Chapter 26 - Bleeding Flashcards
A 43-year-old man is experiencing a severe nosebleed. His blood pressure is 190/110 mm Hg and his heart rate is 90 beats/min and bounding. The preferred treatment for this patient includes:
Select one:
A. placing a rolled 4² × 4² dressing between his lower lip and gum.
B. having the patient pinch his own nostrils and then lie supine.
C. pinching the patient’s nostrils and having him lean forward.
D. packing both nostrils with gauze pads until the bleeding stops.
C. pinching the patient’s nostrils and having him lean forward.
Explanation
The elevated blood pressure (which may be the cause of the nose bleed) indicates that the blood vessels need to be closed off (i.e. pinch). Leaning forward keeps the blood in one spot and contributes to clotting. Also, this prevents an airway obstruction as the blood doesn’t drain down the throat.
A. Incorrect - placing a rolled 4² × 4² dressing between his lower lip and gum.
This does little to stop the bleed other than waiting on the clotting factors. The increased blood pressure, possibly what caused the bleed, indicates clotting faster may need help.
B. Incorrect - having the patient pinch his own nostrils and then lie supine.
Laying down will keep the blood drawing away from the wound. Keeping the blood at the wound increases clotting factors. Also, this has the potential to create an airway obstruction as the blood drains down the throat.
D. Incorrect - packing both nostrils with gauze pads until the bleeding stops.
This can make the bleeding worse.
A 67-year-old male presents with weakness, dizziness, and melena that began approximately 2 days ago. He denies a history of trauma. His blood pressure is 90/50 mm Hg and his pulse is 120 beats/min and thready. You should be MOST suspicious that this patient is experiencing:
Select one:
A. acute appendicitis.
B. an aortic aneurysm.
C. gastrointestinal bleeding.
D. intrathoracic hemorrhaging.
C. gastrointestinal bleeding.
Explanation
Melena is the indicating sign. Melena is dark sticky feces containing partly digested blood. Of the options listed, the gastrointestinal bleed is likely.
A. Incorrect - acute appendicitis.
Does not create Melena
B. Incorrect - an aortic aneurysm.
This would not be indicated by melena.
D. Incorrect - intrathoracic hemorrhaging.
Does not create Melena as intrathoracic bleeding is anywhere from the lungs to the rectum into the cavity space outside the hollow tube organs that would create melena.
A young male was shot in the abdomen by an unknown type of gun. He is semiconscious, has shallow breathing, and is bleeding externally from the wound. As you control the external bleeding, your partner should:
Select one:
A. apply a nonrebreathing mask.
B. assist the patient’s ventilation.
C. obtain baseline vital signs.
D. perform a secondary assessment.
B. assist the patient’s ventilation
Explanation
Semiconscious & shallow breathing indicates that the patient needs aid in increasing their respiration gas exchange (aka ventilation)
A. Incorrect - apply a nonrebreathing mask.
Semiconscious & shallow breathing contraindicate a nonrebreather mask as the patient may not be breathing sufficiently on heir own for this method to be effective
C. Incorrect - obtain baseline vital signs
Once the massive bleeding has received care, the next step is to take care of the ABC’s (airway, breathing, circulation). Vitals are taken in process of the primary assessment & secondary assessment
Another version of this is the MARCH algorithm.
- M- Massive Hemorrhage
- A - Airway
- R - Respiration
- C - Circulatory
- H - Head-to-Toe, Hypothermia
D. Incorrect - perform a secondary assessment.
Once the massive bleeding has received care, the next step is to take care of the ABC’s (airway, breathing, circulation). These take priority over a secondary assessment.
Circulation of blood within an organ or tissue in adequate amounts to meet the cells’ oxygen, nutritional, and waste-removal needs is termed _______.
Select one:
A. hypoperfusion
B. hemorrhage
C. coagulation
D. perfusion
D. perfusion
Explanation
Prefusion - The passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to an area in adequate amounts to meet the cells’ oxygen, nutritional, and waste-removal needs.
