Chapter 25 Bleeding

Key Concepts:

Terms in this set (158)

1. Types of blood vessels:
a. Arteries—carry blood away from the heart
i. Become smaller the farther they are from the heart
ii. As blood flows out of the heart, it passes into the aorta, the largest artery in the body
b. Arterioles—smaller vessels that connect the arteries and capillaries
c. Capillaries— pass among all the cells of the body and link arterioles and venules
d. Venules—very small, thin-walled vessels that empty into the veins
e. Veins—carry blood from the tissues to the heart
2. Oxygen and nutrients easily pass from the capillaries into the cells, and waste and carbon dioxide diffuse from the cells into the capillaries.
a. This transportation system allows the body to rid itself of waste products.
3. Blood contains:
a. Red blood cells—responsible for the transportation of oxygen to the cells and for transporting carbon dioxide away from the cells to the lungs
b. White blood cells—responsible for fighting infection
c. Platelets—responsible for forming blood clots
d. Plasma—the fluid portion of the blood
4. Blood clot formation depends on several factors:
a. Blood stasis
b. Changes in the blood vessel walls (such as a wound)
c. Blood's ability to clot (affected by disease or medication)
5. When tissues are injured, platelets begin to collect at the site of injury
a. Red blood cells become sticky and clump together
b. Protein in plasma reinforces the developing clot
6. Autonomic nervous system
a. Monitors the body's needs from moment to moment
b. Adjusts blood flow by constricting or dilating blood vessels
c. Automatically redirects blood away from other organs to the heart, brain,
lungs, and kidneys in an emergency
d. Adapts to changing conditions in the body to maintain homeostasis and perfusion
i. If the system fails to provide sufficient circulation for every body part to perform its function, shock results.
1. Pain (most common)
2.Swelling in the area of bleeding
4.Bleeding into the chest cavity or lung may cause dyspnea, tachycardia, and hypotension, and hemoptysis (bright red blood that is coughed up)
5.Hematoma—a mass of blood in the soft tissues beneath the skin
6.Bruising—a contusion or ecchymosis (may not be present initially)
7.Bleeding from any body opening
a.Bright red bleeding from the mouth or rectum
b. Hematuria—blood in the urine
c. Nonmenstrual vaginal bleeding
8. Hematemesis—vomited blood
a. Bright red or dark red
b. Coffee-grounds appearance
9. Melena—black, foul-smelling, tarry stool with digested blood
10. Pain, tenderness, bruising, guarding, or swelling (possible closed fracture)
11. Broken ribs; bruises over the lower part of the chest; or a rigid, distended abdomen (indicate possible lacerated spleen or liver)
12. Hypoperfusion (hypovolemic shock)
a. Change in mental status, such as anxiety, restlessness, or combativeness
b. Weakness, faintness, or dizziness on standing
c. Changes in skin color or pallor (pale skin)
d. Later signs of hypoperfusion suggesting internal bleeding include:
i. Tachycardia
ii. Weakness, fainting, or dizziness at rest
iii. Thirst
iv. Nausea and vomiting
v. Cold, moist (clammy) skin
vi. Shallow, rapid breathing
vii. Dull eyes
viii. Slightly dilated pupils that are slow to respond to light
ix. Capillary refill of more than 2 seconds in infants and children
x. Weak, rapid (thready) pulse
xi. Decreasing blood pressure
xii. Altered level of consciousness
xii. Altered level of consciousness
H. Patients with these signs and symptoms require prompt transport.
1. The tourniquet is useful if a patient has substantial bleeding from an extremity injury.
2. Several different types of commercial tourniquets are available.
a. Follow the manufacturer's instructions
3. Follow the steps in Skill Drill 25-2 to apply a commercial tourniquet.
4. If a commercial tourniquet is unavailable, you can create a tourniquet using a triangular bandage and a stick or rod:
a. Fold a triangular bandage until it is 4 inches (101 mm) wide and six to eight layers thick.
b. Wrap the bandage around the extremity twice. Place the bandage high and tight, proximal to the injury.
c. Tie one knot in the bandage. Then place a stick or rod on top of the knot, and tie the ends of the bandage over the stick in a square knot.
d. Use the stick or rod as a handle, and twist it to tighten the tourniquet until the bleeding has stopped.
e. Secure the stick in place, and make the wrapping neat and smooth.
f. As a last resort, you can use a blood pressure cuff as a tourniquet.
5. Whenever you apply a tourniquet, make sure you observe the following precautions:
a. Do not apply a tourniquet directly over any joint.
b. Always place the tourniquet proximal to the injury.
c. Make sure the tourniquet is tightened securely.
d. Never use wire, rope, a belt, or any other narrow material because it could cut into the skin.
e. Place padding under the tourniquet if possible to protect the tissues and help with arterial compression.
f. Never cover a tourniquet with a bandage.
g. Do not loosen the tourniquet after you have applied it.
6. Mark the exact time the tourniquet was applied and be sure to communicate the time and site of application, and the rationale of application clearly and specifically to hospital personnel.