Blood Volume and Management Quiz
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Questions and Answers

What is the average blood volume in an adult male body per kilogram of body weight?

  • 75 mL
  • 80 mL
  • 65 mL
  • 70 mL (correct)

    • The body can tolerate an acute loss of more than 20% of its total blood volume.

    False

    What effect does losing more than 1 litre of blood have on an adult?

    Significant changes in vital signs including increased heart and respiratory rates and decreased blood pressure.

    An adult female body contains approximately ___ mL of blood per kilogram of body weight.

    <p>65</p> Signup and view all the answers

    Match the following blood volume amounts with the appropriate demographics:

    <p>Adult Male = 70 mL/kg Adult Female = 65 mL/kg Infants = Less blood volume than adults Children = Less blood volume than adults</p> Signup and view all the answers

    What happens if a healthy adult loses blood rapidly?

    <p>They may develop hypovolemic shock.</p> Signup and view all the answers

    If significant bleeding occurs due to a pelvic fracture, applying external circumferential pressure of a pelvic binder may help control the massive bleeding that accompanies a ___ fracture.

    <p>pelvic</p> Signup and view all the answers

    What is one function of hemostatic agents?

    <p>They enhance clot formation at the wound site.</p> Signup and view all the answers

    What is necessary for blood loss management in the prehospital setting?

    <p>Rapid transport.</p> Signup and view all the answers

    Wound packing has not been effective for civilian EMS.

    <p>False</p> Signup and view all the answers

    What is the primary purpose of a tourniquet?

    <p>To control bleeding from partial or complete amputation.</p> Signup and view all the answers

    A tourniquet should never be applied directly over a ______.

    <p>joint</p> Signup and view all the answers

    Match the following terms with their descriptions:

    <p>Hemostatic agents = Enhance clot formation at wound site Wound packing = Used for junctional bleeding control Tourniquets = Control bleeding from limbs with severe injuries Gauze = Used to fill and pack a wound cavity</p> Signup and view all the answers

    Which of the following is a guideline for applying a tourniquet?

    <p>Use the widest bandage possible.</p> Signup and view all the answers

    Wound packing is particularly useful for bleeding in joint areas.

    <p>False</p> Signup and view all the answers

    What should be done to manage the source of bleeding in wound packing?

    <p>Push gauze into the wound to contact the source of bleeding.</p> Signup and view all the answers

    What is one of the primary effects of norepinephrine?

    <p>Increased peripheral vascular resistance</p> Signup and view all the answers

    The body’s compensatory mechanisms continue to function effectively even as hypoperfusion persists.

    <p>False</p> Signup and view all the answers

    What metabolic change occurs when the cellular oxygen supply is inadequate?

    <p>Anaerobic metabolism</p> Signup and view all the answers

    As myocardial oxygen demand increases during hypoperfusion, the body's compensatory mechanisms _____.

    <p>fail</p> Signup and view all the answers

    Match the following conditions with their outcomes:

    <p>Inadequate oxygen delivery = Anaerobic metabolism Increased catecholamines = Elevated blood glucose levels Cellular edema = Release of lysosomal enzymes Vasoconstriction = Increased peripheral vascular resistance</p> Signup and view all the answers

    Which of the following is a result of impaired cellular metabolism?

    <p>Decreased oxygen affinity for hemoglobin</p> Signup and view all the answers

    Fluid leaking from blood vessels is a sign of adequate perfusion.

    <p>False</p> Signup and view all the answers

    The term _____ hour of trauma is critical in emergency medicine, emphasizing timely intervention.

    <p>Golden</p> Signup and view all the answers

    What is a common type of distributive shock characterized by a widespread infection?

    <p>Septic shock</p> Signup and view all the answers

    Neurogenic shock can result from a spinal cord injury.

    <p>True</p> Signup and view all the answers

    What physiological response is primarily affected in patients experiencing neurogenic shock?

    <p>Vasodilation</p> Signup and view all the answers

    In distributive shock, circulating blood volume pools in the __________ vessels.

