Bleeding & Shock
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Questions and Answers

What type of shock is characterized by a decrease in volume?

  • Distributive shock (correct)
  • Cardiogenic shock
  • Hypovolemic shock
  • Obstructive shock

    • Which phase follows the electrical phase after cardiac arrest?

  • Respiratory phase
  • Circulatory phase (correct)
  • Refractory phase
  • Metabolic phase

    • What initial rhythm is most frequently observed in cardiac arrest situations?

  • Ventricular tachycardia
  • Ventricular fibrillation (correct)
  • Asystole
  • Atrial fibrillation

    • What is NOT a characteristic of compensated shock?

    <p>Significant fluid loss</p> Signup and view all the answers

    Which of the following types of shock is caused by a massive bleeding issue?

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

    How many links are present in the Chain of Survival?

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

    What common source of infection is often linked to sepsis?

    <p>Respiratory tract</p> Signup and view all the answers

    Which statement is true regarding norepinephrine?

    <p>Stimulates alpha cells</p> Signup and view all the answers

    What is shock simply defined as?

    <p>Inadequate tissue perfusion</p> Signup and view all the answers

    Which of the following is NOT a basic etiology of shock?

    <p>Inadequate tissue oxygenation</p> Signup and view all the answers

    How many major categories of shock are recognized?

    <p>4</p> Signup and view all the answers

    What is hypovolemic shock primarily caused by?

    <p>Fluid loss</p> Signup and view all the answers

    Which medication is preferred for treating anaphylactic shock?

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

    Which of the following effects is NOT associated with sympathetic nervous system stimulation?

    <p>Decreased heart rate</p> Signup and view all the answers

    What are the two stages of shock?

    <p>Compensatory and decompensatory</p> Signup and view all the answers

    A sign of early shock is indicated by which of the following?

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

    How many layers is the skin composed of?

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

    What is an open injury that exposes blood vessels and nerve tissue within the dermal layer of the skin called?

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

    A laceration caused by a knife or razor is described as what type?

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

    When applying an occlusive dressing to a chest wound, how many sides should the dressing be secured?

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

    Which of the following should NOT be done when treating exposed internal abdominal organs?

    <p>Applying high-flow oxygen</p> Signup and view all the answers

    What type of wound has no open pathway from the outside to the injured site?

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

    What describes simple scrapes to the outer layer of the skin?

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

    What is the first step an EMT should take when encountering a patient with severe bleeding?

    <p>Apply pressure to the wound</p> Signup and view all the answers

    What type of wound involves flaps of skin and tissue that are torn loose but still attached?

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

    Approximately how many liters of total blood volume does an average adult weighing 154 pounds have?

    <p>6–8 liters</p> Signup and view all the answers

    Which type of shock is most commonly caused by significant blood or fluid loss?

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

    What percentage of blood volume can an average adult lose before obvious signs of shock appear?

    <p>15 percent</p> Signup and view all the answers

    If direct pressure is not effective in controlling bleeding from a lower extremity, what is the next step?

    <p>A tourniquet</p> Signup and view all the answers

    What does the term epistaxis refer to?

    <p>A nosebleed</p> Signup and view all the answers

    Which medication has no effect on blood clotting?

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

    What type of injury is characterized by a wound that is beneath unbroken skin?

    <p>Closed injury</p> Signup and view all the answers

    Which of the following symptoms is NOT a sign of a closed soft tissue injury?

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

    What is a common complication associated with animal bites?

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

    Which statement about tourniquets is correct?

    <p>The use of a tourniquet is not recommended for an open lower extremity injury.</p> Signup and view all the answers

    What initial step should be taken to control bleeding?

    <p>Direct pressure</p> Signup and view all the answers

    Which type of bandage is specifically designed to immobilize an injury?

    <p>Splint bandage</p> Signup and view all the answers

    What happens to the appearance of gunshot wounds typical of their entry and exit points?