A. Incorrect - hypoperfusion
Hypo is low. Hypoperfusion is inadequate perfusion that does not meet the needs of the tissues.
B. Incorrect - hemorrhage
Bleeding or the abnormal flow of blood.
C. Incorrect - coagulation
The process by which the blood clots to form solid masses, or clots.
Following blunt trauma to the abdomen, a 21-year-old female complains of diffuse abdominal pain and pain to the left shoulder. Your assessment reveals that her abdomen is distended and tender to palpation. On the basis of these findings, you should be MOST suspicious of injury to the:
Select one:
A. spleen.
B. gallbladder.
C. pancreas.
D. liver.
A. spleen.
Explanation
Pain felt in the left shoulder as a result of a ruptured spleen is known as Kehr’s sign. This feels worse when the individual breathes in. A ruptured spleen can cause pain in the left shoulder because bleeding from the spleen may irritate the phrenic nerve, a nerve that originates in the neck and extends through the diaphragm.
B. Incorrect - gallbladder.
Gall bladder referred pain presents in the right shoulder and between the shoulder blades, but not the left shoulder.
C. Incorrect - pancreas.
- Possibly correct answer, but less likely, statistically, than Ruptured Spleen
- Pain typically manifests in the T5-T9 regions; however, when the tail of the pancreas is involved pain tends to be referred to the left shoulder due to its innervation by C3-5.
- Blunt trauma injuries to the pancreas are rare but are associated with significant overall mortality and a high complication rate. Motor vehicle collisions are the leading cause of blunt pancreatic trauma, followed by falls, and sports injuries.
D. liver.
Liver referred pain presents in the right shoulder but not the left shoulder.
Hypovolemic shock occurs when:
Select one:
A. the patient’s systolic blood pressure is less than 100 mm Hg.
B. the body cannot compensate for rapid blood loss.
C. at least 10% of the patient’s blood volume is lost.
D. the clotting ability of the blood is enhanced.
B. the body cannot compensate for rapid blood loss.
Explanation
Hypovolemic shock occurs when the body loses 20%+ of its fluids resulting in hypoperfusion (shock)
A. Incorrect - the patient’s systolic blood pressure is less than 100 mm Hg.
This is a contraindication to Nitroglycerin because the drug will create a hypotensive emergency, but is still considered normal blood pressure. This does not indicate shock alone.
C. Incorrect - at least 10% of the patient’s blood volume is lost.
Hypovolemic shock occurs at 20% fluids loss.
D. Incorrect - the clotting ability of the blood is enhanced.
There is evidence to support hypercoagulability during hypovolemia, but it is not the cause of hypervolemia.
If applying a dressing to control the bleeding of a patient’s arm, the EMT should ________.
Select one:
A. apply direct pressure first
B. use large or small gauze pads or dressings depending upon the size of the wound
C. cover the entire wound, above and below, with the dressing
D. All of these answers are correct.
D. All of these answers are correct.
If direct pressure fails to immediately stop severe bleeding from an extremity, you should apply:
Select one:
A. a splint and elevate the extremity.
B. additional sterile dressings.
C. a tourniquet proximal to the injury.
D. digital pressure to a proximal artery.
C. a tourniquet proximal to the injury.
Explanation
A. a splint and elevate the extremity.
- “Previously, elevation of the extremity was also recommended, but there is no evidence it helps to control bleeding and it may aggravate other injuries.” (pg 889)
- A splint aid in not moving the injury which would push more blood towards the wound. If direct pressure has failed, splinting won’t be more effective.
B. additional sterile dressings.
More packing aids in keeping the blood contained but does not stop the bleeding as effectively as direct pressure. More dressings won’t be more effective.