    <p>expanded vascular</p> Signup and view all the answers

    Match the types of shock with their descriptions:

    <p>Septic shock = Resulting from widespread infection and low blood pressure Neurogenic shock = Results from spinal cord injury causing vasodilation Anaphylactic shock = Severe allergic reaction leading to vasodilation Hypovolemic shock = Resulting from low blood volume and inadequate perfusion</p> Signup and view all the answers

    Which of the following is NOT a common type of distributive shock?

    <p>Hypovolemic shock</p> Signup and view all the answers

    A patient in neurogenic shock typically exhibits cold and clammy skin.

    <p>False</p> Signup and view all the answers

    What is a potential outcome of untreated septic shock?

    <p>Multiple-organ dysfunction syndrome</p> Signup and view all the answers

    What is the best indicator of tissue perfusion during the compensated phase of shock?

    <p>Level of responsiveness</p> Signup and view all the answers

    Blood pressure is typically maintained during the decompensated phase of shock.

    <p>False</p> Signup and view all the answers

    What percentage of blood loss can be estimated during hemorrhagic shock in the compensated phase?

    <p>15% to 30%</p> Signup and view all the answers

    During the compensated phase of shock, the body can still _____ for blood loss.

    <p>compensate</p> Signup and view all the answers

    Match the following characteristics with the appropriate phase of shock:

    <p>Compensated Phase = Level of responsiveness is the best indicator Decompensated Phase = Skin becomes mottled and pupils dilate</p> Signup and view all the answers

    What type of test result may be positive during the compensated phase of shock?

    <p>Orthostatic tilt test</p> Signup and view all the answers

    Treatment during the compensated phase of shock will sometimes result in recovery.

    <p>True</p> Signup and view all the answers

    What happens to the cardiac output during the decompensated phase of shock?

    <p>It falls dramatically.</p> Signup and view all the answers

    What is one of the earliest signs of shock in a patient?

    <p>Restlessness and anxiety</p> Signup and view all the answers

    Falling blood pressure is an early sign of shock.

    <p>False</p> Signup and view all the answers

    What is the best indication of brain perfusion?

    <p>The state of consciousness</p> Signup and view all the answers

    If a patient is poorly perfused, the kidneys may _____ shut down.

    <p>shut down</p> Signup and view all the answers

    What happens to the heart rate when tissue perfusion decreases?

    <p>It speeds up</p> Signup and view all the answers

    Match the symptoms of hypovolemic shock with their descriptions:

    <p>Pale skin = Indicates vasoconstriction and reduced blood flow Increased thirst = A response to dehydration Cool, clammy skin = Associated with reduced perfusion and anxiety Nausea = Can occur due to reduced blood flow to the digestive system</p> Signup and view all the answers

    What is one method to assess kidney perfusion in a prehospital setting?

    <p>Capillary refill</p> Signup and view all the answers

    As bleeding continues, the _____ constricts to help maintain blood pressure.

    <p>arteries</p> Signup and view all the answers

    Study Notes

    Introduction

    • Paramedics are shifting their focus away from airway management to bleeding
    • Bleeding is now recognized as a critical, time-sensitive condition that can lead to shock
    • Shock is a state of collapse and failure of the cardiovascular system, leading to inadequate tissue perfusion
    • Untreated shock can damage vital organs and cause death

    Anatomy and Physiology of the Cardiovascular System

    • The cardiovascular system's crucial function is maintaining blood flow carrying oxygen to the tissues and waste products away
    • In the lungs, blood releases carbon dioxide and picks up oxygen
    • In the peripheral tissues, blood unloads oxygen and picks up waste products
    • Disruption or slowing of blood flow disrupts oxygen delivery
    • Emergency metabolic system (which does not require oxygen) produces toxic metabolic waste

