EMT Ch. 26- Bleeding

w/o adequate perfusion, cells in the brain/spinal cord begin to die after ___

4-6 min

w/o adequate perfusion, lungs begin to die after ___

15-20 min

w/o adequate perfusion, kidneys begin to die after ___

45 min

w/o adequate perfusion, skeletal muscle begins to die after ___

2-3 hrs

average total blood volume in adults

6 L (10-12 pints)

the body cannot tolerate an acute blood loss of more than ___ of its total blood volume

20%

characteristics of severe external bleeding

• poor general appearance

• no response to external stimuli

• signs/symptoms of shock

• significant amount of blood loss is noted

• blood loss is rapid/ongoing

• bleeding cannot be controlled

• bleeding is associated w/ significant MOI

arterial bleeding

• bright red blood from open artery

• spurts in time w/ pulse

• difficult to control

• causes BP to drop & decreases spurting

venous bleeding

• dark red blood from open vein

• flow rate depends on size of vein

• does not spurt, easier to manage

capillary bleeding

• dark red blood from damaged capillary vessels

• oozes from wound steadily/slowly

• more likely to clot

hemophilia

• condition where individual lacks 1+ of blood’s clotting factors

• bleeding may occur spontaneously

common signs of nontraumatic internal bleeding

abdominal

• tenderness

• guarding

• rigidity

• pain

• distention

in older pts, dizziness, faintness, weakness

signs/symptoms of closed fracture bleeds

• pain

• tenderness

• bruising

• guarding

• swelling

signs/symptoms of lacerated spleen/liver

• broken ribs

• bruises over lower chest

• rigid/distended abdomen

• referred pain in right shoulder (liver)

• referred pain in left shoulder (spleen)

later signs of hypovolemic shock suggesting internal bleeding:

• tachycardia

• weakness, fainting, dizziness at rest

• thirst

• nausea/vomiting

• cold, moist skin

• shallow, rapid breathing

• dull eyes

• slightly dilated pupils slow to respond to light

• capillary refill longer than 2 sec in peds

• weak, rapid pulse

• decreasing BP

• altered LOC

precautions for applying tourniquets

• do not apply directly over joint

• place proximal to injury

• if tourniquet does not immediately control bleeding, apply second one adjacent to first

• make sure tourniquet is tightened securely

• never use wire, rope, a belt, other narrow material that can cut skin

• if possible, consider placing padding under tourniquet as applying to protect skin & help w/ atrial compression

• never cover w/ bandage

• do not loosen tourniquet after application unless directed by med control

• mark application time on tourniquet & communicate time, site, & rationale for application

junctional tourniquet

• controls life-threatening bleeds in areas where standard tourniquet application is not possible (groin, axilla)

• may be indicated for severe hemorrhage at junction of torso w/ arms or legs

causes of bleeding from nose, ears, mouth

• fracture of base of skull

• facial injuries

• sinusitis infections, nose drop use/abuse, dried/cracked nasal mucosa, intranasal use of street drugs

• high BP

• coagulation disorders

• digital trauma (nose picking)

• cancer

true/false: do not attempt to stop bleeding from nose/ears caused by skull fractures

true

Capillaries link the arterioles & the:

venules

The smaller vessels that carry blood away from the heart & connect the arteries to the capillaries are called the:

arterioles

Blood stasis, changes in the vessel wall, & certain medications affect the:

ability of the blood to effectively clot

Which of the following occurs after tissues are injured?

Platelets collect at the injury site

An organ or tissue might better resist damage from hypoperfusion if the:

body's temperature is considerably less than 98.6°F (37.0°C)

Significant vital sign changes will occur if the typical adult acutely loses more than ______ of his or her total blood volume.

20%

An infant with a total blood volume of 800 mL would start showing signs of shock when as little as ______ of blood is lost.

100 mL

The severity of bleeding should be based on all of the following findings, except:

systolic blood pressure

In which of the following situations would external bleeding be the most difficult to control?

Femoral artery laceration & a blood pressure of 140/90 mm Hg

Which of the following statements regarding the clotting of blood is correct?

A person taking blood thinners will experience slower blood clotting

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

1 L

In older patients, the first indicator of nontraumatic internal bleeding might be:

weakness or dizziness

Early signs & symptoms of intra-abdominal bleeding include:

pain & distention

A 67-year-old male presents with weakness, dizziness, & melena that began approximately two days ago. He denies a history of trauma. His blood pressure is 90/50 mm Hg & his pulse is 120 beats/min & thready. You should be most suspicious that this patient is experiencing:

gastrointestinal bleeding

Gastrointestinal bleeding should be suspected if a patient presents with:

hematemesis

A 22-year-old male was kicked in the abdomen multiple times during an assault. He is conscious but restless & his pulse is rapid. His skin is cold & moist. Your assessment reveals a large area of bruising to the right upper quadrant of his abdomen. The most appropriate treatment for this patient includes:

preparing for immediate transport

After blunt trauma to the abdomen, a 21-year-old female complains of diffuse abdominal pain & pain to the left shoulder. Your assessment reveals that her abdomen is distended & tender to palpation. On the basis of these findings, you should be most suspicious of injury to the:

spleen

In nontrauma patients, an early indicator of internal bleeding is:

dizziness upon standing

A young male was shot in the abdomen by an unknown type of gun. Law enforcement personnel have ensured that the scene is safe. The patient is semiconscious, has shallow breathing, & is bleeding externally from the wound. As you control the external bleeding, your partner should:

assist the patient's ventilations

A 39-year-old male sustained a large laceration to his leg during an accident with a chainsaw & is experiencing signs & symptoms of shock. You should first:

apply direct pressure to the wound

Most cases of external bleeding from an extremity can be controlled by:

applying local direct pressure

If direct pressure fails to immediately stop severe bleeding from an extremity, you should apply:

a tourniquet proximal to the injury

Regardless of the type of tourniquet used, it is important to remember that:

the tourniquet should only be removed at the hospital because bleeding might return if the tourniquet is released

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

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

the patient is at risk for vomiting & aspiration

Bleeding from the nose following head trauma:

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

Which of the following findings would be the most significant when assessing a patient with possible internal bleeding?

The patient takes rivaroxaban (Xarelto)

A patient is bleeding severely from a severed femoral artery high in the groin region. Which of the following would most likely control the bleeding?

Apply a topical hemostatic agent with direct pressure

A 70-year-old man presents with a severe nosebleed. His medical history includes chronic obstructive pulmonary disease, depression, & a hemorrhagic stroke three years ago. His BP is 190/110 mm Hg, his pulse is 100 beats/min, & his respirations are 24 breaths/min. His medications include albuterol, sertraline (Zoloft), & multivitamins. Which of the following is most likely causing his nosebleed today?

High blood pressure

Internal bleeding into a fractured extremity is most often controlled by:

splinting the extremity