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98 Cards in this Set

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  • Back
What is the leading cause of death in the United States for people age 1 to 44?
What are the three main components of the circulatory (or cardiovascular) system?


Blood vessels
What are the five functions of blood?
1) Transportation of gases

2) Nutrition

3) Excretion

4) Protection

5) Regulation
Define "perfusion."
The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries
Define "hypoperfusion."
Inability of the body to adequately circulate blood to the body's cells to supply them with oxygen and nutrients. Also known as shock. A life-threatening condition.
Define "shock."
Also known as hypoperfusion -- the inability of the body to adequately circulate blood to the body's cells to supply them with oxygen and nutrients. A life-threatening condition.
Define "hemorrhage."
Bleeding, especially severe bleeding
What is the main cause of shock/hypoperfusion?
What organs are the most sensitive to inadequate perfusion?

Spinal cord

What are Plavix and Coumadin?
Two common "blood-thinner" medications that can make hemorrhaging more severe. Always find out about blood thinners when taking a SAMPLE history.
External bleeding is often classified by which vessels are damaged and bleeding. Following this logic, what are the three classifications of external bleeding?
1) Arterial bleeding

2) Venous bleeding

3) Capillary bleeding
Between arterial bleeding, venous bleeding, and capillary bleeding, which is toughest to control?
Arterial bleeding
In cases of arterial bleeding, what color is the blood?
Bright red
Define "arterial bleeding."
Bleeding from an artery, which is characterized by bright red blood and as rapid, profuse, and difficult to control.
Define "venous bleeding."
Usually dark red or maroon in color, venous bleeding flows steadily, and the bleeding can be profuse. It is usually easy to control. Especially when dealing with very large veins like the jugular, damage to the vein can actually suck in air or debris and cause an embolism.
Define "capillary bleeding."
Usually slow and oozing, generally minor and easy to control. Color is somewhere between the bright red of arterial blood and the deep maroon of venous blood.
A sudden loss of ____ liter(s) of blood (____ cc) is considered serious in an adult.
1 liter, or 1000 cc
A sudden loss of ____ liter(s) of blood (____ cc) is considered serious in a child.
1/2 liter, or 500 cc
A sudden loss of ___ cc of blood is considered serious in a one-year-old baby.
150 cc
If a patient is bleeding and the patient is showing signs of shock, the bleeding should be considered _____.
What are the main signs of shock, in order of appearance?
1) Altered mental status

2) Pale, cool, clammy skin

3) Nausea and vomiting

4) Vital sign changes:
a) pulse increases and weakens
b) respirations increase
c) soon, blood pressure drops -- this is severe
d) systolic and diastolic pressures become closer to one another
Besides the main signs of shock (altered mental status, skin changes, nausea, vital sign changes), what other signs might you see?
1) Thirst

2) Dilated pupils

3) Cyanosis around lips and nail beds
What are the three main methods of controlling bleeding?
1) Direct pressure

2) Hemostatic dressings

3) Tourniquets
In case of profuse bleeding, spurting blood, etc...
...don't waste time finding a dressing. Use your gloved hand to apply pressure as quickly as possible.
What are the four things to remember when applying direct pressure in order to control bleeding?
1) Apply pressure until the bleeding is controlled

2) If the bleeding is from an extremity and you don't suspect a broken bone, elevate the extremity above the level of the heart

3) Never remove a dressing once applied.

4) Evaluate your efforts, and be prepared to move on to the next step in controlling the bleeding
Define "pressure dressing"
a bulky dressing held in position with a tightly wrapped bandage to apply pressure to help control bleeding.
Define "tourniquet."
A device used for bleeding control that constricts all blood flow to and from an extremity
Where can a tourniquet be used?
Only on extremity injuries. Do NOT place the tourniquet on a joint (if the wound is on the knee, for example, apply the tourniquet ABOVE the knee), and try to apply the tourniquet about two inches, no more, proximal to the wound.
How can you make an improvised tourniquet?
Use anything that can provide a 2-4" wide band several layers thick. You can even use a blood pressure cuff.
When should you loosen a tourniquet?
ONLY when advised by medical direction. Loosening it can burst open formed clots and cause bleeding to continue.
Define "pressure point."
A site where a main artery lies near the surface of the body and directly over a bone. Pressure on such a point can stop distal bleeding.
What's a term used to describe a site where a main artery lies near the surface of the body and directly over bone? Pressure on such a site can stop distal bleeding...
Pressure point
What four sites are used as pressure points to control bleeding?
The left and right brachial arteries