    Anatomy and Physiology of the Heart

    • The heart is a muscular cone-shaped organ located behind the sternum
    • It's roughly the size of a closed fist and weighs between 280-350g in men and 225-280g in women
    • The heart has four chambers: two atria and two ventricles
    • The atria receive deoxygenated blood from the body, and the ventricles pump blood out to the body and lungs
    • Atrioventricular and semilunar valves regulate blood flow within the heart

    Blood Flow Within the Heart

    • Pathways of blood flow through the heart
    • Superior and inferior vena cava bring deoxygenated blood to the right atrium
    • Blood travels through the tricuspid valve to the right ventricle
    • The right ventricle pumps blood through the pulmonic valve to the lungs
    • The lungs oxygenate the blood, and the freshly oxygenated blood returns to the left atrium via the pulmonary veins
    • Blood passes through the mitral valve into the left ventricle
    • The left ventricle pumps oxygenated blood through the aortic valve into the aorta to the rest of the body

    The Cardiac Cycle

    • The repeating pumping process of the heart
    • Begins with the contraction of cardiac muscle and ends before the next contraction
    • Factors like stroke volume and heart rate influence cardiac output, impacting oxygen delivery to tissues
    • Increased venous return stretches the ventricles, leading to increased cardiac contractility (Starling's Law of the Heart)
    • Ejection fraction, the percentage of blood pumped per contraction, maintains normal cardiac function

    Blood and its Components

    • Blood is composed of plasma and formed elements (cells)
    • Plasma is a watery fluid containing 92% water and dissolved substances (8% dissolved substances)
    • Red blood cells (erythrocytes) are disc-shaped, most numerous, contain hemoglobin to carry oxygen, and are responsible for the reddish color
    • White blood cells (leukocytes) are crucial for fighting infections
    • Platelets are essential for clot formation

    Blood Circulation and Perfusion

    • Blood vessels, including arteries, veins, arterioles, and capillaries, form the circulatory system
    • Perfusion is the circulation of blood in sufficient amounts to meet the cells' needs
    • Blood must travel at a sufficient but not overwhelming speed to allow cells to exchange oxygen and nutrients.

    Autonomic Nervous System

    • Continuously monitors the body's needs
    • Can redirect blood flow during emergencies, prioritizing critical organs (heart, brain, lungs, kidneys)

    Perfusion Needs

    • Continuous blood flow is crucial, especially for the heart and spinal cord.
    • Kidneys and skeletal muscles require perfusion for optimal performance.
    • The time organs can handle inadequate perfusion depends on factors like organ location and temperature.

    Pathophysiology of Hemorrhage

    • Hemorrhage refers to bleeding, ranging from minor wounds to severe internal bleeding.
    • External bleeding typically occurs when skin is broken. Capillary bleeding seeps; venous flows, and arterial spurts.
    • Internal bleeding, often less visible but equally dangerous, can originate from various causes.

    External Hemorrhage

    • External bleeding occurs when skin is broken.
    • Severity and type of wound impact bleeding.
    • Artery bleeding typically spurts; venous flows, and capillary oozes.
    • Other injuries can worsen bleeding.

    Internal Hemorrhage

    • Internal bleeding is less visible bleeding.
    • Trauma is a common cause.
    • Locations like the digestive tract, ruptured ectopic pregnancies, and abdominal aneurysms are locations to consider
    • Treatment involves prompt action, focusing on shock treatment and quick transport to hospitals.

    Controlled Versus Uncontrolled Hemorrhage

    • External bleeding is typically controlled with direct pressure and elevation.
    • Arterial bleeding requires more time to clot. Tourniquets are used for controlled bleeding when direct pressure doesn't work
    • Internal bleeding usually needs rapid transportation for treatment

    The Significance of Bleeding

    • Determining the amount of blood lost is difficult; location influences visual perception.
    • Adults lose 70-65mL/kg of blood according to gender and weigh.
    • Blood loss over 20% body volume is serious and requires prompt medical attention
    • Rate of loss impacts the severity of symptoms.

