How long can lungs and kidneys survive for without adequate perfusion?
Almost an hour
How long can skeletal muscles survive without adequate perfusion?
2 hours
The heart
Can function even if nervous system shuts down
Capillaries
Diameter of a single RBC
Blood clot forms depending on one or more of the following principles
Blood stasis, changes in vessel walls (such as wound) or blood's ability to clot (due to disease process or medication)
Final step in formation of blood clot
As RBC's begin to clump, another substance in the body called fibrinogen reinforces the RBC's
Blood supply to organs
Some tissues require constant blood supply ,while others circulate blood only intermittently
How long does it take for heart and lungs to be injured after loss of perfusion?
4-6 min
Cells of CNS
Do not have ability to regenrate
How long does it take for kidneys to be damaged without perfusion?
45 min
How long does it take for GI tracts to be damaged without perfusion?
A little longer than 2 hours
Cushing's reflex
Bradychardic, widening bp, and irregular respirations like cheyne-stokes respirations, central neurogenic hyperventilation, or Biot respirations) - brain is becoming hypoperfused so it sends out sympathetic and parasympathetic response (HR is lowered and
Amount of blood loss and damage in body
Normal body has 5-6 L; significant changes in vital will occur after 1L is lost (increased heart rate and respirations and decrease in bp); 1 year old has 800 mL and changes in vitals occur after 100 mL to 200 mL; how well people compensate for blood loss
Consider bleeding to be serious if
Associated with significant MOI, Patient has poor general appearance and is calm, assessment reveals signs and symptoms of shock, you note significant amount of blood loss, blood loss is rapid, can't control bleeding
Arterial Bleeding
Bleeding from open artery is bright red and spurts with pulse; difficult to control because of high pressure; bp and spurting will slow as loss of blood occurs
Venous bleeding
Darker; flows slowly or severely depending on size; under less pressure and doesn't spurt; easier to manage; can be profuse and life threatening; more likely to clot spontaneously than arterial bleeding
Capillary bleeding
Dark red blood oozes from wound slowly but steadily; more likely to spontaneously clot than arterial bleeding
Normally after you are cut...
On its own, bleeding tends to stop within 10 min in normal response to internal mechanism and exposure to air; at first blood flows rapidly from open vessel, but soon after the cut ends of the vessel begins to narrow, reducing the amount of bleeding, then
Times when normal body mechanisms will fail for loss of blood
Movement, meds, removal of bandages, external environment, body temp
Hemophilia
body does not have one or more of the factors that affect clotting
How much blood loss can occur when you break a femur?
1 L or more of blood can leak into soft tissues of the thigh
Most common symptom of internal bleeding
Pain
What can bleeding in the chest cause?
dyspnea, tachycardia, hypotension
Other names for a bruise
Contusion, ecchymosis or hematoma (Mass of blood in soft tissue beneath the skin)
Signs and symptoms of closed fracture bleeding
Pain, tenderness, bruising , guarding, swelling
Signs and symptoms of lacerated spleen or liver
Broken ribs, bruises over the lower parts of the chest, and rigid, distended abdomen
The first sign of hypovolemic shock
AMS such as anxiety, restlessness and combativeness
Methods to control external bleeding
1. Direct even pressure and elevation (6", hold pressure for at least 5 min)
2. Pressure dressings and/or splints
3. Tourniquets
*Use 4"x4" gauze pads for smaller wounds and sterile universal dressing for larger wounds
What to do if an object is coming out of external wound
apply bulky dressings to stabilize object in place
What to do if an open fracture causes external bleeding
DO NOT elevate until you have splinted it
When will bleeding stop?
When external pressure exceeds arterial pressure
When and how to use a tourniquet
Especially useful if patient has substantial bleeding from and extremity injury below axilla or groin 1. Follow protocol 2. Hold direct pressure over bleeding site 3. Place tourniquet around the extremity just above the bleeding site 4.. Click the buckle
Applying tourniquet using at triangular bandage and stick or rod (if commercial tourniquet is not available
**Never cover the tourniquet with a bandage 1. Fold bandage until it is 4" wide and 6-8 layers thick 2. Wrap the bandage around the extremity twice. Choose an area only slightly proximal to the bleeding to reduce the amount of tissue damage to the extremi
Types of splints
Air splint (soft splint, pressure splint), Rigid splint (classic), Traction splint (for femur fracture)
Air Splint
Acts like a pressure dressing applied to an entire extremity rather then to a small, local area; Use only approved, clean or disposable valve stems when orally inflating
Traction Splint
Stabilize femur fractures; When EMT pulls traction to the ankle, counteraction is applied to the ischium and groin, this reduces thigh muscle spasms and prevents one end of the fracture from impacting or overriding the other; pad the areas well to prevent
Nose picking
Digital trauma
Epistaxis
Nose bleed
How to control epistaxis
1. Follow protocol 2. Help patient sit, lean forward with head tilted forward 3. Apply direct pressure for at least 15 min by pinching fleshy parts of nostrils together 4. Place rolled 4"x4" gauze between upper lip and gum to control bleeding as another o
Symptoms of skull fracture
Bleeding from ears or nose **Do not attempt to stop bleeding (pressure may cause blood to collect in the head)
How to treat skull fracture
Loosely cover bleeding site with a sterile gauze pd to collect blood and help keep contaminants away from the site. Apply tight compression by wrapping the dressing loosely around the head.
Signs of CSF
Staining of the dressing looks like a halo
Caring for patients with internal bleeding
You can usually control bleeding by splinting the extremity, usually most affectively with air splint, and you should never use a tourniquet to control bleeding from closed, internal, soft tissue injuries