Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Trauma and Hemorrhage

—

In one line

·Trauma breaks blood vessels and organs; bleeding (hemorrhage) (uncontrolled bleeding) drains the body's blood supply and causes shock (not enough blood pressure to feed vital organs).

—

Normal physiology

·Blood flows in a closed loop of vessels — arteries carry oxygen-rich blood out from the heart, capillaries deliver it to every cell, and veins bring the used blood back. Blood pressure is the squeeze that pushes blood through the pipes. Clotting factors and platelets (tiny sticky fragments in the blood) plug any small tears instantly to keep the system sealed.

—

What goes wrong

·Trauma tears open blood vessels — sometimes small capillaries, sometimes huge arteries — and blood pours out. Bleeding can be visible (external) or hidden inside the chest, belly, pelvis, or thigh (internal). Big bleeds drain the tank faster than the heart can compensate, so blood pressure crashes and organs starve. If bleeding continues, the body gets too cold (hypothermia), too acidic (acidosis from cells burning fuel without oxygen), and clotting stops working (coagulopathy from using up all the clotting factors and platelets). That trio — cold, acidic, no clotting — is the lethal triad, and once it sets in, even stopping the bleeding may not save the patient.

—

Hallmark signs

·Fast heart rate (tachycardia) — the heart beats faster than 100 times per minute
·Low blood pressure (hypotension) — top number below 90
·Cool, pale, clammy skin
·Confusion, restlessness, or anxiety
·Weak or absent pulses in the arms or legs
·Little or no urine output (oliguria)
·Visible bleeding from a wound, or blood pooling under the skin (bruising)
·Swollen, tender abdomen or flanks

—

Red flags · escalate now

·Blood pressure top number below 90 despite giving fluids (suggests massive ongoing bleeding or shock)
·Confused, drowsy, or unresponsive (means the brain is starving for oxygen)
·No urine for hours (sign the kidneys are shutting down from poor blood flow)
·Abdomen rigid and painful, or flanks bruised (may mean internal bleeding in belly or behind the gut)
·Breathing very fast or gasping, lips or fingers turning blue (severe oxygen shortage)

—

Workup

·Hemoglobin and hematocrit (Hgb/Hct)
·Lactate level
·INR, PT, PTT, fibrinogen, and platelet count (coagulation panel)
·Base deficit or bicarbonate level (from blood gas or basic metabolic panel)
·FAST ultrasound (Focused Assessment with Sonography for Trauma)
·Chest X-ray
·Pelvic X-ray
·CT scan of chest, abdomen, and pelvis with IV contrast (only if patient is stable enough)

—

Treatment

·Perform ABCDE survey (Airway, Breathing, Circulation, Disability, Exposure) in the first 60 seconds
·Apply tourniquet high and tight on an arm or leg if bleeding does not stop with direct pressure
·Give blood products in balanced 1:1:1 ratio (packed red blood cells : plasma : platelets) instead of crystalloid alone
·Permissive low blood pressure (hypotension): keep systolic blood pressure at 80–90 mmHg until bleeding is controlled (except in traumatic brain injury)
·Give tranexamic acid (TXA) 1 gram IV over 10 minutes, then 1 gram over 8 hours, within 3 hours of injury
·Emergency surgery or interventional radiology to find and control the bleeding source
·Avoid large volumes of crystalloid (normal saline or lactated Ringer's) alone

—

NCLEX trap

·In trauma and bleeding (hemorrhage), give blood, plasma, and platelets in equal amounts (1:1:1 ratio) right away. Normal saline alone waters down the blood and wrecks clotting. Find and stop the bleeding first—fluids alone cannot seal the torn vessels.
·Confusion in trauma and bleeding (hemorrhage) comes from low blood pressure and shock, not just low oxygen. Oxygen helps, but the real fix is stopping the bleeding and giving blood products to restore blood pressure. Without that, the brain stays starved.
·In trauma and bleeding (hemorrhage) with severe limb bleeding, use a tourniquet above the wound right away. Direct pressure alone is too slow. Tourniquets save lives and limbs in class three and four bleeding.
·In trauma and bleeding (hemorrhage), act now during the golden hour (the first sixty minutes after injury). Do the ABCDE check, find where blood is leaking, use tourniquets for limbs, give blood products, and call the surgeon at the same time. Do not wait.
·In trauma and bleeding (hemorrhage), the lethal triad includes acid buildup, broken clotting, and too-cold body. Keep the patient warm actively. Give warm blood and fluids. Even a normal temperature at first can drop fast during shock, and cold makes clotting fail.
·In trauma and bleeding (hemorrhage) with internal bleeding in the belly, the patient is dying from bleeding, not infection. Call the surgeon now, get blood products started, and prepare for the operating room or interventional radiology (a procedure where a doctor threads a tiny tube through blood vessels to plug the leak from inside). Waiting kills the patient.

—

Install Maldek by Hill as an app — studies work even offline