    <p>Exit wound appears smaller than the entry wound</p> Signup and view all the answers

    Which statement best describes the effect of a temperature below normal on the clotting process?

    <p>It makes the clotting process slower and less effective.</p> Signup and view all the answers

    What is the primary cause of hypovolemic shock?

    <p>Fluid loss</p> Signup and view all the answers

    Which medication is considered the first-line treatment for anaphylactic shock?

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

    Which of the following is NOT a basic etiology of shock?

    <p>Inadequate respiratory rate</p> Signup and view all the answers

    What are the two stages of shock?

    <p>Compensatory and decompensatory</p> Signup and view all the answers

    Which sign is typically associated with early stages of shock?

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

    How many major categories of shock are generally recognized?

    <p>4</p> Signup and view all the answers

    What physiological response does sympathetic nervous system stimulation induce?

    <p>Increased respiratory rate</p> Signup and view all the answers

    What is the time frame defining sudden death after the onset of symptoms?

    <p>1 hour</p> Signup and view all the answers

    What characterizes compensated shock?

    <p>Near-normal vital signs despite fluid loss</p> Signup and view all the answers

    Which type of shock is specifically categorized under distributive shock?

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

    What is the primary cause of cardiogenic shock?

    <p>Failure of the heart to pump effectively</p> Signup and view all the answers

    During which phase following cardiac arrest does the metabolic phase begin?

    <p>10 minutes after the electrical phase</p> Signup and view all the answers

    What are the three phases the body goes through following cardiac arrest?

    <p>Electrical, circulatory, metabolic</p> Signup and view all the answers

    Which of the following is the most frequent initial rhythm in cases of cardiac arrest?

    <p>Ventricular fibrillation</p> Signup and view all the answers

    What is a characteristic effect of norepinephrine in the body?

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

    How many links are present in the Chain of Survival?

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

    What type of shock is characterized by plasma and water loss without an immediate loss of oxygen-carrying capacity?

    <p>Non-hemorrhagic shock</p> Signup and view all the answers

    Which type of shock is primarily caused by a significant infection leading to widespread vasodilation?

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

    Which condition is typically associated with burn shock?

    <p>Leaking of plasma from damaged capillaries</p> Signup and view all the answers

    What is a common symptom of septic shock?

    <p>Flushed and hot skin</p> Signup and view all the answers

    Which of the following is NOT a category of shock?

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

    Which type of obstructive shock is caused by fluid accumulation in the pericardial cavity?

    <p>Cardiac tamponade</p> Signup and view all the answers

    What defines hypovolemic shock specifically?

    <p>Loss of whole blood leading to decreased circulation</p> Signup and view all the answers

    Which sign is indicative of a patient experiencing shock?

    <p>Altered mental status</p> Signup and view all the answers

    Which type of bleeding is characterized as bright red and spurting?

    <p>Arterial bleeding</p> Signup and view all the answers

    What is the first step recommended for controlling major hemorrhage?

    <p>Direct pressure</p> Signup and view all the answers

    When using a tourniquet, where should it be placed in relation to the wound?

    <p>Proximal to the wound</p> Signup and view all the answers

    What is the primary treatment method for epistaxis?

    <p>Sit the patient down and lean them forward</p> Signup and view all the answers

    What is true regarding avulsions in open soft tissue injuries?

    <p>They can be partial or complete</p> Signup and view all the answers

    In the case of punctures, how should the embedded object be handled?

    <p>It should be stabilized and not removed</p> Signup and view all the answers

    What is a common complication associated with closed soft tissue injuries, particularly contusions?

    <p>Formation of a hematoma</p> Signup and view all the answers

    What distinguishes venous bleeding from arterial bleeding?

