EMT Chapter 26*30 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; Smaller vessels that connect the arteries and 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; Pass among all the cells and link arterioles and venules

Coagulation

The formation of clots to plug openings in injured blood vessels and stop blood flow.

Contusion

A bruise form an injury that causes bleeding beneath the skin without breaking the skin; also see ecchymosis

Ecchymosis

A buildup of blood beneath the skin that produces a characteristic blue or black discoloration as the result of an injury; also see contusion; bruising, cappillary bleeding

Epistaxis

nosebleed (a common emergency)

hematemesis

vomiting blood

Hematoma

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

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

coughing up 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; also called 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; allow for compression of life-threatening bleeding in areas where standard tourniquet application is not possible

Melena

black, tarry stools; feces 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 to provide necessary oxygen and nutrients and to remove waste. It meets the needs of the cell

Shock

A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypoperfusion.

tourniquet

The bleeding control method used when a wound continues to bleed despite the use of direct pressure and elevation; useful if a patient is bleeding severely from a partial or complete amputation.

Vadodilation

widening of blood vessels

vasoconstriction

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

Veins

The blood vessels that carry blood from the tissues of the heart

Venules

Very small, thin-walled blood vessels that empty into the veins

The cardiovascular system

circulates blood to cells and tissues

Cardiovascular System 3 parts

Pump (heart), Container (blood vessels), Fluid (blood and body fluids)

Works as two paired pumps

Upper chamber (atrium); Lower chamber (ventricle)

Blood leaves each chamber through

a one-way valve

Right side receives __ blood from veins

oxygen-poor

Left side supplies __ blood to arteries

oxygen-rich

Arteries

Carry blood away from the heart

Blood contains

Red blood cells, White blood cells, Platelets, Plasma

Red blood cells

Responsible for the transportation of oxygen to the cells and carbon dioxide away from the cells to the lungs

White blood cells

Responsible for fighting infection

Platelets

Responsible for forming blood clots

Blood clot formation depends on

Blood stasis, Changes in the blood vessel walls, Blood’s ability to clot

When tissues are injured, platelets begin to collect at the site of injury

Red blood cells to become sticky and clump together

Autonomic Nervous System

Automatically redirects blood away from other organs to the heart, brain, lungs, and kidneys in an emergency (Called fight or flight reaction)

Blood enters an organ or tissue first through the

arteries, then arterioles, and finally capillary beds

Speed of blood flow

Fast enough to maintain circulation; Slow enough to allow cells to exchange oxygen and nutrients for carbon dioxide and waste

Some tissues need

a constant supply of blood, while others can survive with very little

Body will not tolerate a blood loss greater than

20% of blood volume (typical adult is 1 liter)

Changes in vital signs may occur with significant blood loss

Increase in heart rate, Increase in respiratory rate, Decrease in blood pressure

How well people compensate for blood loss is related to

how rapidly they bleed

Signs and symptoms of shock

Low BP, tachycardia, AMS

Arterial bleeding

Pressure causes blood to spurt and makes bleeding difficult to control; Typically brighter red and spurts in time with the pulse

Venous bleeding

Dark red, flows slowly or rapidly depending on the size of the vein; Does not spurt and is easier to manage

Capillary bleeding

Bleeding from damaged capillary vessels; Dark red, oozes steadily but slowly

Bleeding tends to stop rather quickly, within about 10 minutes

When skin is broken, blood flows rapidly until the ends of the cut vessel constrict and a clot forms; Bleeding will not stop if a clot does not form

Some medications interfere with clotting

Aspirin, non-steroidal anti-inflammatory meds like ibuprofen, Aleve, Motrin, etc; Blood thinners such as Plavix, Coumadin

Patients with hemophilia lack clotting factors

Hereditary condition only in males

Hemophilia Patient

lacks blood-clotting factors

Internal Bleeding

Bleeding in a cavity or space inside the body

Possible conditions causing internal bleeding

Stomach ulcer, Lacerated liver, Ruptured spleen, Broken bones, especially ribs or femur, Pelvic fracture

High-energy MOI

Should increase your index of suspicion for serious unseen injuries

DECAP-BTLS

Deformities, Contusions, Abrasions, Punctures/penetrations, Burns, Tenderness, Lacerations, Swelling

Internal bleeding is not always caused by

trauma

Signs and Symptoms of Internal Bleeding Hypoperfusion

Change in mental status, Weakness, faintness, or dizziness on standing, Changes in skin color or pallor (pale skin)

