Ch 29 Bleeding And Shock

Question 1

Layers of arteries and veins

Answer 1

External elastic membrane
Smooth muscle
Internal elastic membrane
Endothelium
Lumen

Question 2

Perfusion

Answer 2

Adequate circulation of blood which supplies cells and tissues with oxygen and nutrients

Question 3

Shock caused by

Answer 3

Volume loss
Pump failure
Loss of blood vessel tone
Obstruction of blood flow

Question 4

Relative hypovolemia

Answer 4

Blood is not lost but dehydration or burns affect the plasma levels of blood

Question 5

Hypovolemia shock

Answer 5

Shock due to low volume in circulatory system
Decrease in pressure within vessels so heart pumping is not capable of moving blood

Question 6

Hemorrhagic shock

Answer 6

Shock due to low blood volume

Question 7

Cardiogenic shock

Answer 7

Shock due to pump problems

Question 8

Distributive shock

Answer 8

Shock due to failed blood vessel tone
Massive drop in pressure due to systemic dilation (all vessels dilating means not enough blood goes where it needs to)
Frequently causes flushing, mottling, or rash
Include:
Anaphylactic shock
Neurogenic shock (dilation due to interrupted commands)
Septic shock

Question 9

Septic shock

Answer 9

Incorporates hypovolemia and cardiogenic elements
Toxins may affect pumping

Question 10

Obstructive shock

Answer 10

Shock due to flow of blood being blocked
Ex. Cardiac tamponade, pulmonary embolism (clot blocking blood flow in large lung blood vessel)

Question 11

Fight or flight

Answer 11

Receptors sense decreasing BP, release epinephrine and norepinephrine to construct vessels esp in skin kidneys and GI
Sweat glands empty contents
Stomach tries to empty contents
Kidneys produce less urine
Increased heart rate

Question 12

S&S of shock

Answer 12

Pale, sweaty skin
Increased heart & respiratory rate
Altered
Delayed cap refill
Decreased urinary output
Nausea & vomiting

Question 13

Pediatric shock

Answer 13

Fast heart and respiratory rate to identify shock, not low BP (don’t wait)

Question 14

Decompensated shock S&S

Answer 14

Low BP
Altered, more severe
Slow heart rates
Slow respiratory rates

Question 15

Decompensated shock often leads to

Answer 15

Cardiac arrest

Question 16

Diastolic pressure (bottom)

Answer 16

Pressure before heart squeezes

Question 17

Systolic pressure

Answer 17

Will drop as bleeding out

Question 18

Three conditions contributing to mortality of shock patients

Answer 18

Acidosis (low pH)
- bad waste removal and anaerobic metabolsim
hypothermia
- less cell activity
coagulopathy
- clotting deficiency
- deficiency increases as acidosis increases
- increases when pt is cold

Question 19

Shock treatment

Answer 19

Root cause
General treatment:
- rapid transport
- give oxygen (regulate acidosis)
- prevent heat loss
- shock position: lay flat
- ALS if needed

Question 20

Arterial bleeding

Answer 20

Spurting blood
Pulsating flow
Bright red

Question 21

Vein bleeding

Answer 21

Steady, slow flow
Dark red color

Question 22

Capillaries

Answer 22

Slow, even flow

Question 23

Junctional hemorrhage

Answer 23

Massive bleeding
Where appendages connect to trunk

Question 24

Direct pressure

Answer 24

If mild, place sterile dressing between wound and hand
If severe, place hand directly over
Try aiming pressure toward a bone
Once bleeding is controlled, bandage to make a pressure dressing

Question 25

Wound packing

Answer 25

For cavities in extremities or junctional areas
NOT for chest or abdomen
Once cavity full, resume direct pressure and maybe pressure dressinf

Question 26

If one tourniquet doesn’t work place another

Answer 26

Directly Proximal

Question 27

Inflatable (air) splints

Answer 27

Control internal and external extremity bleeding
May be used even if no bone injury suspected
Useful if multiple wounds or one long wound over entire extremity

Question 28

CSF flowing out

Answer 28

Do not stop, collect with gauze pads