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Questions and Answers
What is a common sign of shock in infants that indicates inadequate perfusion?
What is a common sign of shock in infants that indicates inadequate perfusion?
Which type of shock is primarily characterized by a loss of blood leading to inadequate fluid volume in the circulatory system?
Which type of shock is primarily characterized by a loss of blood leading to inadequate fluid volume in the circulatory system?
Which of the following signs is NOT typically associated with shock?
Which of the following signs is NOT typically associated with shock?
Which protocol is essential for the management of a patient suspected of experiencing hemorrhagic shock?
Which protocol is essential for the management of a patient suspected of experiencing hemorrhagic shock?
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What is a critical factor in the recognition of shock to ensure patient survival?
What is a critical factor in the recognition of shock to ensure patient survival?
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Which of the following is an early sign of shock?
Which of the following is an early sign of shock?
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What happens to the blood pressure of infants and children in shock?
What happens to the blood pressure of infants and children in shock?
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Which type of bleeding is characterized by bright red, oxygen-rich blood that spurts from the wound?
Which type of bleeding is characterized by bright red, oxygen-rich blood that spurts from the wound?
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What is the recommended action for external bleeding given the presence of shock symptoms?
What is the recommended action for external bleeding given the presence of shock symptoms?
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Which of the following should NOT be done when managing a patient in shock?
Which of the following should NOT be done when managing a patient in shock?
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What is a common sign of shock related to the pupils?
What is a common sign of shock related to the pupils?
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What indicates serious blood loss in an adult patient?
What indicates serious blood loss in an adult patient?
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In managing shock, which of the following is considered an important early intervention?
In managing shock, which of the following is considered an important early intervention?
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Which of the following describes capillary bleeding?
Which of the following describes capillary bleeding?
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Which symptom would you expect in a patient exhibiting hypoperfusion?
Which symptom would you expect in a patient exhibiting hypoperfusion?
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What is one of the signs that may indicate hypovolemic shock due to internal bleeding?
What is one of the signs that may indicate hypovolemic shock due to internal bleeding?
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Which symptom is NOT typically associated with internal bleeding?
Which symptom is NOT typically associated with internal bleeding?
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In which type of trauma is internal bleeding most likely to occur?
In which type of trauma is internal bleeding most likely to occur?
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What should be the immediate priority in emergency care for a patient exhibiting signs of internal bleeding?
What should be the immediate priority in emergency care for a patient exhibiting signs of internal bleeding?
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How should a patient with a suspected nosebleed be positioned?
How should a patient with a suspected nosebleed be positioned?
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What is a late sign of hypovolemic shock that should be assessed?
What is a late sign of hypovolemic shock that should be assessed?
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Which emergency care measure is appropriate for controlling bleeding from an extremity?
Which emergency care measure is appropriate for controlling bleeding from an extremity?
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Which type of shock is primarily associated with blood loss through internal bleeding?
Which type of shock is primarily associated with blood loss through internal bleeding?
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What can be a common misconception about recognizing shock in infants?
What can be a common misconception about recognizing shock in infants?
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What is a critical step in emergency care for someone suspected of having internal bleeding?
What is a critical step in emergency care for someone suspected of having internal bleeding?
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Study Notes
Patient Case Study
- Dan and Joyce were treating a patient after a car accident
- Initially, the patient was conscious and speaking
- Blood pressure was normal, but the heart rate was rapid
- During transport, the patient became disoriented
Chapter 27: Bleeding and Shock
- Overview of the Cardiovascular System is needed
- Shock assessment and emergency care are required
- External bleeding requires body substance isolation precautions, assessing blood loss, recognizing types of bleeding, and emergency care for external bleeding from the ears, nose, and mouth
- Internal bleeding requires assessing blood loss, recognizing symptoms, and providing emergency care
The Circulatory System
- The heart pumps blood to body organs through the cardiovascular system
- This process is vital; interruption for more than a few minutes can cause death
Heart
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Structure and function: Atrium (right and left) and Ventricle (right and Left)
- Right atrium receives blood from veins, pumps oxygen-poor blood to the right ventricle
- Left atrium receives blood from the pulmonary veins (lungs), pumps oxygen-rich blood to the left ventricle
- Right ventricle pumps oxygen-poor blood to the lungs
- Left ventricle pumps oxygen-rich blood to the body
- Valves prevent backflow of blood
- Cardiac conductive system: specialized contractile and conductive tissue in the heart; coordinated contraction through electrical impulses
- Automaticity: the ability of cardiac muscle cells to generate their own impulses
Blood Vessels
- Arteries
- Arterioles
- Capillaries
- Venules
- Veins
Arteries
- Carry blood away from the heart
- Major arteries: Coronary (heart), Aorta (major artery leading from the heart), Pulmonary (lungs), Carotid (neck), Femoral (thigh), Radial (lower arm), Brachial (upper arm), Posterior tibial (lower leg), Dorsalis pedis (foot).
