Hemorrhage - Book 4

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Hemorrhage - Book 4
2010-06-05 19:23:07

Hemorrhage - Book 4
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  1. Shock
    State of inadequate tissue perfusion

    (The transition between normal function and death)
  2. Preload
    The pressure exerted by blood as it returns from the venous system (pressure within the ventricles at the end of diastole)

    Preload serves to fill the empty heart
  3. Starling's Law of the Heart
    Increase in cardiac contractility due to myocardial muscle stretching

    Def: An increase in cardiac output occurs in proportion to the diastolic stretch of the heart muscle fibers
  4. Afterload
    Resistance by the arteries to the heart's pumping

    Def: The resistance a contraction of the heart must overcome in order to eject blood (the tension of cardiac muscle during systole)
  5. Normal cardiac output is ____ L/minute

    • Stroke Volume x Heart Rate = Cardiac Output
    • ex: 70 mL x 70bpm = 4,900 mL (4.9L)
  6. Microcirculation
    Blood flow in the arterioles, capillaries and venules (the smallest of vessels)
  7. Tunica Adventitia
    Outer layer of artery (blood vessel) that determines the artery's max diameter
  8. Tunica Media
    The middle layer of artery that controls the vessel lumen size (diameter) - hence the flow of blood through the artery
  9. Tunica intima
    Smooth interior layer of artery that provides for free flow of blood
  10. Hemoglobin
    A molecule to which oxygen attaches when red blood cells pass through the pulmonary circulation

    Def: An iron-based compound found in red blood cells that bind with oxygen and transport it to body cells
  11. Hematocrit
    Percentage of total blood volume that consists of red blood cells
  12. Platelet
    Small, irregular shaped cytoplasm fragment that is important for clotting and the repair of blood vessels
  13. Types of hemorrhage
    Capillary: slow, even flow. Bright red color

    Venous: Steady, slow flow. Dark red color

    Arterial: Spurting blood. Pulsating flow. Bright red color.
  14. Phases of the clotting process
    Vascular phase: 1st step- Smooth blood vessel muscle contracts, reducing vessel lumen and flow of blood through it

    Platelet Phase: 2nd step - platelets adhere to blood vessel walls and to each other (aggregate)

    Coagulation: 3rd step - formation of protein called fibrin that forms a network around a wound to stop the bleeding, ward off infection and lay a foundation for healing and repair of the wound.
  15. Fibrin
    Protein fibers that trap red blood cells as part of the clotting process.
  16. Lactic acid
    Compound produced from pyruvic acid during anaerobic glycolysis
  17. Anaerobic
    Able to live without oxygen
  18. Epistaxis
    Nose bleed
  19. Heomptysis
    Coughing up blood
  20. Esophageal Varices
    Enlarged and tortuous esophageal veins
  21. Melana
    Black, tar like feces due to gastrointestinal bleeding

    (blood remaining in the bowel for some time)
  22. Anemia
    Reduction in the hemoglobin content in the blood to a point below that required to meet oxygen requirements of the body
  23. Fluid accounts for ____ percent of body's weight?
  24. Stage 1 Hemorrhage
    • Blood loss up to 15%
    • Patient may display some nervousness and marginally cool skin with slight pallor
  25. Catecholamine
    A hormone, such as epi or norepi, that strongly affects the nervous and cardiovascular systems, metabolic rate, temperature and smooth muscle
  26. Stage 2 Hemorrhage
    Blood loss of 15-25%

    Patient displays thirst, anxiety, restlessness, cool clammy skin, increased respiratory rate
  27. Stage 3 Hemorrhage
    Blood loss between 25-35%

    • Pt experiences air hunger, dyspnea, severe thirst, anxiety, restlessness
    • Survival unlikely without rapid intervention
  28. Stage 4 Hemorrhage
    Blood loss greater than 35%

    Pulse barely palpable, respirations ineffective, patient lethargic, confused, moving towards unresponsiveness

    Survival unliklely
  29. Injuries that can cause significant blood loss:
    • Fractured Pelvis - 2,000mL
    • Fractured Femur - 1,500mL
    • Fractured Tibia/fibula - 750mL
    • Fractured Humerus - 750mL
    • Large Contusion - 500mL
  30. Hematochezia
    Stool with frank blood in it - reflects active bleeding in the colon or rectum
  31. Orthostatic Hypotension
    A decrease in blood pressure that occurs when a person moves from a supine to an upright position
  32. Tilt Test
    Drop in systolic BP of 20 mmHg or an increase in the pulse rate of 20bpm when a patient is moved from supine to sitting

    = suggestive of relative hypovolemia