Chapter 26 - Bleeding

aorta

the main artery that receives blood from the left ventricle and delivers it to all the other arteries that carry blood to the tissues of the body

arterioles

the smallest branches of arteries leading to the vast network of capillaries

artery

a blood vessel, consisting of three layers of tissue and smooth muscle, that carries blood away from the heart

capillaries

the small blood vessels that connect arterioles and venules;

various substances pass through capillary walls, into and out of the interstitial fluid, and then on to the cells

coagulation

the formulation of clots to plug openings in injured blood vessels and stop blood flow

contusion

a bruise from an injury that causes bleeding beneath the skin without breaking the skin

ecchymosis

a buildup of blood beneath the skin that produces a characteristic blue or black discoloration as the result of an injury

epistaxis

a nosebleed

hematemesis

vomited blood

hematoma

a mass of blood that has collected within damaged tissue beneath the skin or in a body cavity

hematuria

blood in the urine

hemophilia

a hereditary condition in which the patient lacks one or more of the blood’s normal clotting factors

hemoptysis

the coughing up of blood

hemorrhage

bleeding

hemostatic dressing

a dressing impregnated with a chemical compound that slows or stops bleeding by assisting with clot formation

hypoperfusion

a condition in which the circulatory system fails to provide sufficient circulation to maintain normal cellular functions;

aka shock

hypovolemic shock

a condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion

junctional tourniquet

a device that provides proximal compression of severe bleeding near the axial or inguinal junction with the torso

melena

black, foul-smelling, tarry stool containing digested blood

open-book pelvic fracture

a life-threatening fracture of the pelvis caused by a force that displaces one or both sides of the pelvis laterally and posteriorly

pelvic binder

a device to splint the bony pelvis to reduce hemorrhage from bone ends, venous disruption, and pain

perfusion

the circulation of blood within an organ or tissue in adequate amounts to meet the current needs of the cells

shock

a condition in which the circulatory system fails to provide sufficient circulation to maintain normal cellular functions;

aka hypoperfusion

tourniquet

the bleeding control method used when a wound continues to bleed despite the use of direct pressure;

useful if a patient is bleeding severely from a partial or complete amputation

vasoconstriction

the narrowing of a blood vessel, such as with hypoperfusion or cold extremities

veins

the blood vessels that carry blood from the tissues to the heart

venules

very small, thin-walled blood vessels

In addition to airway management, what are two of the most important skills you will learn as an EMT?

recognizing and managing life-threatening bleeding

Bleeding can be _____ and obvious or _____ and hidden.

external, internal

What is the most common cause of hypoperfusion following a traumatic injury?

uncontrolled bleeding (hemorrhage)

What does the cardiovascular system do?

circulates blood to the body’s cells and tissues, delivering oxygen and nutrients and carrying away metabolic waste products

What is the main system responsible for supplying and maintaining adequate blood flow?

cardiovascular system

What are the three parts of the cardiovascular system?

1. the pump (the heart)

2. a container (the blood vessels that reach the cells of the body)

3. the fluid (blood and body fluids)

All organs depend on the ____ to provide a rich blood supply.

heart

Since the heart cannot tolerate a disruption of its blood flow for more than a few minutes, what does the heart muscle need?

a rich and well-distributed blood supply

What are the four main components of blood?

• erythrocytes

• leukocytes

• plasma

• platelets

What factors does blood clot formation depend on?

• blood stasis

• changes in the blood vessel wall (such as a wound)

• blood’s ability to clot (affected by disease processes or medications)

What do platelets do when tissues are injured?

platelets begin to collect at the site of injury, causing erythrocytes to become sticky and clump together

What nervous system monitors the body’s needs and adjusts the blood flow by constricting or dilating the blood vessels as required?

autonomic nervous system

During an emergency, the autonomic nervous system automatically redirects blood away from other organs to…

the heart, brain, lungs, and kidneys

Why must blood pass through the cardiovascular system fast enough but also slow enough?

fast enough = to maintain adequate circulation

slow enough = to allow each cell time to exchange oxygen and nutrients for carbon dioxide and other waste products

How long can cells in the brain and spinal cord survive without adequate perfusion?

4 to 6 minutes

How long can cells in the lungs survive without adequate perfusion?

15 to 20 minutes

How long can cells in the kidneys survive without adequate perfusion?

45 minutes

How long can cells in the skeletal muscle survive without adequate perfusion?

2 to 3 hours

How much blood per kilogram of body weight is in a typical adult male body?

70 mL of blood peer kilogram of body weight

How much blood per kilogram of body weight is in a typical adult female body?

65 mL of blood per kilogram of body weight

The body cannot tolerate an acute blood loss greater than ___% of the total blood volume.

