EMR: Test 4 (Chapter(s): 13, 26-32) Study Guide

Used guided notes from class to make this. Grade on Test (50 questions, 100 points): 92/100

What is the definition of shock?

**Inadequate cellular perfusion (hypoperfusion)**

Does low blood pressure mean a person is in shock?

**No; but low bp can lead to shock**

What does hypoperfusion mean?

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**Low levels of the blood being transported around so low levels of oxygen, nutrients**

Name 6 types of shock

1. Hypovolemic
2. Dissociative
3. Cardiogenic
4. Obstructive
5. Anaphylactic
6. Septic

Shock (x2): A blood problem

1. Hypovolemic
2. Dissociative

Hypovolemic: Description

**Result of an inadequate amount of fluid or volume in the circulatory system**

Hypovolemic: Causes

* Hemorrhagic causes and non-hemorrhagic causes
* Severe thermal burns
* Blood loss
* Diarrhea
* Vomiting
* Dehydration

Hypovolemic: BP, Respiration, HR, and Skin Changes

* BP: Decreases
* RR: Increases
* HR: Increases
* Skin: Pale, cool, clammy

Dissociative: Description

Mechanical obstruction that prevents an adequate volume of blood from filling the heart chambers; decreased airway to carry O2

Dissociative: Causes

* CO poisoning
* Cyanide poisoning
* Asphyxia
* Sickle cell anemia

Dissociative: BP, Respiration, HR, and Skin Changes

* BP: Decreases
* RRR Increases
* HR: Increases
* Skin: Rash, Hives, Pale, Blue, Flushed

Shock (x2): A heart problem

1. Cardiogenic
2. Obstructive

Cardiogenic: Description

When the heart cannot maintain sufficient output to meet the demands of the body; irregular/absent functioning of heart, causes poor circulation

Cardiogenic: Causes

* Inadequate function of the heart
* CHF
* Cardiac arrest
* Electrocution
* Overdose

Cardiogenic: BP, Respiration, HR, and Skin Changes

* BP: Decreases
* RR: Increases
* HR: Increases
* Skin: Gray, cool, pale, clammy

Obstructive: Description

Mechanical obstruction that prevents an adequate volume of blood from filling the heart chambers; physical obstruction in heart or coronary vessels

Obstructive: Causes

* Cardiac tamponade
* Tension pneumothorax
* Pulmonary embolism

Obstructive: BP, Respiration, HR, and Skin Changes

* BP: Decreases
* RR: Increases
* HR: Increases
* Skin: Cool, clammy, pale

Shock (x4): A blood vessel problem (Distributive)

1. Anaphylactic
2. Septic
3. Neurogenic
4. Psychogenic

Anaphylactic: Description

Shock caused by an allergic reaction

Anaphylactic: Causes

* Allergic reaction

Anaphylactic: BP, Respiration, HR, and Skin Changes

* BP: Decreases
* RR: Increases, decrease
* HR: Increases
* Skin: Blue, flushed, itchy

Septic: Description

Widespread dilation of vessels, in combination with plasma loss through the vessel walls, results in shock; whole body infection

Septic: Causes

* Infections (bacteria or body tissues)

Septic: BP, Respiration, HR, and Skin Changes

* BP: Decreases
* RR: Increases
* HR: Increases
* Skin: Rash, Fever

Neurogenic: Description

* Nerve impulses to blood vessels below the level of the injury are blocked
* All vessels cut off from nerve impulses will dilate, causing the blood to pool

Neurogenic: Causes

* High spinal-cord injury

Neurogenic: BP, Respiration, HR, and Skin Changes\*

* BP: Decreases
* RR: Increases
* HR: Decreases
* Skin: Flushed, Warm Skin → Cold/Clammy

Perfusion Triangle

HR: UP

BP: DOWN

RR: IRREGULAR

List some possible ways to treat shock: 

