EMT: Chapter 25 [bleeding]

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:

spleen

Internal bleeding into a fractured extremity is MOST often controlled by:

splinting the extremity

When using a stick and square knot as a tourniquet to control severe bleeding from an amputated arm, the EMT should:

stop twisting the stick when the bleeding stops

The severity of bleeding should be based on all of the following findings, EXCEPT:

systolic BP

Which part of the cardiovascular system is considered "a container"?

the blood vessels

Hypovolemic shock occurs when:

the body cannot compensate for rapid fluid loss

External bleeding from a vein is relatively easy to control because:

veins are under a lower pressure

Which portion of the blood carries oxygen to and wastes away from body tissues?

RBCs

An infant with a total blood volume of 800 mL would start showing signs of shock when as little as ______ of blood is lost.

100 mL

Which organ or organ system has the greatest tolerance for lack of perfusion (shock)?

GI system

Which type of bleeding is characterized by a bright red color and spurting?

arterial

The smaller vessels that carry blood away from the heart and connect the arteries to the capillaries are called the:

arterioles

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:

assist the patient's ventilations

An organ or tissue may be better able to resist damage from hypoperfusion if the:

body's temperature is considerably less than 98.6 F

Perfusion is MOST accurately defined as the:

circulation of blood within an organ in adequate amounts to meet the organ's metabolic needs

What mechanism(s) does the body use to control bleeding?

clotting, coagulation, vasoconstriction

an organ or tissue that is considerably ____________ is much better able to resist damage from hypoperfusion.

colder

In older patients, the first indicator of nontraumatic internal bleeding may be:

weakness or dizziness

How soon do cells in the brain and spinal cord start to die without constant perfusion?

within 4-6 minutes

In which of the following situations would external bleeding be the MOST difficult to control?

femoral artery laceration and a blood pressure of 140/90 mm Hg

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:

gastrointestinal bleeding

Which of the following conditions might an EMT suspect as a possible cause for bleeding from the nose and mouth?

(all of the above): skull fracture, high BP, sinus infection

Most cases of external bleeding from an extremity can be controlled by:

applying local direct pressure

A fractured femur can result in the loss of ______ or more of blood into the soft tissues of the thigh.

1 L

Significant vital sign changes will occur if the typical adult acutely loses more than ______ of his or her total blood volume.

20%

In general, what is the maximum amount of acute blood loss the adult body can tolerate?

20% of the total body volume (1 liter)

What is the approximate blood volume of an 80-kg adult male?

5.60 L

Which of the following statements regarding the clotting of blood is correct?

a person taking blood thinners will experience slower blood clotting

If direct pressure fails to immediately stop severe bleeding from an extremity, you should apply:

a tourniquet proximal to the injury

Which of the following would be the first sign of hypovolemic shock?

anxiety

when treating a patient with signs and symptoms of hypovolemic shock and no outward signs of bleeding, always consider the possibility of bleeding into the:

abdomen

Blood stasis, changes in the vessel wall, and certain medications affect the:

ability of the blood to effectively clot

the most common symptom of internal abdominal bleeding is:

acute abdominal pain

You determine that your patient is experiencing internal bleeding. What should you do first?

administer O2

Which of the following splinting devices would be MOST appropriate to use for a patient who has an open fracture of the forearm with external bleeding?

air splint

A 48-year-old male has a suspected open-book pelvic fracture. He is conscious but restless, and his skin is pale and diaphoretic. His respirations are 22 breaths/min and his pulse rate is 120 beats/min. There is no external bleeding noted. The EMT should:

apply a compression device around his pelvis

What should you do first to control external bleeding in an extremity?

apply direct pressure

If applying a dressing to control the bleeding of a patient's arm, the EMT should ________.

apply direct pressure first, use large or small gauze pads or dressings depending on the size of the wound, and cover the entire wound above/below with the dressing

A 39-year-old male accidentally cut his wrist while sharpening his hunting knife. He is conscious and alert with adequate breathing, but is bleeding significantly from the wound. You should:

control the bleeding with direct pressure

In nontrauma patients, an early indicator of internal bleeding is:

dizziness upon standing

Gastrointestinal bleeding should be suspected if a patient presents with:

hematemesis

Which of the following is a term for vomited blood?

hematemesis

signs and symptoms of internal bleeding in both trauma and medical patients include:

hematemesis

The ability of a person's cardiovascular system to compensate for blood loss is MOST related to:

how rapidly he or she bleeds

The condition in which low blood volume results in inadequate perfusion is called what?

hypovolemic shock

if the typical adult loses more than 1 L of blood, significant changes in vital signs, such as _______________ will occur.

increased respiratory rate

Bleeding from the nose following head trauma:

is a sign of skull fracture and should not be stopped

You are assessing a patient who is bleeding from the ear, which gives you a high index of suspicion that he has a skull fracture. How should you address this?

loosely cover the site

the first sign of hypovolemic shock is a change in:

mental status

blood leaves each chamber of a normal heart through a(n):

one-way valve

Early signs and symptoms of intra-abdominal bleeding include:

pain and distention

Which of the following statements regarding hemophilia is correct?

patients with hemophilia may bleed spontaneously

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. Preferred treatment for this patient includes:

pinching the patient's nostrils and having him lean forward

After applying a pressure dressing to a laceration on a patient's arm, you notice that blood is slowly beginning to saturate it. You should:

place additional dressings over the wound

A 22-year-old male was kicked in the abdomen multiple times during an assault. He is conscious but restless and his pulse is rapid. Your assessment reveals a large area of bruising to the right upper quadrant of his abdomen. The MOST appropriate treatment for this patient includes:

preparing for immediate transport

which of the following is NOT a factor in the formation of blood clots?

pumping function of the heart (IS: blood stasis, ability of blood to clot, & changes to the walls of blood vessels)

During transport of a 40-year-old female with acute abdominal pain, you note that she has stopped talking to you and has become extremely diaphoretic. You should:

repeat the primary assessment

The systemic veins function by:

returning deoxygenated blood back to the body

Which section of the heart receives deoxygenated blood?

right

Hypoperfusion is another name for:

shock

Which condition is likely when signs of hypotension; tachycardia; and cool, clammy skin are found?

shock

Which of the following body systems or components is the LEAST critical for supplying and maintaining adequate blood flow to the body?

the filtering of blood cells in the spleen

Which of the following organs/body systems cannot tolerate lack of blood flow for more than a few minutes?

the heart and brain

You arrive at the home of a 50-year-old female with severe epistaxis. As you are treating her, it is MOST important to recall that:

the patient is at risk for vomiting and aspiration

When encountering a suspected bleeding emergency, the most pertinent finding during the SAMPLE history phase of assessment would be that ________.

the patient states that she takes blood-thinner medications

Which of the following findings would be the MOST significant when assessing a patient with possible internal bleeding?

the patient takes rivaroxaban (Xarelto)

Whether you are using a commercial device or a stick and triangular bandage as a tourniquet, it is important to remember that:

the tourniquet should only be removed at the hospital because bleeding may return if the tourniquet is released