    <p>It has a darker red color and flows steadily</p> Signup and view all the answers

    Study Notes

    Shock

    • Shock is a life-threatening condition characterized by inadequate tissue perfusion
    • Reduced tissue perfusion leads to cellular dysfunction and potential organ failure

    Types of Shock

    • Hypovolemic Shock: Caused by a decrease in blood volume, leading to inadequate tissue perfusion
    • Distributive Shock: Characterized by a decrease in vascular tone, causing blood to pool in the extremities, leading to reduced blood flow to vital organs
      • Anaphylactic Shock: A severe allergic reaction that triggers a widespread inflammatory response leading to rapid vasodilation, decreased blood pressure, and airway compromise
      • Neurogenic Shock: Occurs when the nervous system is damaged, causing vasodilation and inability to maintain blood pressure, often called "spinal shock"
    • Cardiogenic Shock: Results from the heart's inability to pump effectively, leading to inadequate blood flow to the body
    • Obstructive Shock: Occurs when there is a blockage in the circulation, preventing blood from reaching vital organs

    Compensated Shock

    • The body attempts to maintain a near-normal blood pressure and essential organ perfusion by activating compensatory mechanisms, such as increasing heart rate and vasoconstriction
    • Early intervention is crucial during this phase as the body's compensatory mechanisms have limitations

    Decompensated Shock

    • The body's compensatory mechanisms fail, leading to a significant decline in blood pressure and reduced perfusion of vital organs
    • This stage is characterized by a rapid heart rate, weak pulse, and altered mental status
    • Immediate medical intervention is essential for survival

    Cardiac Arrest

    • Cardiac arrest is a life-threatening condition defined as the sudden cessation of heartbeat and breathing
    • The three phases of cardiac arrest are the electrical, circulatory, and metabolic phases
      • Electrical Phase: The heart's electrical activity ceases
      • Circulatory Phase: Blood circulation stops
      • Metabolic Phase: Cellular dysfunction and death occur due to oxygen deprivation

    Chain of Survival

    • The Chain of Survival outlines the critical steps for improving survival rates from sudden cardiac arrest
    • The five links include:
      • Immediate recognition and activation of the emergency medical system (EMS)
      • Early CPR
      • Early defibrillation
      • Effective advanced life support
      • Post-cardiac arrest care

    Defibrillation

    • Defibrillation is a life-saving procedure used to treat ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT)
    • The process involves delivering a controlled electric shock to the heart to reset the electrical rhythm
    • Early defibrillation significantly increases the chances of survival

    Sepsis

    • Sepsis is a life-threatening complication that arises from an overwhelming infection
    • The most common source of infection is bacterial
    • It triggers a massive inflammatory response, can lead to multiple organ dysfunction, and often progresses to septic shock

    Additional Key Points

    • Asystole is the absence of electrical activity and pumping action in the heart
    • An AED (Automated External Defibrillator) can be used on a patient of any age who is in ventricular fibrillation
    • Downtime is the period between the onset of cardiac arrest and the initiation of CPR
    • The metabolic phase of cardiac arrest begins approximately 10 minutes after the event
    • Cardiac output multiplied by stroke volume equals blood pressure
    • Norepinephrine stimulates alpha cells, not beta cells
    • Cardiogenic shock is not caused by bleeding from the heart but rather by the heart's failure to pump effectively
    • Septic shock is indeed a form of distributive shock
    • There are three major etiologies of shock: hypovolemic, distributive, and cardiogenic
    • Decreased blood volume leads to increased afterload, not decreased afterload

    Bleeding and Soft-Tissue Trauma

    • The skin is composed of three layers: epidermis, dermis, and subcutaneous layer.
    • A closed wound is an injury where there is no open pathway from the outside to the injured site.
    • Simple scrapes affecting the outer layer of the skin are called abrasions.
    • Impaled objects should not be removed in the field except if located in the cheek or neck and obstructing airflow.
    • The three major types of blood vessels are arteries, capillaries, and veins.
    • Always use Standard Precautions when dealing with bleeding to avoid skin and mucous membrane exposure.
    • Hemorrhagic shock and death can rapidly occur with severe internal bleeding.
    • The second step in bleeding control of an extremity bleed, after direct pressure fails, is to use a tourniquet.
    • A cold body temperature may hinder the effectiveness and speed of the clotting process.
    • A blood loss of 15% will affect a patient's vital signs.

