Exam 5 Study Cards

Functions of Blood

Transportation of gases, nutrition, excretion, protection, regulation

Hypoperfusion (Shock)

Shock is the inadequate perfusion of body cells, and it occurs when the circulatory system fails.

Hypovolemic Shock

Occurs when blood is lost, or the liquid portion of the blood is removed from the circulatory system

Absolute Hypovolemia

Occurs during internal or external hemorrhage, when blood physically leaves the circulatory system

Relative Hypovolemia

Burns or dehydration, when the plasma is shifted out of the blood vessels, and therefore out of the circulatory system. Blood is not lost, but the volume is extremely depleted

Hemorrhagic Shock

Shock from the physical loss of blood

Cardiogenic Shock

Failure of the heart to pump blood. Example is the left ventricle rupturing, or a valve not pumping adequately.

Distributive Shock

Shock caused by the failure of blood vessel tone.

Anaphylactic Shock

a severe allergic reaction causes systemic vasodilation and massive drops in blood pressure. As noted earlier, increased capillary permeability is also a side effect of anaphylaxis and can cause volume-related issues as well.

Neurogenic Shock

Occurs as a result of a spinal cord injury. Key messages to the sympathetic nervous system that manage the constriction of the blood vessels get interrupted.

Septic Shock

In septic shock, a body infection causes a systemic inflammatory response to occur. This inflammatory response causes blood vessels to dilate and capillary membranes to become permeable. Dilation causes huge drops in blood pressure, and permeability robs the circulatory system of volume. Has both hypovolemic and cardiogenic shock elements.

Obstructive Shock

Conditions like a pulmonary embolism, cardiac tamponade, and a tension pneumothorax obstruct the flow of blood in and out of the heart and lungs and cause hypoperfusion to the body cells.

Compensation

The body undertakes systematic steps to correct or make up for hypoperfusion in the body

Decompensation

When the compensatory actions in the body begin to fail. Due to the ability of the heart to increase cardiac output, this condition swiftly overcomes the body's ability to self-correct. Indications are sudden drops in blood pressure.

Irreversible Shock

As the cells begin to fail due to hypoperfusion, so do the organs. With the failure of organs, the body begins to shut down as well. This leads to irreversible shock. Even if the patient survives, the underlying damage to cells and and the organs is irreversible.

Early signs of shock

Altered mental status: how altered determines how much perfusion the brain is getting.

Pulse Pressure

the difference between the systolic and diastolic blood pressure.

Signs of Shock

Altered Mental Status - brain not receiving enough oxygen

Pale, cool, clammy skin - the body diverts blood away from the skin to other vital organs like the heart and brain

(flushed, warm, dry for anaphylactic and SOMETIMES neurogenic shock)

Nausea and Vomiting - blood diverted from the digestive system to other vital organs

Vital Signs Change - tachycardia; heart pumping more blood, tachypnea; higher breathing rate to give the blood and brain more oxygen, hypotension; one of last vitals to change therefore constant reassessment is important, narrowing pulse pressure

Late Signs - You may see cyanosis around the nail beds and around the lips

Normal pulse pressure

should be at least 25% of the systolic blood pressure

Trauma Triad of Death

three conditions that significantly contribute to mortality in shock patients. The deadly triad consists of acidosis, hypothermia, and coagulopathy (reduced ability to form clots).

Hemorrhage

Severe Bleeding

Arterial Bleeding

Spurting blood, pulsing flow, bright red color.

Venous Bleeding

Steady flow, dark red color

Capillary Bleeding

Slow, even flow

Junctional Hemorrhage

occurs where appendages of the body connect to the trunk. Neck, both armpits, and both sides of the groin are sites where massive bleeding is likely.

Methods of controlling major bleeding

Direct Pressure

Hemostatic Agents

Wound Packing

Tourniquet

Specialized compression junctional hemorrhage devices

Steps to Control a Bleed

1. Apply firm pressure with the palm of your hand or use your fingers for a smaller wound

2. Hold the pressure firmly until the bleeding is controlled.

3. When applying direct pressure, resist the temptation to apply layers of "absorbent" dressings.

4. Once the bleeding has been controlled, bandage a dressing firmly in place to form a pressure dressing.

5. Do not remove a dressing once it has been placed on the wound. If the wound is still bleeding profusely, then other alternative measures such as tourniquets could be useful.

Packing a Wound

1. Scene Safety / PPE

2. Begin with direct pressure

3. If available, a second provider should remove clothing from the wound area and prepare packing materials (typically hemostatic gauze).