Signs and Symptoms of Internal Bleeding Later signs of hypoperfusion

Tachycardia, Weakness, fainting, or dizziness at rest, Thirst, nausea and vomiting, Cold, moist (clammy) skin, Shallow, rapid breathing, Dull eyes, slightly dilated pupils, Capillary refill of more than 2 seconds in infants and children, Weak, rapid (thready) pulse, Decreasing blood pressure, Altered level of consciousness

Never use a tourniquet to control bleeding from

closed, internal injuries

Do not be distracted from identifying life threats

Sometimes bleeding may need to be controlled even before airway is secured (Arterial bleeds)

Transport rapidly if

Airway or breathing problems, Significant bleeding, Signs symptoms of internal bleeding

Transport but Also watch for

Tachycardia or tachypnea, Low blood pressure, Weak pulse, Clammy skin

With a critically injured patient or a short transport time

there may not be time to conduct a secondary assessment

Direct Pressure

Most common and effective way to control external bleeding

Pressure Dressing

Stretch the band tight enough to control bleeding (You should still be able to palpate a distal pulse)

Tourniquets

If direct pressure fails, apply this above level of bleeding

Always place the tourniquet

proximal to the injury

Do not apply a tourniquet directly over any joint

Always go above joint

Once applied write “TK” and

exact time that you applied tourniquet on piece of tape, stick to patients forehead (Can also write directly on pt’s forehead with marker)

Only the ER doctor or surgeon can undo

a tourniquet after it is applied

Air splints

Soft splints or pressure splints; Can control internal or external bleeding associated with severe injuries; Immobilize fractures; Act like a pressure dressing; Use only approved,zclean, or disposable valve stems

Pelvic binder

A type of splint that may be indicated for a suspected closed unstable pelvic fracture; Helps to control internal bleeding

Rigid splints

Will help immobilize fractures; Reduce pain; Prevent further damage to soft-tissue injuries; Once the splint is applied, monitor circulation in the distal extremity

Traction splints

Designed to stabilize femur fractures; When the EMT pulls traction to the ankle, counter-traction is applied to the ischium and groin; once the splint is applied, monitor circulation in the distal extremity

Facial bleeding poses risk to airway

always position patient correctly and suction

Bleeding from the nose or ears following a head injury

Do not attempt to stop blood flow/ Apply light compression with a dressing

Amputations

Severing of a body part from the body

Which of the following is NOT a component of the cardiovascular system?

Lungs

Perfusion is MOST accurately defined as

circulation of blood within an organ with sufficient amounts of oxygen

A man involved in a motorcycle crash has multiple abrasions and lacerations. Which of the following injuries has the HIGHEST treatment priority?

1-inch laceration to the thigh with spurting, bright red blood

Which of the following sets of vital signs is LEAST indicative of internal bleeding?

BP, 140/90 mm Hg; pulse rate, 58 beats/min; respirations, 8 breaths/min

When caring for a patient with internal bleeding, the EMT must first

take appropriate standard precautions

The quickest and MOST effective way to control external bleeding from an extremity is

direct pressure and elevation

When applying a tourniquet to an amputated arm, the EMT should

avoid applying the tourniquet over a joint

A 70-year-old man is experiencing a severe nosebleed. When you arrive, you find him leaning over a basin, which contains an impressive amount of blood. He has a history of coronary artery disease, diabetes, and migraine headaches. His BP is 180/100 and his heart rate is 100 beats/min. Which of the following is the MOST likely contributing factor to his nosebleed?

His blood pressure

When caring for a patient with severe epistaxis, the MOST effective way to prevent aspiration of blood is to

tilt the patient’s head forward while he or she is leaning forward

Controlling internal bleeding requires

surgery in a hospital

You arrive at home of a 50 year old female with severe epistaxis. As you are treating her, it is most important to recall

the patient is at risk for vomiting and aspiration

Hypoperfusion is another name for

shock

A fractured femur can result in the loss of _ or more blood into the soft tissues of the thigh

1 L

Which of the following splinting devices would be most appropriate to use for a patient who has an open fracture of the forearm with external bleeding?

air splint

Hypovolemic shock occurs when

low fluid volume leads to inadequate perfusion

Bleeding from the nose following head trauma

is a sign of a skull fracture and should not be stopped

Which of the following occurs after tissues are injured?

platelets collect at the injury site

Which of the following statements regarding hemophilia is correct?

patients with this might bleed spontaneously