Chapter 26: Bleeding

how long can the heart, brain, and spinal tissue survive from blood loss

4-6 mins, have high metabolic rate

how long can the lungs survive from blood loss

15-20 mins

how long can the kidneys survive from blood loss

45 mins

how long can the skeletal muscles survive from blood loss

2-3 hrs

does resistance go up or down if temp is < 98.6 F

increased resistance from hypo perfusion

compensation of shock after what % of blood loss

20%

decompensation of shock after what % of blood loss

30-40%

how much volume of blood is in infant v.s. adults

800 mL vs 6L

how much blood should a infant lose to go into shock

3 to 6 oz or 100-200 mL

what causes an increased risk of shock

how fast the blood loss is

how much blood can a adult comfortably donate over 15-20 mins and what can happen if they donate the same amount of blood in a shorter period of time

500 mL, increased risk of shock

what causes blood to be lost faster

size of vessel cut and type of vessel

arterial bleeding

bright red, spurting blood, highest pressure

venous bleeding

dark red (deoxygenated)

steady continuous flow of blood

lower BP

capillary bleeding

dark red, oozes steadily but slowly

more likely to clot spontaneously than venous blood

when do most non severe bleeding tend to stop bleeing

within 10 mins

how do clots form when the skin is broken

when skin is broken, blood flows rapidly from open vessel

vasoconstriction of local damaged vessels

thrombocytes and clotting factors form a clot

s&s of internal bleeding

swelling

distention

rigidity

bleeding into the chest cavity or lung may cause dyspnea and/or hemoptysis

signs of shock

ecchymosis

hematoma

hematuria

hematemesis

melena

abnormal vaginal bleeding (non menstrual vaginal bleeding)

bleeding in pleural space (hemothorax)

what sound do you hear for hemothorax

dull sounds

most effective way to control external bleeding

direct pressure with gloved fingertip or hand over the top of a sterile dressing

how to control bleeding for a internal object

apply bulky dressing to stabilize the object in place and apply pressure as best as you can

how long do you hold pressure for a bleeding wound

for at least 5 mins

hemostatic agents

2 forms

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

granular powder and gauze impregnanted with a clay substance

when to add tourniquet and a second one

when bleeding does not stop

what to not do when applying a tourniquet

don’t apply directly over joint

make sure its tightness securely

don’t forget to put padding under the tourniquet

do not loosen the tourniquet after you have applied it

don’t forget to write the time of when it was applied

do not cover tourniquet with a bandage

do not use wire, rope, a belt, or any other narrow material

what can help control bleeding other than a tourniquet

a splint

air splints

can control internal or external bleeding associated with severe injuries

rigid splints

immobilize fractures

prevent further soft-tissue damage

epistaxis

nosebleed

if enough blood loss happens during epistaxis

shock

how to control epistaxis

by pitching the nostrils together and have patient sit up and tilt head slight forward, or recovery position if unconscious

bleeding from nose, ears, and mouth following a head injury

may indicate skull fracture

do not attempt to stop blood flow

avoid excessive pressure

loosely cover bleeding site with sterile gauze pad

target or halo-shaped stain indicates CSF

if patient is bleeding, pale and sweaty, how to make them feel better

keep them calm, reassured, and keep them as still and quiet as possible

how to treat for shock when someone if bleeding

place in supine position

high flow oxygen

maintain body temp

splint the injured extremity

never use tourniquet to control bleeding for closed, internal, soft tissue injuries