    Factors Increase Bleeding

    • Medications like aspirin, ibuprofen, and Coumadin can affect clotting.
    • High blood pressure can increase the force of bleeding.
    • Damaged blood vessels may bleed more than ordinary vessels.
    • Certain medical conditions, like hemophilia, can increase bleeding tendencies.

    Emergency Care for Open Neck Wounds

    • Apply pressure to the wound with gloved hands.
    • Use an occlusive dressing to seal the wound and prevent air entry.
    • Apply a bandage to hold the dressing in place.
    • Transport the patient immediately.

    Types of Bandages

    • Roller bandages are typically used for limbs and apply even pressure.
    • Circular bandages are used for the chest and abdomen to hold dressings in place.
    • Spiral bandages secure dressings on limbs with consistent pressure.
    • Figure-of-eight bandages are used for joints like the ankles and wrists to provide stability.

    Shock

    • Shock is inadequate tissue perfusion
    • Distributive shock is associated with a decrease in vessel tone (not volume)
    • Anaphylactic shock is a type of distributive shock
    • Neurogenic shock can be referred to as vasodilatory shock
    • In compensated shock, the body maintains near-normal vital signs and perfusion of vital organs
    • The body can maintain near-normal vital signs with some fluid loss, this is compensated shock
    • The three phases of cardiac arrest are electrical, circulatory and metabolic
    • The Chain of Survival has 5 links
    • The most frequent initial rhythm in cardiac arrest is ventricular fibrillation
    • The lower energy level delivered by the biphasic defibrillator is thought to cause less tissue damage
    • The most common source of infection in sepsis is the respiratory tract

    True or False

    • Asystole is the absence of electrical activity and pumping action in the heart (True)
    • An AED could be used on a patient of any age who is in ventricular fibrillation (True)
    • Downtime is the time from when the patient goes into cardiac arrest until CPR is started (True)
    • The metabolic phase starts 10 minutes after cardiac arrest (False)
    • Cardiac output multiplied by stroke volume equals blood pressure (True)
    • Norepinephrine stimulates beta cells (False, it stimulates alpha and beta cells)
    • Cardiogenic shock is caused by massive bleeding from the heart (False)
    • Septic shock is a form of distributive shock (True)
    • There are three major etiologies or causes of shock (True)
    • Decreased blood volume increases afterload (False)

    Chapter 15 Quiz Answers:

    • Shock is simply defined as inadequate tissue perfusion (C)
    • All of the following are basic etiologies of shock except inadequate respiratory rate (D)
    • How many major categories of shock are there? (C)
    • Hypovolemic shock is due to fluid loss (A)
    • The medication of choice in the treatment of anaphylactic shock is epinephrine (A)
    • All of the following are effects of sympathetic nervous system stimulation except vasoconstriction (D)
    • The two stages of shock are compensatory and decompensatory (C)
    • A sign of early shock is tachycardia (D)
    • Sudden death is defined as a patient who dies within 1 hour of the onset of symptoms (B)
    • The circulatory phase of cardiac arrest typically lasts 2 minutes (D)

    Chapter 15 Review:

    • Shock is a serious condition that results in inadequate tissue perfusion.
    • The body's response to shock is triggered by the sympathetic nervous system
    • Two stages of shock are compensated and decompensatory
    • The three major etiologies of shock are hypovolemic, distributive, and cardiogenic
    • Anaphylaxis is a type of distributive shock, caused by an allergic reaction
    • The medication of choice for anaphylactic shock is epinephrine
    • The most frequent initial rhythm in cardiac arrest is ventricular fibrillation
    • In cardiac arrest, the three phases are the electrical phase, the circulatory phase, and the metabolic phase
    • The Chain of Survival has 5 links
    • The most common source of infection in sepsis is the respiratory tract

