Case Study 2

Hemostasis
Patient is brought into emergency room following a fall while walking in the yard during
an icy storm.
Noted during an examination:
Large hematoma on occiital lobe of cranium.
H!: ""# $P%
$P: &'()' mmHg
Puils dilated
!esiration: 2"
". *hat can be assumed about the atient+
*e can assume that the atient bumed the back of his head which burst a blood ,essel
and caused bleeding- or a hemorrhage. *hen the blood ,essel burst and bleeds out a
hematoma- or a ool of blood- will form on the outside of the ,essel. .ue to the
hemorrhaging- we can assume this atient is losing a lot of blood. His blood ressure is
chronically low that he is exeriencing hyotension and shock. *hen a erson is in
shock- the symathetic resonse increases ,asoconstriction and heart rate to try to
maintain ade/uate erfusion.
2. *hat can be assumed about Stroke 0olume and Cardiac 1utut+
*e can assume that the atient2s stroke ,olume- or ,olume of blood during one beat- and
his cardiac outut- amount of blood umed by a single ,entricle in one minute are both
,ery low based on his low blood ressure. 3his atient also has a ,ery low %4P of )&.
3his also confirms that the heart is not uming sufficient amounts of blood to the body.
3he in5ury to his head is lowering the ,enous return- therefore lowering the cardiac
outut.
6. Considering the area of imact- if cranial ressure kees increasing-
a. what effect will it ha,e on the 4utonomic Ner,ous System+
3he increased cranial ressure will be detected by the barorecetors and result in the
symathetic resonse being imosed in order to get the blood ressure to a more stable
le,el.
b. what effect will the 4NS ha,e on systemic blood ,essels+ *hy+
3he systemic resonse sent from the 4NS will try to increase the o,erall ,enous return by
ulling blood from the reser,oir. 7f the ,enous return is increased- this will hel to
increase the cardiac outut. 3he symathetic resonse will also work to increase blood
,olume by regulating the amount of fluids lea,ing the body through hormones.
Noreinehrine and einehrine- antidiuretic- and angiotensin 77 are all hormones that
hel regulate and increase the blood ,olume. Noreinehrine and einehrine are
resonsible for the atient2s dilated uils.
#. $lood flow in the circulation is described by the laws of hemodynamics as the
relationshi between ressure- flow and resistance.
8i,en a hematoma in the cranium- what haens to
a. Pressure: in the damaged area: 4lthough the ressure throughout the body is
low- the ressure to the damaged area will increase because the hematoma is essentially a
ool of blood ressing on the brain.
b. !esistance: 3he symathetic ner,ous system is working to increase blood
ressure- so the ,essels are ,asoconstricting which leads to a higher resistance.
c. 9low: blood flow will decrease because there is not enough erfusion to the
tissues.
). 7n order for the cranial bleeding to sto homeostasis occurs in a series of reactions
called Hemostasis.
a. Prolonged vascular spasms: ,essels constrict suddenly in order to re,ent
blood from leaking out of damaged ,essel. Continues through the next hases. 3he
greater the damage- the greater ,asoconstriction.
Platelet plug formation: latelets arri,e to the damaged location- where they
stick to collagen fibers. Platelets also de,elo rocesses that hel to attract latelets.
Platelet lug is formed to hel close off damaged ,essel. :xamle of ositi,e feedback.
Coagulation phase: most imortant hase- where an insoluble rotein network
forms a blood clot made of fibrin and also tras formed elements.

b. *hat is the rimary difference between the intrinsic and extrinsic athways+
7ntrinsic is when the damage is to the inside of the ,essel and takes a longer
time- while extrinsic is when the damage is on the outside of ,essel and only takes a few
seconds.
c. $oth of the abo,e athways lead to a common athway- list the stes in a
common athway.
:xtrinsic and intrinsic initiate factor ;
9actor ;-77- and 0- calcium- and latelet factor 6 form rothrombin acti,ator
Prothrombin con,erts to thrombin
3hrombrin con,erts soluble fibrinogen to soluble fibrin
9actor 0777 is acti,ated in resence of calcium and turns fibrin monomers to fibrin
olymers
<. the rocess of a clot dissol,ing is called ==fibrinolysis==what digesti,e en>yme is
i,ol,ed+ =====lasmin==============