As promised, we're moving on from the abdomen and moving into the blood, but only briefly so pay attention. In course two, you learned about the different components of the blood. We learned about the cardiovascular system. In this video, we're not going to review that information, so be sure you are familiar with it before moving on here. If we were only to follow national registry guidelines for what you need to know about diseases and problems with the blood, we would really only cover a disease called sickle cell disease. We would talk about nosebleeds also called epistaxis. We're going to cover a couple additional things though. Think of it as bonus material. There are a couple of processes that affect blood cells and components directly, and the two we're going to talk about are both genetic disorders, meaning they are inherited. Neither one is something you can catch. In sickle cell anemia, the patient has some red blood cells that do not function normally. Specifically, they do not carry oxygen like normal red blood cells do. They are also shaped differently than regular blood cells. They form a shape like a sickle. Hence the name of the disorder. When the patient with sickle cell is under increased stress from illness, fatigue, dehydration for example, more of the blood cells sickle and carry oxygen more poorly. Patients with sickle cell anemia usually know that they have the disease and will provide that information on history. Many of the problems they have because they're sickle cell is the result of these episodes where more of their blood sickles. The most predominant feature is pain. Supportive care often with oxygen and transport to the hospital is warranted. The next blood disorder we will talk about is haemophilia. There are a couple of different types of haemophilia, but the end result is the same. The blood does not clot like it ought to. Obviously, this is particularly dangerous if the patient has had some sort of trauma. Depending on how severe the form of haemophilia the patient has, will determine how much or how little the blood clots. Most patients know they have haemophilia and sometimes will even have taken a medication commonly referred to simply as factor, when they have an injury. If a patient has had major trauma, or presents with some sort of bleeding like vaginal bleeding or GI bleeding, expeditious transport to the hospital is important for the management of blood loss. Rather than problems with bleeding, some patients may form blood clots. For blood to clot, it needs three things present: decreased movement, a tendency to clot, and damage to the tissue. The tendency to clot can be either because of a genetic predisposition or from acquired problems. An example of an acquired problem is a surgery, where the patient lays in bed and doesn't move around like normal resulting in decreased movement. The two most common sites blood clots are found are in the lower legs and the lungs. The symptoms of blood clots in the legs are swelling, pain, and redness. The symptoms are frequently described in the calf. But more dangerous clots are ones that extend up into the upper leg. Regardless, any patient with symptoms concerning for a blood clot in the leg also known as a DVT, or Deep Vein Thrombosis, should be evacuated to the hospital. Blood clots that break off from the leg and get lodged in the lungs can be life-threatening. You learned about these in course two and they're called pulmonary emboli. Most blood clots occur in the veins since that is where the blood tends to be moving more slowly and is easier to clot. It is possible however for blood clots to occur in the arteries as well. You have learned about examples of these already. Strokes and myocardial infarctions to name too. Blood clots can also occur in the arteries of the extremities. The symptoms of this in contrast to venous clots are acute onset of pain that is severe, a cool extremity and lack of pulses. One final thing to point out with regard to bleeding and clotting, many patients are now on medications called blood thinners. They might be on them for their blood clots or to prevent blood clots, or because of recent procedures. You should have increased concern for any patient that has had trauma and is on a blood thinner. Similar is true, if they have a GI bleed or vaginal bleeding. Getting any bleeding to stop in these patients is going to be more challenging. Recognizing these medications is one of the many reasons it's important for you to be in the habit of looking up unfamiliar medications. It can make a huge difference in your general impression of the patient. Speaking of bleeding that sometimes seems like it doesn't stop, nosebleeds are next. Nosebleeds or also called the epistaxis. Most of you have probably had one or two of these in your life. Sometimes they are result of trauma, but sometimes they seem to just happen. Regardless of the cause controlling epistaxis or attempting to control it, is certainly in the list of things you should be prepared to do as an EMT. Most nosebleeds originate from the small blood vessels that run through the anterior portion of your nose. They're near the surface and small trauma can disrupt them. Your system might have a specific protocol for how they want you to manage epistaxis. See your skills video for details on how we manage epistaxis. In short, make sure your patient is sitting upright and leaning forward. Have them blow their nose to get all the clocks out and then apply pressure with a nasal clamp or their own hands. The real key to this is constant pressure for five to 10 minutes. No peaking. You can't be checking every 30 seconds to see if it's stopped. Remember your patients on blood thinning medications and with bleeding disorders, will be much more difficult to control. So, that covers bleeding disorders and with that you are almost done with all of mastering medicine. Before we wrap up this course and you move on to take on trauma, we're going to talk about a couple special patient populations, to keep in mind as you manage all of the medical issues you have learned about so far.