* Providing oxygen
* Keeping the patient warm
* Follow standard precautions
* Control all obvious bleeding
* Make sure the patient has an open airway
* Maintain manual in-line stabilization if necessary, and check breathing and pulse
* High-flow oxygen to assist in perfusion
* Hypoperfusion; treat aggressively and transport

If you do these things, you have treated shock:

* OXYGEN
* SUPINE
* BLANKET
* TRANSPORT

Compensated Shock: Description

early stages when the body can still compensate for blood loss (bp is normal)

Compensated Shock: signs/symptoms

* Anxiety
* The feeling of impending doom
* Weak, thready, rapid pulse
* Clammy (pale, cool, moist)!!!
* Capillary refill is +2 seconds
* Thirsty
* Bp isn’t low, but getting closer together (narrowing)

Decompensated Shock: Description

**stage when bp is falling (lower bp; irregular breathing; sweat/pale/blue)**

Decompensated Shock: signs/symptoms

* Falling bp (below 100)
* Decline mental status
* Labor breathe
* Thready, absent pulse
* Dull eye, dilated pupils

Irreversible Shock: Description

no way to assess when effects are irreversible in the field; must recognize and treat shock early (really low bp (50); stop breathing)

How is shock different for children?

**- BP IS THE LAST MEASURABLE FACTOR -**

* Children in shock, bp drops = death (fast)
* Adults decline “steady”

Expect Shock if they have the following conditions: 

* Multiple severe fractures
* Abdominal or chest injury
* Spinal injury
* Severe infection
* Major heart attack
* Anaphylaxis

What are the two types of bleeding?

External and/or internal

What are three things bleeding can cause?

Weakness, shock, and/or death

What are the three most important things that blood delivers to the cells?

Oxygen, water, glucose

How much ATP is created with anaerobic respiration? And with aerobic respiration?

Anaerobic- 2 ATP, Aerobic- 36 ATP

What is the definition of perfusion?

The circulation of blood within an organ or tissue to meet the cells’ needs for oxygen, nutrients, and waste removal

What is the definition of shock

A life-threatening condition that occurs when the body is not getting enough blood flow

What are the three types of blood cells are there and what’s their overall function?

1. White blood cells: fighting infection
2. Red blood cells: transport oxygen
3. Platelets: clot blood

Describe three differences between arteries and veins.

1. Veins: have valves, smaller, go back to the heart
2. Arteries: no valves, bigger, higher pressure, goes out to the body

Describe the differences between arteries and arterioles.

1. Arteries: carry blood away from the heart
2. Arterioles: smaller vessels that connect the arteries and capillaries

What happens between the capillaries and cells?

Capillaries: pass among all the cells and link arterioles and venules, cells: building blocks of body

What is the difference between venules and veins?

1. Venules: very small, thin-walled vessels that empty into the veins
2. Veins: carry blood from the tissues to the heart

What is the role of the autonomic nervous system?

* Monitors the body’s needs
* Adjusts blood flow
* Automatically redirects blood away from other organs to the heart, brain, lungs, and kidneys in an emergency
* Adapts to maintain homeostasis and perfusion

What does this system do with blood in an emergency situation?

Moves the blood to the most important organs

External bleeding = _____

visible hemorrhage

How much blood loss can the body tolerate before shutting down?

Body will not tolerate a blood loss greater than 20% of blood volume

How do vital signs change with external blood loss? (HR, RR, BP)

1. Increase in heart rate
2. Increase in respiratory rate
3. Decrease in blood pressure

What does an arterial bleed look like?

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

What does bleeding from a vein look like? 

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

What does a capillary bleed look like?

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

What is a normal clotting time?

Within 10 minutes

How does a clot form?

When tissues are injured, platelets begin to collect at the site of injury → Red blood cells become sticky and clump together

What is hemophilia and how does it affect clotting?

Patient lacks blood-clotting factors; injuries may become serious (no matter how minor)

What does an anticoagulant do and how does it affect bleeding?