Arterioles
- Smallest branches of arteries leading to capillaries
Capillaries
- Tiny blood vessels connecting arterioles and venules
- Found throughout the body
- Allow for nutrient and waste exchange at the cellular level
Venules
- Smallest branches of veins leading to capillaries
Veins
- Carry blood back to the heart
- Major veins: Pulmonary (lungs to left atrium), Venae cavae (superior and inferior - oxygen-poor blood to right atrium)
Blood
- Red blood cells: Give blood its color, carry oxygen to organs, carry carbon dioxide away from organs
- White blood cells: Part of the body's defense against infections
- Plasma: Fluid carrying blood cells and nutrients
- Platelets: Essential for blood clot formation
Pulse
- Left ventricle contraction creates a wave of blood through arteries
- Pulse can be palpated where an artery is near skin surface and over a bone
- Peripheral pulse locations: Radial, Brachial, Posterior tibial, Dorsalis pedis, Carotid, Femoral
Blood Pressure
- Measures pressure in arteries during heart contraction and relaxation
- Systolic: Pressure during ventricle contraction
- Diastolic: Pressure during ventricle relaxation
Perfusion
- Delivers oxygenated blood to organs, removing waste products and carbon dioxide
- Cellular respiration is involved
- Shock (hypoperfusion) is widespread inadequate tissue perfusion.
Shock
- Signs and symptoms: Pale or cyanotic skin, cool or cold skin, rapid weak pulse, altered mental status, rapid breathing, nausea and vomiting, low/decreasing blood pressure (latter is a late sign)
- Shock (hypoperfusion) results in inadequate perfusion of cells with oxygen, nutrients, and removal of metabolic waste products
- Cell and organ malfunction results without prompt recognition and treatment
- Types of shock: Cardiogenic, distributive (septic, anaphylactic, neurogenic), hypovolemic, hemorrhagic
Types of Shock
- Caused by disorders of the pump (cardiogenic), pipe (septic, anaphylactic, neurogenic), or fluid (hypovolemic, hemorrhagic)
Trauma Patients and Shock
- Trauma patients develop shock from blood loss
- This is called hypovolemic shock
Shock (Hypoperfusion) - Signs and symptoms
- Restlessness
- Anxiety
- Altered mental status
Shock (Hypoperfusion) - Signs and symptoms
- Peripheral perfusion
- Delayed capillary refill greater than 2 seconds
- Weak or absent peripheral pulses
- Pale, cool, clammy skin
Shock (Hypoperfusion) - Signs and symptoms - Vital Signs
- Decreased blood pressure (late sign)
- Increased pulse rate (early sign), weak and thready
- Increased breathing rate, shallow, labored, irregular
Shock - Other signs and symptoms
- Dilated pupils
- Marked thirst
- Nausea and vomiting
- Pallor with cyanosis to the lips
- Infants and children can maintain blood pressure until blood volume is less than half gone
- By then, they are close to death
- Less reserve than adults
Emergency Care for Shock
- Body substance isolation
- Maintain airway / artificial ventilation
- Administer oxygen if needed
- Control any external bleeding
- Place patient in shock position (head turned to one side unless suspected of neck injury)
- Keep patient warm and comfortable
- Emergency care for shock can include using a pneumatic antishock garment (PASG)
Emergency Care for External Bleeding
- Bleeding control: concentrated direct pressure (fingertip pressure on bleeding point), diffuse direct pressure, extremity elevation, pressure points, splints
Pressure Splints
- Reduction of bone motion reduces tissue damage, bleeding, and fracture
- The use of air pressure splints can control severe bleeding in soft tissue or fracture injuries
- Pneumatic counterpressure devices(PASG) can be used
Tourniquet
- Used as a last resort to control bleeding, particularly from amputated extremities
- Use wide bandage and secure tightly
- Tourniquets may cause permanent damage
Bleeding from the Ears, Nose, and Mouth
- Potential causes: Injured skull, facial trauma, digital trauma, sinusitis; hypertension, coagulation disorders
- Bleeding from the ears or nose may be a result of skull fracture; do not attempt to stop the bleeding if the result of trauma
- Collect blood with a loose dressing (infection prevention)
Emergency Medical Care for Nose Bleeds
- Position patient sitting, leaning forward
- Apply direct pressure to the fleshy part of nose
- Keep the patient calm.
Internal Bleeding
- Internal bleeding results in significant blood loss, shock, subsequent death
- Suspicion and severity are based on the mechanism of injury and clinical signs/symptoms
- Relationship to mechanism of injury: Blunt trauma(falls, motorcycle, pedestrian, automobile collisions, blast injuries)
- Look for evidence of contusions, abrasions, deformity, impact marks, and swelling
- Penetrating trauma
- Injured/damaged organs lead to concealed bleeding
- Painful, swollen, deformed extremities can also lead to internal blood loss
- Amount of blood loss associated with various injuries (measured in milliliters; e.g., femur 600 mL)
Internal Bleeding (Signs and Symptoms)
- Pain, tenderness, swelling, or discoloration of suspected site of injury
- Bleeding from mouth, rectum, or vagina; other orifices
- Vomiting bright red blood or coffee-ground colored blood
- Dark, tarry or bright red stools
- Tender, rigid, or distended abdomen
- Late signs and symptoms of hypovolemic shock
Emergency Care for Internal Bleeding
- Body substance isolation
- Maintain airway / artificial ventilation
- Administer oxygen if not already done during initial assessment
- Control bleeding in an extremity by direct pressure and splint application
- Immediate transport is critical for patient with signs/symptoms of shock
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Description
This quiz focuses on key concepts from Chapter 27 about bleeding and shock in relation to patient care following a car accident. It covers shock assessment, types of bleeding, and emergency care practices. Understanding the cardiovascular system and its critical functions is essential for effective intervention.