4. When ready, focus the team and expose the wound. Look for the specific site of bleeding.

5. Place the end of the gauze against the site of the bleeding. Begin feeding gauze into the wound cavity. Feed gauze into the cavity until the cavity is full

6. Once the cavity is full, resume direct pressure. Consider using a pressure bandage

Pressure Dressing

Will control most non-massive external bleeding, and may be useful to maintain direct pressure once a wound has been packed. Be aware, however, that a pressure dressing should not take the place of direct pressure or tourniquet application in serious hemorrhage situations.

hemostatic agents

products designed to enhance direct pressure's ability to control bleeding by way of various biochemical reactions when they come in contact with blood. They are substances applied as powders, dressings, gauze, or bandages to open wounds to stop bleeding

Tourniquet Placement

2-3 inches proximal to the wound

Others previously said as high on the limb as possible

Follow local protocol

Do not place over a joint

Signs of Internal Bleeding

1. Injuries to the surface of the body, which could indicate underlying injuries

2. Bruising, swelling, or tenderness over vital organs (especially in the chest and abdomen). Basic knowledge of anatomy is important for this reason.

3. Painful, swollen, or deformed extremities

4. Bleeding from the mouth, rectum, vagina, or other body orifice

5. A tender, rigid, or distended abdomen

6. Vomiting a coffee grounds-like substance or bright red vomitus, indicating the presence of blood. (Red blood is usually from an active, current, "new" bleeding. Dark blood is usually "old.")

7. Melena (dark, tarry stools) or hematochezia (bright red blood in the stool)

8. Signs and symptoms of shock. They will appear only after internal bleeding has already resulted in significant blood loss.

Soft Tissues

the skin, fatty tissues, muscles, blood vessels, connective tissues, membranes (tissues that line or cover organs), glands, and nerves

Hard Tissues

Teeth, bones, and cartilage

Skin Functions

Protection, water balance, temperature regulation, excretion, shock absorption

Contusion

Bruise; most frequent encountered type of closed wound. Cells and blood vessels in the dermis are damaged.

Hematoma

A hematoma differs from a contusion in that hematomas involve a larger amount of tissue damage, including damage to larger blood vessels, with greater internal blood loss.

Crush Injury

Force can be transmitted from the body's exterior to its internal structures, even when the skin remains intact, and the only indication of injury is a simple bruise. This force can cause the internal organs to be crushed or ruptured, causing internal bleeding.

Abrasions

simple scrapes and scratches in which the outer layer of the skin is damaged, but not all the layers are penetrated.

Laceration

A cut. It may be smooth or jagged. This type of wound is often caused by an object with a sharp edge, such as a razor blade, broken glass, a jagged piece of metal, or a chainsaw. However, a laceration can also result from a severe blow or impact with a blunt object.

Puncture Wound

Results from the penetration of the skin. Typically, puncture wounds are caused by objects such as bullets, nails, ice picks, splinters, and knives.

Avulsion

Flaps of skin and tissues are torn loose or pulled off completely. A degloved hand, or an ear torn/ripped off.

Amputations

Amputated fingers, toes, hands, feet, or limbs are completely cut through or torn off.

Steps for Open Wounds

1. Expose the wound. Clothing that covers a soft-tissue injury must be lifted, cut, or split away.

2. Clean the wound surface. Do not try to pick embedded particles and debris from the wound. Simply remove large pieces of foreign matter from the surface.

3. Control bleeding. Start with direct pressure or direct pressure and elevation. When necessary, apply a tourniquet.

4. For all serious wounds, provide care for shock, including administration of high-concentration oxygen.

5. Prevent further contamination. Use a sterile dressing to prevent infection later. When none is available, use the cleanest cloth material at the scene.

6. Bandage the dressing in place after you have controlled the bleeding. If an extremity is involved, check for a distal pulse to make certain that circulation has not been interrupted by the application of a tight bandage.

7. Keep the patient lying still. Any movement will increase circulation and could restart bleeding.

8. Reassure the patient. This will help ease the patient's emotional response and perhaps lower the pulse rate and blood pressure.

Burns Severity Classification

By agent and source

By depth

By severity

Superficial Burn

Sunburn. It involves only the epidermis (the outer layer of the skin). It is characterized by reddening or darkening of the skin (depending on the skin tone of the patient) and perhaps some swelling

Partial Thickness Burn

The epidermis is burned through and the dermis (the second layer of the skin) is damaged, but the burn does not pass through to underlying tissues. There will be deep, intense pain; noticeable reddening or darkening; blisters; and a mottled (spotted) appearance to the skin.

Full Thickness Burn

All the layers of the skin are damaged. Some full thickness burns are difficult to tell apart from partial thickness burns. There are usually areas that are charred black or brown, or areas that are dry and white. The patient may complain of severe pain or, if enough nerves have been damaged, may not feel any pain at all (except at the periphery of the burn, where adjoining partial thickness burns may be causing pain).