Thins the blood; a substance that is used to prevent and treat blood clots in blood vessels and the heart

Name two blood thinners.

1. Warfarin
2. Coumadin

What are four possible causes of internal bleeding?

1. Bleeding ulcers
2. Bleeding from colon
3. Ruptured ectopic pregnancy
4. Aneurysms

Melena is a sign of internal bleeding. What is this?

Dark sticky feces containing partly digested blood

What is another sign of internal bleeding?

* **Pain (most common)**
* **Swelling in the area of bleeding**
* **Distention**
* **Dyspnea, tachycardia, hypotension**
* **Hematoma**
* **Bruising**
* **Pain, tenderness, bruising, guarding, or swelling**
* **Broken ribs**
* **Bruises over the lower part of the chest**
* **Rigid, distended abdomen**

Trauma from a fall is considered anything __ feet taller than the patient.

3

Cushing's triad

increase in intracranial pressure (ICP) *opposite of shock*\*

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BP: INCREASE

HR: DECREASE

RR: DECREASE

List five examples of soft tissues found in the body

Muscles, fat, blood vessels, nerves, tendons, tissues

Functions of the skin

Body’s first line of defense, sensory organ, helps body regulate temperature, and helps maintain fluid balance

Wounds are classified as either __ or __

open; closed

Definition of a closed wound

Define Contusion

A contusion causes bleeding beneath the skin but does not break the skin

Define Hematoma

Blood collected within damaged tissue or in a body cavity

Define Crush/Blunt trauma

A significant amount of force is applied to the body

Define Blast injury

Direct or indirect exposure to an explosion

Bruising shows what in an injury?

Bleeding blood vessels

What does MOI stand for?

Mechanism of injury

Definition of an open wound

Injury that breaks through the skin

Five types of open wounds

Abrasions, lacerations, avulsions, penetrating wounds, amputation

Abrasions and Lacerations Treatment

Control bleeding using direct, even pressure and elevation, pressure dressings and/or splints, and tourniquets

Penetration Treatment

An injury resulting from a piercing object- secure it with gaze

Impaled Object Treatment

Remove an impaled object only when the object is  in the cheek or mouth and obstructs the airway or the object is in the chest and interferes with CPR

Avulsion Treatment

Address bleeding, place flap back in place if possible, bandage if needed

Amputation Treatment

Address bleeding, find amputation and place in bag, place that bag in ice, should not be water/ice directly on the body part

Three types of burns and the differences between them all

1. First degree- superficial burns.
2. Second-degree- partial thickness, affects the epidermis and the dermis.
3. Third degree- full thickness, goes through the dermis and deeper tissues (thermal bur, chemical bur, and inhaled burn).

Rule of 9’s: face, stomach, arm, legs

Face- 9, stomach- 18, each arm- 9, legs- 18 each.

The palm of the hand equals what percentage of the body surface burned? 

1%

Three types of chemicals that could burn your skin.

1. alkaline
2. acid
3. bleach

Chemical Burn Treatment

flush the skin

Definition of a dressing

A piece of material placed on a wound to protect it

Definition of a bandage

 A strip of material used to bind a wound or to protect an injured part of the body

What structures are located in/and or attached to the skull?

**Brain, spinal cord, vertebrae**

What may a depression in the skull indicate?

Skull fracture, brain injury

What structures are in the neck?

Carotid arteries, jugular veins, esophagus, trachea, larynx

What is in the vertebrae and what nerves are located there?

Spinal cord; afferent and efferent nerves

List all the structures that light passes through for vision

Conjunctiva, cornea, pupil, lens, vitreous humor, retina, optic nerve

What does the iris do when a bright light is shined on it?

Constrict

What is located at the back of the eye that is essential for sight?

Optic nerve

Name five different causes of facial damage.

Blood clots, heavy bleeding, direct injuries, dislodged teeth/dentures in the throat

What does Battle Sign look like? What does it show?

Heavy bruising behind the ears; fracture of medial cranial, major sign of head trauma