    Bleeding and Shock

    • Shock is a condition where inadequate tissue perfusion occurs.
    • Causes of shock: Inadequate blood volume, inadequate pump function, inadequate vessel tone.
    • Hypovolemic shock occurs when there's a loss of blood volume (hemorrhagic) or non-blood volume (non-hemorrhagic) such as dehydration.
      • Burn shock results from capillary damage causing plasma loss.
    • Cardiogenic shock arises from issues with the heart function, such as AMI, CHF, dysrhythmias or medications.
    • Distributive shock refers to a wide-spread vasodilation caused by conditions like anaphylaxis, septic shock and neurogenic shock.
    • Obstructive shock is caused by a blockage in the circulatory system, such as a pulmonary embolism, tension pneumothorax, or pericardial tamponade.
    • Hemorrhagic shock involves loss of whole blood and oxygen carrying capacity.
    • Non-hemorrhagic shock: Loss of plasma and water, still maintaining oxygen carrying capacity.
      • Dehydration and recent illnesses can contribute to non-hemorrhagic shock.
    • Septic shock: Massive infection leads to widespread vasodilation.
      • Symptoms: Flushed/hot/dry skin.
      • Sepsis is characterized by two or more of the following signs/symptoms in a patient with suspected infection: Temperature greater than 100.9° F or less than 90 bpm, respiratory rate greater than 20 breaths/minute, altered mental status, and blood glucose greater than 180 mg/dL.
    • Arterial bleeding: Bright red, spurting, most dangerous.
    • Venous bleeding: Darker red, flows, can still be dangerous.
    • Capillary bleeding: Oozes, risk of infection.
    • Controlling bleeding: Direct pressure is the first step.
      • Use gauze pads for small wounds and multitrauma dressings for gaping wounds.
      • If major bleeding is present in primary assessment, use a gloved hand until a dressing can be applied.
    • Tourniquets: Use if direct pressure doesn't control bleeding.
      • Place proximal to the wound, as close as possible.
      • Document the time of application and notify the hospital.
      • Never loosen once applied.
    • Epistaxis: Sit patient down, lean patient forward, pinch the fleshy part of the nose.
    • Closed soft tissue injuries:
      • Contusion: Bruise, AKA Ecchymosis.
      • Hematoma: Similar to contusion, but involves a larger blood vessel.
    • Open soft tissue injuries:
      • Abrasion: Scraping, rubbing, or shearing of the epidermis.
      • Laceration: Regular or irregular break in the skin of varying depth.
      • Avulsion: Loose flap of skin, partial (still attached) or complete (unattached).
      • Amputation: Disruption in the continuity of an extremity.
      • Puncture: Sharp, pointed object being pushed into soft tissue.
      • Impaled objects: Object still embedded in the wound.
        • Never remove unless through cheek or neck and causing airway compromise.
        • Stabilize with bulky dressings.
    • Dressings (cover the wound): 4x4's, gauze pads.
    • Bandages (secure dressing in place): Kerlix, roller gauze

    Study Guide Summary

    • Shock is a serious condition that can lead to organ damage and death if not treated promptly.
    • The different types of shock are categorized by their cause and the underlying physiology.
    • Bleeding is another critical issue that must be addressed swiftly.
    • Various types of bleeding are categorized by their characteristics and severity.
    • The study guide provides a comprehensive overview of the assessment and management of bleeding and shock in pre-hospital settings.

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    Related Documents

    Chapter 15 Quiz PDF
    Chapter 28 Quiz PDF
    Bleeding and Shock Study Guide PDF

    Description

    Explore the critical condition of shock, its types, and underlying causes. Learn about hypovolemic, distributive, cardiogenic, and obstructive shocks, along with their implications for tissue perfusion and organ function. This quiz delves into the mechanisms and characteristics of each type, enhancing your understanding of this life-threatening condition.

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