Rule of Nines

For an adult, each of the following areas represents 9 percent of the body surface: head and neck, each upper extremity, chest, abdomen, upper back, lower back and buttocks, the front of each lower extremity, and the back of each lower extremity. These make up 99 percent of the body's surface. The remaining 1 percent is assigned to the genital region.

Rule of Palm

The rule of palm can be applied to any patient—infant, child, or adult. Since the palm and fingers of the hand equal about 1 percent of the body's surface area, mentally compare the patient's palm and fingers with the size of the burn to estimate its extent.

Dressing

Any material applied to a wound in an effort to control bleeding and prevent further contamination. Dressings should be sterile.

Bandage

Any material used to hold a dressing in place

Universal or Multitrauma Dressing

When bulk is required when a large wound must be covered. These dressings are especially useful for stabilizing impaled objects.

Pressure Dressing

used to control bleeding. Gauze pads are placed on the wound and a bulky dressing is placed over the pads.

Occlusive Dressing

Used when it is necessary to form an airtight seal. This is done when caring for open wounds to the abdomen, for external bleeding from large neck veins, and for open wounds to the chest. Sterile, commercially prepared occlusive dressings are available in two different forms: plastic wrap and petroleum gel-impregnated gauze occlusive dressings.

Hollow Organs (SLUGS)

stomach, large and small intestines, gallbladder, urinary bladder. Can absorb trauma very well

Solid Organs

Liver, Spleen, Pancreas, Kidneys. Can not absorb trauma well, and when punctured they can leak and infect the abdomen.

Flail Chest

fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment. leaves a portion of the chest wall unstable.

Paradoxical motion

The motion of the portion of the chest wall that is detached in a flail chest; the motion—in during inhalation, out during exhalation—is exactly the opposite of normal chest wall motion during breathing.

Pulmonary Contusions

Bruises of the lungs, due to chest trauma sometimes. Injures the lung tissue without lacerating it.

Hemoptysis

coughing up blood

Sucking Chest Wound

An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound.

Flutter Valve Dressing

An occlusive dressing with an opening, therefore air can get out but now get in.

Pneomothorax

Collection of air in the space around the lungs. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally does

Tension Pneumothorax

a type of pneumothorax in which air that enters the chest cavity puts pressure on the heart. This pressure compresses the heart and prevents it from filling. Can also cause a kinking effect on the venae cava.

Hemothorax

The pleural space in the chest cavity fills with blood

Hemopneumothorax

The chest cavity fills with both air and blood

Traumatic Asphyxia

Sudden compression of chest forcing blood out of organs and rupturing blood vessels

Neck and face are a darker color than rest of the body

May cause bulging eyes, distended neck veins, broken blood vessels in face

Cardiac Tamponade

When an injury to the heart causes blood to flow into the surrounding pericardial sac and to compress the heart, the condition produced is cardiac tamponade. The heart's unyielding sac fills with blood and compresses the chambers of the heart to a point where they will no longer adequately fill, backing up blood into the veins.

JVD

Shock Signs

Narrowed pulse pressure

Aortic Injury

Aorta is the largest blood vessel in the body

Penetrating trauma can cause direct damage

Blunt trauma can sever or tear the aorta

Damage can cause high-pressure bleeding; often fatal

Patient complains of pain in chest, abdomen, or back

Signs of shock

Differences in blood pressure between right and left arms

"Ripping" or "tearing" pain

Evisceration

The displacement of organs outside of the body.

peritonitis

inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it)

Signs of an abdominal injury

1. Pain, often starting as mild pain and then rapidly becoming intolerable

2. Cramps

3. Nausea

4. Weakness

5. Thirst

6. Obvious lacerations and puncture wounds to the abdomen

7. Lacerations and puncture wounds to the pelvis and middle and lower back, or chest wounds near the diaphragm

Indications of blunt trauma, such as a large bruised area or an intense bruise on the abdomen

8. Indications of developing shock, including restlessness; pale or grayish, cool, and clammy skin; rapid, shallow breathing; a rapid pulse; and low blood pressure (Sometimes patients with abdominal injuries who are in extreme pain show an initial elevated blood pressure.)

9. Coughing up or vomiting blood; the vomitus may contain a substance that looks like coffee grounds (partially digested blood)

10. Rigid and/or tender abdomen, which the patient tries to protect (guarded ab

moist vs dry occlusive dressing

Moist and Occlusive for abdominal eviscerations

Dry and Occlusives for open neck wounds and chest wounds