The left and right femoral arteries
Where will you find the pressure point used to control distal bleeding of the arm?
On the medial aspect of the upper arm, inside the groove between the biceps and the humerus, midway between shoulder and elbow. This is where you can compress the brachial artery.
Where will you find the pressure point used to control distal bleeding of the leg?
On the medial side of the anterior thigh where it joins the lower trunk of the body. Push hard. That's the femoral artery.
Are splints used as a method of controlling bleeding?
Yes. By stabilizing jagged broken bones, splints can prevent further damage. Also, air splints produce a form of direct pressure.
Air splints are most useful for the control of _____ and _____ bleeding.
Venous and capillary
What are the benefits of using cold packs on a bleeding site?
Cold packs constrict blood vessels, reducing bleeding and swelling, and also ease pain. They should ONLY be used in conjunction with other methods of bleeding control, not as a standalone solution.
A pneumatic anti-shock garment (PASG) can help control bleeding in what areas of the body? How?
1) Lower extremities by direct pressure

2) Pelvic and abdominal cavities by indirect pressure
When is it advised to inflate ONLY the abdominal section of a PASG (pneumatic anti-shock garment?)
What is a contraindication for using a PASG (pneumatic anti-shock garment)?
Shock is present and there is a severe chest wound.
You should remove a patient's ____ _____ _____ before applying a PASG (pneumatic anti-shock garment)
Lower outer garments
If you're going to apply a pneumatic anti-shock garment (PASG) to a patient and you can't remove their lower garments, what should you at least do?
Remove the patient's belt and take sharp objects out of pockets
When should a pneumatic anti-shcok garment (PASG) be removed?
When the patient is stable, an operating room is immediately available, in the presence of a physician that directs you to remove the PASG.
When should you apply ice packs directly to the skin.
Why shouldn't you apply ice packs directly to the skin?
Ice packs directly on the skin can cause frostbite and further damage to the tissue. ALWAYS wrap the ice pack in a towel, and don't leave it in place for more than 20 minutes.
How long should a cold pack be applied to the skin?
No longer than 20 minutes.
When should you use a blood pressure cuff to control bleeding?
When a proper tourniquet is unavailable and the patient has a life-threatening bleed on an extremity.
When should a blood pressure cuff (used as a makeshift tourniquet) be removed from a patient?
Once a pressure dressing and bandage has been applied. Remove the cuff immediately, albeit slowly, once a dressing and bandage has been applied.
What should the pressure level read on an inflated BP cuff used as a tourniquet?
150 mmHg
What do hemostatic agents do?
They absorb and trap red blood cells and assist in clotting.
HSV ( Hunt SVille )
How do you control flow of cerebral spinal fluid (CSF) leaking from a patient's ears or nose?
You don't. Just gently place gauze under the site to collect the fluid.
Define "epistaxis"
What are the three main classifications of blood vessels?


What is the purpose of arteries?
To carry blood away from the heart.
What is the purpose of veins?
To return blood to the heart.
What are common causes of nosebleeds (epistaxis)?
Increased blood pressure

Sinus infection

Digital trauma (nosepicking)
What steps do you take in order to treat a nosebleed?
1) Have patient sit down and lean forward

2) Have either yourself or your patient apply direct pressure to the fleshy portion of the nose around the nostrils.

3) If patient becomes unconscious, place him in the recovery position and prepare for suction and airway management.
How should you have a patient position themselves when they have a nosebleed?
Have them sit and lean forward. Do not let them lead back, as that could send blood into the stomach and cause nausea and vomiting.
Why is internal bleeding so serious?
1) Damage to internal organs and large blood vessels can result in a great deal of blood loss in a short time.

2) Internal blood loss cannot be seen so it's tough to detect and treat

3) Internal blood loss can be severe and cause shock EVEN if it occurs in the extremities, e.g. the sharp ends of a broken femur can be bad enough to cause shock.
What is the best way to detect internal bleeding?
By judging by the mechanism of injury and by performing a thorough history and medical exam.
If the mechanism of injury suggests the possibility of internal bleeding...
...treat the patient as if they are bleeding internally.
What is the leading cause of internal injuries and bleeding?
Blunt trauma
What are some common mechanisms of blunt trauma that may cause internal bleeding?

Car or motorcycle crashes

Auto-pedestrian collisions

Blast injuries
What are mechanisms of penetrating injury that are likely to cause internal bleeding?
Gunshot wounds

Stab wounds

Impaled objects
List some important indicators of internal bleeding.
1) Injuries to the surface of the body

2) Bruising, swelling

3) Pain over vital organs

4) Painful, swollen, or deformed extremities

5) Bleeding from mouth, rectum, vagina, or any other orifice

6) Tender, rigid, or distended abdomen

7) Vomiting a coffee-ground-like substance or bright red vomitus

8) Dark, tarry stools or bright red in the stool

9) Signs and symptoms of shock -- at this point you have a truly life-threatening situation
What are the four steps of assessing a bleeding patient?
Estimate amount lost


Predict potential shock

Treat external bleeding
What are the four steps of applying a tourniquet?
1) Select site

2) Tighten tourniquet

3) Attach notation to patient (exact time tourniquet is applied)

