Chapter 25 Bleeding

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.

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.

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.

Circulation of blood within an organ or tissue in adequate amounts to meet the cells’ oxygen, nutritional, and waste-removal needs is termed _______.

perfusion

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.

Hypovolemic shock occurs when:

the body cannot compensate for rapid blood loss.

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

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.***

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

a tourniquet proximal to the injury.

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

weakness or dizziness.

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

splinting the extremity.

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

20%

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

systolic blood pressure.

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

A. Clotting B. Coagulation C. Vasoconstriction 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:

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?

The patient takes rivaroxaban (Xeralto).

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

Which of the following statements regarding hemophilia is correct?

Patients with hemophilia may bleed spontaneously.

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

Gastrointestinal system

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

Red blood cells

Which section of the heart receives deoxygenated blood?

Right

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

The heart and brain

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

The blood vessels

Which of the following is a term for vomited blood?

Hematemesis

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

A skull fracture High blood pressure A sinus infection All of these answers are correct.***

Hypoperfusion is another name for:

shock.

Perfusion is MOST accurately defined as the:

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

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

5.60 L

Hypovolemic shock occurs when:

the body cannot compensate for rapid fluid loss.

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

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

A person taking blood thinners will experience slower blood clotting.

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

1 L

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.

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.

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.

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.

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.

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.

Bleeding from the nose following head trauma:

is a sign of a skull fracture and should not be stopped.

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.