Chapter 30: Ready for Review
 The cardiovascular and respiratory systems have distinct roles in keeping blood flowing
between the lungs and peripheral tissues.
 Perfusion is the circulation of blood within an organ or tissue in adequate amounts to
meet the cells’ current needs for oxygen, nutrients, and waste removal.
 Hemorrhage simply means bleeding. Bleeding can range from a “nick” to a capillary
while shaving, to a severely spurting artery from a deep slash with a knife, to a ruptured
spleen from striking the steering column during a car crash.
 External hemorrhage can usually be easily controlled by using direct pressure or a
pressure bandage. For extremities, if these methods are not sufficient, use a tourniquet.
 Internal hemorrhage is often not controlled until a surgeon locates the source and sutures
it closed.
 Hemorrhagic shock is the most common cause of shock.
 Hypovolemic shock caused by hemorrhagic trauma has been classified by the American
College of Surgeons Committee on Trauma into four classes, each with its own specific
characteristics and treatments.
 Shock occurs in three successive phases—compensated shock (classes I and II),
decompensated shock (class III), and irreversible shock (class IV).
 Hypoperfusion (shock) occurs when the level of tissue perfusion decreases below normal.
 Early decreased tissue perfusion may result in subtle changes, such as aberrant mental
status, long before a patient’s vital signs (that is, blood pressure, pulse rate, respiratory
rate) appear abnormal.
 As with any patient, airway and ventilatory support take top priority when treating a
patient with suspected shock.
 Stabilizing a serious fracture has a high priority in the control of bleeding. Splinting the
fracture helps control bleeding, and splinting should occur before other bleeding control.
 Methods for controlling external hemorrhage include direct, even pressure; pressure
dressings and/or splints; and tourniquets. Most cases of external hemorrhage can be
controlled with direct pressure to the bleeding site.
 If direct pressure fails to immediately stop the hemorrhaging of an extremity, apply a
tourniquet above the level of the bleeding. If a commercial tourniquet is not available, a
tourniquet can be improvised with a triangular bandage and a stick or rod.
 If bleeding is present at the nose and a skull fracture is suspected, place a gauze pad
loosely under the nose.
 Management of a patient with internal hemorrhaging focuses on the treatment of shock,
minimizing movement of the injured or bleeding part or region, and rapid transport.
 Patients who have suspected shock, whether compensated or decompensated, can benefit
from early surgical intervention and should be transported to a facility with those
capabilities.
 Be alert, and search for early signs of shock.