4) Contact medical direction
What's the problem with using a blood pressure cuff as a tourniquet?
The cuff will slowly deflate. You have to keep an eye on it.
What transport priority to you assign a patient with suspected internal bleeding?
What is the result of untreated shock?
How can the actions of the blood vessels themselves cause shock?
If, for some reason such as anaphylaxis, all the blood vessels decide to dilate at once, there won't be enough blood to adequately fill the increased blood vessel volume, and the body goes into shock.
What is an example of the body making shock worse in its attempts to compensate?
Increased heart rate due to blood loss from bleeding injuries causes more bleeding and lower blood pressure, further increasing the heart rate, and the cycle continues until the patient dies or the bleeding stops.
Generally speaking, what are the three causes of shock?
1) The heart fails as a pump

2) Blood volume is lost

3) Blood vessels dilate excessively
In terms of severity, what are the three stages of shock?
1) Compensated shock

2) Decompensated shock

3) Irreversible shock
Define "compensated shock."
When the patient is developing shock but the body is still able to maintain perfusion.
Define "decompensated shock."
The second stage of shock. Begins at the point when the body can no longer compensate for the low blood volume or lack of perfusion. Late signs such as falling blood pressure develop.
Define "irreversible shock."
When the body has lost the battle to maintain perfusion and irreparable organ and cell damage will inevitably cause death.
Why are children so difficult to assess for shock?
Because their compensating mechanisms are so efficient that they can lose up to half their blood volume before showing changes in blood pressure. Sometimes the first obvious sign of shock in an infant or child is the presence of decompensated shock, and that's a very serious situation indeed.
Define "hypovolemic shock."
Shock resulting from fluid or blood loss
Define "hemorrhagic shock"
Shock resulting from blood loss
Define "cardiogenic shock"
Shock brought on by inadequate pumping of the heart -- often a result of heart attack or congestive heart failure.
Define "neurogenic shock"
Shock due to nerve paralysis (sometimes caused by spinal cord injuries) resulting in excessive dilation of blood vessels.
In order of appearance, what are the outward symptoms of shock?
1) Altered mental status

2) Pale, cool, clammy skin

3) Nausea and vomiting

4) Vital sign changes
a) Pulse rises
b) Respirations increase
c) Blood pressure drops

5) Other symptoms like thirst, dilated pupils, and sometimes cyanosis around lips or nail beds
What are the four primary steps in caring for a patient with internal bleeding?
Maintain ABC's

Administer oxygen

Control external bleeding

Transport immediately
Why shouldn't you use a pulse oximeter on a patient with shock?
Because an oximeter requires adequate perfusion for an accurate reading.
What does the body start to do with blood in the early stages of shock?
It shunts blood away from areas of lesser need to areas of greater need. Vessels in GI organs, skin, extremities, etc. begin to constrict so that the heart, brain, spine, kidneys, and other organs have enough to stay perfused.
What is the goal for on-scene time in a trauma or shock call?
10 minutes or less.

Obviously, the less, the better.
A patient was working on scaffolding and fell about 10 feet. He's conscious, alert, anxious, and has pain on the right side of his chest. Pulse is 102 and regular, respirations 26, skin cool and moist, pupils equal and reactive to light. Do you think he will be stable or do you suspect shock?
Expedite due to possibility of injuries to lungs or organs. Vitals are elevated -- this could be serious.
Your patient is found sitting in a bathroom stall at a restaurant. He's sweaty, pale, leaning against a wall. He tells you he has had a problem with bleeding hemorrhoids lately, and there is bright red blood in the toilet bowl. When you stand him up, he complains he is going to pass out. Do you think he will be stable or do you suspect shock?
This is likely shock. The signs are clear -- pale, sweaty, bleeding is present, and patient almost passes out upon standing (orthostatic hypotension). Move fast.
Patient is a 26-year-old assault victim. His ladyfriend beat him in the head with a phone, causing bleeding from the nose and the forehead. His shirt has streaks of blood on the front, and his nose is still oozing blood. He's alert and oriented, his pulse is 78 strong and regular, respirations 14, skin warm and dry. Do you think he will be stable or do you suspect shock?
He will probably be stable. No outward signs of shock, and the bleeding isn't terribly severe. Still, transport him.
If a patient displays signs of shock and is breathing adequately, what sort of oxygen therapy should you initiate?
Apply high-concentration oxygen via nonrebreather mask
What are contraindications to use of a PASG?
1) Presence of a chest wound

2) Cardiogenic shock

3) Abnormal lung sounds
Which part of a PASG don't you inflate when applying to a child?
The abdominal portion, since it can squeeze a child's chest and interfere with breathing.
What steps do you follow to treat shock?
1) Maintain airway

2) Initiate oxygen therapy

3) Control external bleeding

4) If local protocols call for it, contact medical direction and apply a PASG

5) If no possibility of spinal injury, elevate legs 8-12 inches

6) Prevent loss of body heat by covering patient with blankets

7) Transport immediately!

8) Consider meeting with ALS en route

9) Reassure patient
Small round purplish spots, called petechiae, are caused by:
Capillary bleeding
What type of shock is the one most frequently seen by EMTs?
Hypovolemic shock