    Physiologic Response to Hemorrhage

    • There are three major types of bleeding to consider: arterial, venous, and capillary
    • Different reactions occur based on the bleeding type.
    • Blood flow is controlled by the hemostatic system, which can fail in certain situations.
    • Internal clotting mechanisms or exposure to air will stop bleeding.
    • Capillary and microcirculatory levels
    • Declining perfusion decreases oxygen delivery to cells
    • Cellular metabolism shifts from aerobic to anaerobic.
    • Acidity accumulates and damages tissue, leading to the final phase of shock

    Systemic Inflammatory Response Syndrome (SIRS)

    • A condition triggered by severe clinical insults.
    • Manifested by certain temperature, heart rate, respiratory rate and white blood cell counts.
    • Cytokines are central mediators in the development of SIRS.
    • Specific organs and systems affected (cardiovascular, respiratory, central nervous, renal, liver and gastrointestinal) can all be impacted and have abnormalities, like low perfusion pressure, tachycardia and hypotension, tachypnea, decreased/absent reflexes, impaired/absent sensations under the injury site.
    • Uncontrolled SIRS can progress to multiple organ dysfunction syndrome (MODS), potentially resulting in death

    Phases of Shock

    • Shock has three stages: compensated, decompensated, and irreversible.
    • Compensated shock: body can still compensate for blood loss, blood pressure maintained
    • Decompensated shock: blood pressure falls, body's compensatory mechanisms fail
    • Irreversible shock: significant organ damage, and medical intervention may not be sufficient to reverse the condition

    The Clinical Picture of Hypovolemic Shock

    • Early signs include restlessness, anxiety, and a scared look.
    • Late signs include a decline in tissue perfusion.
    • Dehydrated patients often display pale, cool, clammy skin.

    Treatment of a Patient With Suspected Shock

    • Airway and ventilation support is paramount
    • High-flow supplemental oxygen is used.
    • Any external bleeding must be quickly controlled
    • Large-bore IV lines and crystalloid fluid challenge
    • Rapid transport and appropriate medical centers can be crucial

    IV Therapy

    • IV fluids are inserted for immediate fluid replacement
    • Various fluid types and rates of infusion are based on the suspected cause/issue of shock.
    • Volume expanders and plasma substitutes to replenish lost fluids.

    Management of Specific Types of Shock

    • Hypovolemic shock management priorities are controlling bleeding, establishing an open airway and keeping the patient warm.
    • Cardiogenic shock treatment should be time sensitive.
    • Neurogenic shock requires immobilization and warm fluids.
    • Anaphylactic shock management includes removing the cause and administering epinephrine, and bronchodilators.
    • Use of medical directives and protocols are vital

    Transportation of Patients With Suspected Shock

    • Assessing the need for prompt transport for suspected shock patients, prioritizing those with severe internal bleeding, or those in cardiogenic shock, is crucial

    Prevention Strategies

    • Preventing shock incidents by following safety measures, and assessing the severity of incidents, like during a trauma event, is crucial

    Summary

    • Short summary of the slides content
    • Covering anatomy, hemorrhage, shock, shock assessment and management

    IV Theory (Fluids and Electrolytes)

    • Major electrolytes in the body include sodium (Na+), potassium (K+), calcium (Ca++), chloride (Cl-), magnesium (Mg++), and phosphate (HPO4--).
    • Each has specific functions and normal ranges.
    • Variations from these ranges can affect bodily functions, leading to possible shock

    Acid Base Balance

    • A crucial process in maintaining homeostasis: normal blood pH is 7.35–7.45
    • Buffer systems, respiratory mechanisms, and the kidneys regulate pH levels
    • Normal saline solution is used for maintaining the body's pH balance when needed.

    IV notes

    • Various procedures/practices for performing IV therapy, including procedures to prevent problems
    • Procedures to take in case of complications during IV insertion

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    Bleeding and Shock Chapter 21 PDF

    Description

    Test your knowledge on blood volume in adults and the critical management of blood loss. This quiz covers fundamental concepts related to blood volume, hemorrhage control, and the application of medical interventions in emergencies. Perfect for medical students and healthcare professionals.

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