Chapter 25

perfusion

perfusion

the supply of O2 and its removal of waste from the body’s cells and tissues as a result of the flow of food through the capillaries

hypoperfusion

the body’s inability to adequately circulate blood to the body’s cells to supply them with O2 and nutrients

shock

the body’s inability to adequately circulate blood to the body’s cells to supply them with O2 and nutrient which Id a life threatening condition

arteries

carries oxygen rich blood away from the heart. under a great deal of pressure during the heart’s contractions. has a thick, muscular wall that enables it to dilate or constrict, depending on the amount of O2 and nutrients needed by the cells or organs it feeds

capillaries

O2 rich blood is emptied from the arteries into microscopically small capillaries, which supply every cell of the body. in areas where capillaries and body cells are in contact, a vital exchange takes place.

veins

blood that has been depleted of O2 and loaded with CO2 and other waste in the capillaries empties into the veins, which carry it back to the heart.

veins have ___ that prevent the blood from flowing in the wrong direction. blood in a vein is under much less pressure than blood in the artery

one way valves

transportation of gases

blood picks up inhaled O2 at the alveoli in the lungs and carries it to the body’s cells

nutrition

blood circulates nutrients from the intestines or storage tissues (such as fatty tissues, the liver, and muscle cells) to the other body cells

excretion

blood carries waste products from the cells to organs, such as the kidneys that excrete them from the body

protection

blood carries antibodies and white blood cells, which help fight diseases and infection

regulation

blood carries substances that control the body’s functions, such as hormones, water, salt, enzymes, and chemicals

adequate circulation of blood throughout the body, which fills capillaries and supplies the cells and tissues with oxygen and nutrients is called

perfusion

if, for some reason, blood is not adequately circulated, some of the body’s cells and organs

do not receive adequate supplies of O2, and dangerous waste products build up

hemorrhage

bleeding, especially severe bleeding

what is the major cause of shock in trauma

hemorrhage

arterial bleeding

bleeding from an artery, which is characterized by bright red blood that is rapid, produce and difficult to control

venous bleeding

bleeding from a vein, which is characterized by dark red or maroon blood and a steady, easy to control flow

capillary bleeding

bleeding from capillaries, which is characterized by a slow, oozing flow of blood

bleeding can also be accelerated by

underlying conditions

a growing number of pt’s are on prescription medications designed to

limit the body’s natural ability to for blood clots

blood thinners, these medications are commonly prescribed to pt’s with a history of

stroke, irregular heart bears (atrial fibrillation), heart attack, or artificial heart valves

critical blood loss

1L for an adult, 500CC for a child, 150 CC for an infant

sometimes external blood loss can be examined by

looking at the amount of blood loss on the ground

the control of external bleeding is

one of the most important elements in the preventions and management of shock i

continue through the airway and breathing steps, and correct those problems first. if the bleeding is massive,, move immediately to

the bleeding control steps

bleeding control steps

direct pressure, elevation of the limb, hemostatic agent, tourniquet

scenario question for bleeding in order

direct pressure, high flow O2, splint leg to keep from moving

in most cases, the first step in bleeding control will be to compress the wound with

direct pressure

elevation of an injured extremity has never been proven to

decrease bleeding, but if it can be done quickly and easily, it makes sense to employ this method at the same time as you apply direct pressure

pressure dressing

bulky dressing held in position with a tightly wrapped bandage, which applies pressure to help control bleeding

hemostats agent

substances applied as powders, dressing, gauze, or bleeding bandages to open wounds to stop bleeding

tourniquet

a device used for bleeding control that constricts all blood flow to and from an extremity

tourniquets are used only on

external injuries

do not apply the tourniquet

directly over a joint (elbow or knee)

place the tourniquet approximately

two inches above the bleeding wound

if a commercial tourniquet is not available, a tourniquet can also be made from

ambulance equipment or supplies such as a cravat

tourniquets improvised from materials such as this should be at least

two inches wide and several layers thick

if a blood pressure cuff is used, monitor

the pressure to be sure the cuff does not gradually deflate

splinting

bleeding associated with a musculoskeletal injury mat be controlled by proper splinting of the injury

cold application

a traditional method of controlling bleeding is the application of ice or a cold pack to the injury. the cold minimizes swelling and reduces the bleeding by constricting the blood vessels

head injury

traumatic injuries resulting in a fractured skull may cause bleeding or loss of cerebrospinal fluid (CSF) from the ear or nose

nosebleed

also called epistaxis, may be caused by direct trauma to the nose. have the pt lean forward

blunt trauma is the leading cause of

internal injuries and bleeding

what are some mechanisms of blunt trauma that may cause internal bleeding

falls, motor-vehicle or motor cycle crashes, auto pedestrian collisions, blast injuries

what are some mechanisms of penetrating trauma

gunshot wounds, stab wounds from a knife, ice pick, screw driver, or similar objects, impaled objects

what happens to the body with blood loss

the heart rate increases and blood vessels constrict

shock may develop if

the heart fails as a pump, blood volume is lost, blood vessels dilate, creating a vascular container capacity that is too great to be filled by the available blood

compensated shock

when the patient is developing shock but the body is still able to maintain perfusion

decompensated shock

the body can no longer compensate for low blood volume or lack of perfusion

hypovolemic shock

sculpting from blood or fluid loss

hemorrhagic shock

shock resulting in blood loss

what shock is the most commonly seen by EMT’s

hypovolemic shock

cardiogenic shock

good loss but shock, or lack of perfusion, brought on not by blood loss but by the heart’s inadequate pumping action

neurogenic shock

hypo perfusion due to nerve paralysis resulting in the dilation of blood vessels that increased the volume of the circulatory system beyond the point where it can be filled

signs of shock

altered mental status, pale, cool, clammy skin, nausea and vomiting, vital sign changes, other late signs (thirst, dilated pupils, and cyanosis)

what is the term that has been used to describe the optimal time from the infliction of a traumatic injury until the patient receives definitive treatment in a hospital

golden hour

quit is in fact every minute between the time of injury and the Pt’s getting to an operating

like gold to the PT and to his chances of his survival

your goal in caring for trauma and shock patients is to limit on scene time and provide

immediate transportation to the hospital

limiting time spent on scene is

vital

the goal for on scene time when caring for a trauma or shock pt has been stated as a maximum of

10 minutes

the time limit on scene is called the

platinum 10 minutes

in pt’s showing signs of shock, or a MOT that suggests the possibility, some elements of PT assessment, such as a detailed exam and treatments are best

done in the ambulance en route to the hospital

if a pt is conscious, speak

calmly and clearly as reassuring throughout your assessment, care and transport.

what increases the body’s work and worsens developing shock

fear