

Answer 1

75%

Question 2

What is the most common form of shock?

Answer 2

Hemorrhagic (a form of hypovolemic)

Question 3

What are the 3 basic components of the circulatory system?

Answer 3

• heart
• blood vessels
• blood

Question 4

What is the afterload as pertaining to the circulatory system?

Answer 4

the resistance to blood flow out of the heart

Question 5

What is the effective pulse range? what should it be at approximately at rest?

Answer 5

50-180 but should be around 70 at rest

Question 6

What is normal cardiac output per minute (in Liters)

Answer 6

5 L/min.

Question 7

Do arteries or arterioles have a better control over changing their diameter to control how much blood flows into the perspective tissues or organs?

Answer 7

Arterioles have more control over their lumen size

Question 8

What is the major determinate for peripheral vascular resistance?

How do you calculate it peripheral vascular resistance?

Answer 8

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

Question 9

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?

Answer 9

MAP starts at about 80mmHg and goes down to about 18 mmHg as blood starts to enter the venous system

Question 10

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?

Answer 10

Arteries/arterioles = 13% of total blood volume

Capillaries = 7% of total blood volume

Veins/Venules = 64% of total blood volume

Question 11

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?

Answer 11

Hydrostatic Pressure pushes intracapillary fluid into the interstitial space

Oncotic Pressure pulls fluids back into the capillary

Net Filtration

Question 12

Plasma accounts for what % of volume in the blood?

Erythrocytes accounts for what % of volume in the blood?

Answer 12

plasma = 55% and is mostly water

erythrocytes = 45% (hematocrit = % of RBCs in blood)

(Platelets are next most frequent blood cell type)

Question 13

What describes the relationship between the ability of hemoglobin to bind and release oxygen at varying partial pressures?

Answer 13

Oxyhemoglobin Dissociation Curve

Question 14

Describe the flow rate and color expected with arterial, venous, and capillary hemorrhaging?

Answer 14

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

Question 15

What are the 3 stages of hemostasis (clotting)

Answer 15

• Vascular phase
• platelet phase
• coagulation phase

Question 16

What happens in the vascular phase of hemostasis?

first phase

Answer 16

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

Question 17

What happens in the platelet phase of hemostasis? (second phase)

Answer 17

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.

Question 18

What happens in the coagulation phase of hemostasis? (third phase)

Answer 18

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

Question 19

What are some factors that can aid (1) or inhibit (4) the clotting process?

Answer 19

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)

Question 20

What drug plays a major role in the management of trauma and hemorrhagic shock? What does it do?

Answer 20

Tranexamic Acid (TXA)

It is a Antifibrinolytic so it inhibits fibrinolysis (the breakdown of fibrin)

Question 21

What is coagulopathy?

Answer 21

A condition in which the blood’s ability to clot is impaired

Question 22

Epistaxis = ?

Answer 22

Nosebleed

Question 23

Hemoptysis = ?

Answer 23

Coughing up blood

Question 24

Hematemesis = ?

Answer 24

Blood in vomit

Question 25

Hematochezia = ?

Answer 25

Blood in poop

Question 26

Melena = ?

Answer 26

Black and tarry poop

Question 27

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?

Answer 27

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?

Question 28

What 3 things are important to identify when you have a hemorrhaging Pt?

Answer 28

• Time elapsed since injury
• Class of hemorrhaging
• Rate of which shock is worsening

Question 29

Describe stage 1 hemorrhages

Answer 29

• 15% or less blood loss

- may be nervous with slightly pale cool skin w/ slight pallor

Question 30

Describe stage 2 hemorrhages

Answer 30

• 15-30% blood loss
• Pt thirsty, anxious, restless, cool/clammy skin
• increased respiratory rate

Question 31

Describe stage 3 hemorrhages

Answer 31

• 30-40% blood loss
• dyspnea, “air hunger”, severe thirst, anxiety, restless
• survival unlikely without rapid intervention

Question 32

Describe stage 4 hemorrhages

Answer 32

• 40% or more blood loss
• barely palpable pulse, ineffective respirations, lethargic, confused, closely unresponsive
• survival unlikely

Question 33

What occurs in compensated shock? (5)

Answer 33

• 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)

Question 34

What occurs in decompensated shock? (4)

Answer 34

• unpalpable pulse
• blood pressure drops drastically
• Pt becomes unconscious
• respirations slow or stop

Question 35

What happens in irreversible shock?

Answer 35

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

Question 36

What are the 5 types of shock?

Answer 36

• hypovolemic
• cardiogenic
• neurogenic
• anaphylactic
• septic

Question 37

Erythema = ?

Answer 37

skin reddening

Question 38

When would you perform a rapid trauma assessment vs a focused assesment?

Answer 38

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)

Question 39

Syncope = ?

Answer 39

fainting or loss of consciousness

Question 40

What are 3 anatomical sites where firm digital pressure have to be performed with extreme percision?

Answer 40

• 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)

Question 41

What are 4 ways to control hemorrhaging?

Answer 41

• 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

Question 42

What is the most practical fluid for prehospital administration in shock patients?

Answer 42

An Isotonic crystalloid like normal saline (Lactate Ringer’s)

Question 43

What is the ultimate goal of fluid resuscitation?

Answer 43

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)

Question 44

How much fluid does a Pt in shock and hemorrhaging normally need?

Answer 44

1-2L (20ml/kg for kids)

Question 45

What 3 ways can a Pt respond to fluid resuscitation?

Describe each one.

Answer 45

1. Rapid Responder - responds quickly to first bolus and will stabilize. (Usually only loss of 20% or less of blood)
2. 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)
3. Minimal/No Response - No response to fluid admin and usually caused by uncontrollable hemorrhaging

Question 46

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?

Answer 46

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