PHTLS Questions Answers
Class I Hemorrhage - ANS up to 15% blood loss, minimal tachicardia, no measurable changes
in BP or pulse pressure, or RR
Class II Hemorrhage - ANS 15-30% Most adults are capable of compensating, increased RR,
Tachycardia, narrowed pulse pressure,
Class III Hemorrhage - ANS 30-40% no longer able to compensate for volume loss,
hypotension occurs, HR >120 BPM, RR 30-40, severe anxiety or confusion
Class IV Hemorrhage - ANS more than 40% loss, severe shock, HR >140 BPM, RR >35,
confusion lethargy, decreased systolic blood pressure, typically in the range of 60 mm Hg.
Ratio for loss blood replacement - ANS 3 litres of electrolyte solution replacement for each liter
of blood lost
Distributive Shock - ANS uncontrolled vasodilation causes reduced resistance causing a
decrease in the diastolic blood pressure
Distributive Shock - ANS Decrease in preload+decrease in cardiac output
Psychogenic Shock - ANS Vasovagal - stimulation of the tenth cranial nerve (vagus nerve)
produces bradycardia. May also cause vasodilation.
Typically occurs in a very brief period.
Septic Shock - ANS Cytokines released because of an infection can cause damage to blood
vessel walls and cause vasodilation
Anaphylactic Shock - ANS Respiratory distress, airway obstruction and vasodilation
Potential Blood loss from a single femoral fracture - ANS 30-40%
Amount of blood loss that can happen before signs of compensatory mechanisms fail and BP
become <90 mmHq - ANS Greater than 30%
Hypertension medications that may prevent compensatory tachycardia to maintain BP - ANS
Beta Adrenergic blocking agents and calcium channel blockers
Managing Volume Resuscitation
, Uncontrolled hemorrhage-suspected chest, abdomen, retroperitonium - ANS Maintain a systolic
bp 80-90 or MAP 60-65
Managing Volume Resuscitation
CNS injuries or TBI - ANS maintaining the systolic BP (SBP) above 90 or MAP 85-90
Managing Volume Resuscitation
Controlled Hemorrhage
large scalp or extremity controlled with a tourniquet, PT falls into class II,III,IV shock - ANS
rapid bolus of 1-2 litres
Three responses of initial fluid bolus
Rapid Response - ANS vital signs return indicating that PT lost less than 20%
PT is best managed at SBP between 80-90, IV fluid should be titrated
Three responses of initial fluid bolus
Transient Response - ANS Vital signs improve (pulse slows, BP increases) however PT shows
deterioration. PT has typically lost 20-40% of blood volume
Three responses of initial fluid bolus
Minimal or no response - ANS No change in PT after 1-2 liter Bolus
Leading cause of TBI - ANS MVC
Three separate membranes that surround the brain - ANS meninges
Outermost meninges - ANS Dura mater- composed of tough fibrous tissue
The innermost meninges that is directly in contact with the brain - ANS Pia Mater-
Vessels that lay on top of the Pia Mater - ANS Cerebral Blood Vessels
The meninge that lays in the middle between the dura and pia mater - ANS Arachnoid
membrane-loosely covers the brain and its blood vessels
MAP-Mean Arterial Pressure - ANS The average pressure for the entire cardiac cycle
MAP=Diastolic Pressure + 1/3 of the Pulse Pressure
PP- Pulse Pressure - ANS The difference between the systolic and diastolic
PP= Systolic (SBP) - Diastolic (DBP)
CPP- Cerebral Perfusion Pressure - ANS The amount of pressure it takes to push blood
through the cerebral circulation. CPP=Mean Arterial pressure (MAP) - Intracranial pressure
(ICP)
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