D. digital pressure to a proximal artery.
Digital pressure to a “pressure point” used to be recommended. As this is creating a less effective form of a tourniquet and once this protocol is indicated, it can only be removed by a physician. All this in mind, manual pressure is not stable and stops the medical provider from performing any other action.
In older patients, the first indicator of non-traumatic internal bleeding may be:
Select one:
A. a low blood pressure.
B. weakness or dizziness.
C. diaphoresis and pale skin.
D. a heart rate over 120 beats/min.
B. weakness or dizziness. (pg 885)
Explanation
Basically, it’s because the book says so and doesn’t offer more on as to why this is a first indicator.
A. a low blood pressure.
Low blood pressure (LBP) alone is a late stage of shock and would be traumatic. Non-traumatic, LBP can also be caused by certain medications that are more prevalent in older patients
C. diaphoresis and pale skin.
Diaphoresis and pale skin are indicators of shock
D. a heart rate over 120 beats/min.
This is simply tachycardic
Internal bleeding into a fractured extremity is MOST often controlled by:
Select one:
A. splinting the extremity.
B. applying a tourniquet.
C. keeping the patient warm.
D. applying chemical ice pack.
A. splinting the extremity (pg 894)
Explanation
“Air splints (commonly known as soft splints or pressure splints) can control internal or external bleeding associated with severe extremity injuries, such as fractures. They also immobilize the fracture itself. An air splint acts like a pressure dressing applied to an entire extremity rather than to a small local area.” (pg 894)
B. applying a tourniquet.
This cuts off blood but would not stop the bone shards from tearing into surrounding tissues increasing bleeding once the tourniquet is removed, and does not stop the bone tissues from being further damaged due to movement.
C. keeping the patient warm.
This will help to treat shock, but will not stop bleeding nor prevent the fracture from becoming worse.
D. applying chemical ice pack.
This can help reduce blood rushing to the area, but it may not stop the bleeding not stabilize the fracture.
Significant vital sign changes will occur if the typical adult acutely loses more than ______ of their total blood (fluid) volume.
Select one:
A. 5%
B. 15%
C. 10%
D. 20%
D. 20%
Explanation
“The body cannot tolerate an acute blood loss of greater than 20% of this total blood volume, or more than 2 pints (about 1 liter) in the average adult.” (pg 882)
The severity of bleeding should be based on all of the following findings, EXCEPT:
Select one:
A. clinical signs and symptoms.
B. the mechanism of injury.
C. systolic blood pressure.
D. poor general appearance.
C. systolic blood pressure.
Explanation
- “Remember that blood pressure may be the last measurable factor to change in shock. As we have seen, the body has serval automatic mechanisms to compensate for the initial blood loss and to help maintain blood pressure. Thus, by the time you detect a drop in blood pressure, shock is well developed.” (pg 496-497)
- The other signs and symptoms can help to decrease the time shock has to develop. Blood Pressure may not be an early nor effective indicator of severe bleeding.
What mechanism(s) does the body use to control bleeding?
Select one:
A. Clotting
B. Coagulation
C. Vasoconstriction
D. All of these answers are correct.
D. All of these answers are correct.
Whether you are using a commercial device or a stick and triangular bandage as a tourniquet, it is important to remember that: Select one: A. the tourniquet should only be removed at the hospital because bleeding may return if the tourniquet is released. B. bulky dressings should be securely applied over the tourniquet to further assist in controlling the bleeding. C. you should try to control the bleeding by applying pressure to a proximal arterial pressure point first. D. the tourniquet should be applied directly over a joint if possible because this provides better bleeding control.
A. the tourniquet should only be removed at the hospital because bleeding may return if the tourniquet is released.
Which of the following findings would be the MOST significant when assessing a patient with possible internal bleeding?
Select one:
A. The patient has not eaten in 24 hours.
B. The patient had a stroke 5 years prior.
C. The patient takes rivaroxaban (Xeralto).
D. The patient has a history of hypertension.
C. The patient takes rivaroxaban (Xeralto).