20%

(approximately 1 L of blood)

With significant blood loss, what adverse changes in vital signs will occur?

• increased heart rate

• increased respiratory rate

• decreased blood pressure

How well a patient’s body can compensate for blood loss is related to…

how rapidly the blood loss occurs

How much blood can a healthy adult comfortably donate within 15 to 20 minutes and adapt well to this decrease in blood volume?

1 pint (500 mL) of blood

You should consider bleeding to be severe if any of the following conditions exist:

• the patient has a poor general appearance and is unresponsive

• signs and symptoms of shock

• significant amount of blood loss

• blood loss is rapid and ongoing

• uncontrolled bleeding

• significant MOI

Describe arterial bleeding.

• from an open artery

• bright red

• spurting in time with the pulse

• difficult to control because of the high pressure

Describe venous bleeding.

• from an open vein

• darker than arterial blood

• flows slowly or rapidly depending on the vein size

• does not spurt

• easier to manage because it is under less pressure

Describe capillary bleeding.

• from damaged capillary vessels

• dark red

• oozes from a wound steadily but slowly

Which types of bleeding are more likely to clot spontaneously (arterial/venous/capillary)?

venous and capillary

On its own, bleeding tends to stop rather quickly, within about…

10 minutes

(in response to internal mechanisms and exposure to air)

What happens in the body when a person’s skin is broken?

• blood flows rapidly from the open blood vessel

• the cut ends of the blood vessel begin to narrow (vasoconstriction)

• a clot forms, plugging the hole and sealing the injured portions of the blood vessel (coagulation)

What will happen if an effective clot does not form?

bleeding will never stop unless you use a tourniquet

Often, the only signs of internal bleeding caused by broken bones are…

local swelling and bruising caused by the accumulation of blood around the ends of the broken bone

What should you do if you suspect that a patient is bleeding internally?

treat for shock and promptly transport them to the hospital

What kinds of MOIs can result in internal bleeding?

• falls

• blast injuries

• motor vehicle crashes

• blunt trauma

• penetrating trauma

What kinds of NOIs can result in internal bleeding?

• bleeding ulcers

• bleeding from the colon

• ruptured ectopic pregnancy

• aneurysms

In older patients, what may be the first sign of nontraumatic internal bleeding?

dizziness, faintness, or weakness

What is the most common symptom of internal bleeding?

pain

What are some signs and symptoms of internal bleeding?

• pain

• swelling in the area of bleeding

• abdominal distention

• dyspnea

• tachycardia

• hemoptysis

• hypotension

• hematoma

• bruising or ecchymosis

• bleeding from any body openings

What are the methods that are available to control external bleeding?

• direct pressure

• pressure dressings and/or splints

• tourniquets

• junctional tourniquet

• hemostatic dressing

• wound packing

What are hemostatic dressings used together with and when are they used?

wound packing and direct pressure;

when direct pressure alone is ineffective or when tourniquet placement is impossible

When is a tourniquet used?

only if a patient has substantial bleeding from an extremity injury

After placing a tourniquet and bleeding has stopped, what should you do?

PMS check on the extremity

What are the precautions for using a tourniquet?

• don’t apply directly over any joint

• if it doesn’t immediately control bleeding, apply another adjacent to the first

• make sure it is securely tightened

• never use wire, rope, belts, or other narrow material that could cut into the skin

• consider placing padding under the tourniquet

• never cover a tourniquet

• don’t loosen or remove unless directed by the hospital

What can happen if a bone fracture is not splinted?

bone ends are free to move and may continue to injure partially clotted blood vessels;

also owww

What conditions can result in bleeding from the nose, ears, and/or mouth?

• fracture of the base of the skull

• facial injuries

• sinusitis

• infections

• nose drop use and abuse

• dried or cracked nasal mucosa

• intranasal use of street drugs

• high blood pressure

• coagulation disorders

• digital trauma (nose picking)

• cancer

What may happen if a person swallows a large amount of blood?

they may become nauseated and start vomiting the blood

Where do most nontraumatic nosebleeds occur from?

sites in the septum

What are the steps for controlling epistaxis (nosebleed)?

1. have them sit leaning forward

2. apply direct pressure for at least 15 minutes by pinching the fleshy part of the nostrils together

3. keep the patient calm and quiet because anxiety increases blood pressure

4. apply ice over the nose

5. maintain until bleeding is completely controlled

Bleeding from the nose or ears following a head injury may indicate a…

skull fracture

What should you do if you suspect a skull fracture?

• do not attempt to stop the blood flow

• loosely cover the bleeding site with a sterile gauze pad to collect the blood and keep contaminant away from the site

• wrap the dressing loosely around the head

If blood or drainage contains cerebrospinal fluid, what will you see on the dressing?

a target or halo shape staining the dressing