<ul><li>Understand the  definition  and  major types  of shock, </li></ul><ul><li>Recognize  signs and symptoms  of shock,...
<ul><li>Shock is inadequate tissue perfusion with oxygenated blood </li></ul>
<ul><li>Not enough blood volume  </li></ul><ul><li>Pump failure </li></ul><ul><li>Abnormalities of peripheral circulation ...
<ul><li>Most common type of shock </li></ul><ul><ul><li>Insufficient circulating volume </li></ul></ul><ul><ul><ul><li>Pri...
<ul><li>Failure of the heart to pump effectively </li></ul><ul><ul><li>Due to damage to the heart muscle </li></ul></ul><u...
<ul><li>Mechanical block to heart’s outflow  </li></ul><ul><ul><ul><li>Pulmonary embolus </li></ul></ul></ul><ul><ul><ul><...
<ul><li>Similar to hypovolemic shock - insufficient intravascular volume of blood or “relative&quot; hypovolemia  </li></u...
<ul><li>Septic shock </li></ul><ul><ul><li>Overwhelming infection leading to profound systemic vasodilation  </li></ul></u...
<ul><li>If shock is “inadequate  tissue  perfusion with oxygenated blood,” then . . . </li></ul><ul><li>. . . look at the ...
<ul><li>Cardiovascular </li></ul><ul><li>Respiratory </li></ul><ul><li>Skin </li></ul><ul><li>CNS </li></ul><ul><li>Renal ...
<ul><li>Compensated - early </li></ul><ul><ul><li>Initial stage, body progressively compensated for blood loss </li></ul><...
<ul><li>“ All bleeding stops eventually” </li></ul><ul><li>Rapid, simple interventions are highly advantageous to the pati...
<ul><li>Internal </li></ul><ul><ul><li>Blunt force trauma </li></ul></ul><ul><ul><ul><li>Contusions, lacerations, shear, f...
<ul><li>Arterial bleeding </li></ul><ul><ul><li>Usually bright red in color, rich in oxygen </li></ul></ul><ul><ul><li>Oft...
<ul><li>STOP the bleeding </li></ul><ul><li>Supportive care measures </li></ul><ul><ul><li>Positioning of victim </li></ul...
<ul><li>Apply direct pressure : </li></ul><ul><li>with gloved hand, </li></ul><ul><li>sterile dressing(s). </li></ul>Bleed...
<ul><li>Apply pressure directly to wound site: </li></ul><ul><ul><li>Gloved hand, dressing </li></ul></ul><ul><ul><li>If d...
<ul><li>If possible, raise wound site above level of victim’s heart </li></ul><ul><li>Apply direct pressure : </li></ul><u...
<ul><li>Find proximal “pressure point” and press on it  </li></ul><ul><li>(radial, ulnar, brachial, axillary, femoral arte...
<ul><li>Apply band above injury site, tighten to stop bleeding: </li></ul><ul><ul><li>Last resort—risky </li></ul></ul><ul...
<ul><li>Goal: improve perfusion of brain and heart </li></ul><ul><li>Position patient:  Have patient lie down and elevate ...
<ul><li>Administer supplemental oxygen </li></ul><ul><li>Obtain vascular access </li></ul><ul><ul><li>Administer fluid/blo...
<ul><li>BP 90, P < 120 </li></ul><ul><li>O 2  saturation > 92% </li></ul><ul><li>Warm, moist skin,  <  2 sec capillary ref...
<ul><li>Shock = inadequate tissue perfusion </li></ul><ul><li>Find shock by looking at tissue perfusion </li></ul><ul><li>...
<ul><li>Most common source of shock = hemorrhage </li></ul><ul><li>Management of hemorrhagic shock </li></ul><ul><ul><li>S...
“ Chance favors the prepared mind.” Louis Pasteur
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Hemorrhage And Shock

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Hemorrhage And Shock

  1. 2. <ul><li>Understand the definition and major types of shock, </li></ul><ul><li>Recognize signs and symptoms of shock, </li></ul><ul><li>Recognize types of external bleeding (arterial, venous, capillary), </li></ul><ul><li>Recognize signs and symptoms of internal bleeding , </li></ul><ul><li>Initiate treatment of shock by appropriately positioning the patient and by stopping hemorrhage when possible, </li></ul><ul><li>Treat external hemorrhage appropriately by direct pressure, elevation, pressure points, and/or tourniquet, and </li></ul><ul><li>Apply a dressing and bandage. </li></ul>
  2. 3. <ul><li>Shock is inadequate tissue perfusion with oxygenated blood </li></ul>
  3. 4. <ul><li>Not enough blood volume </li></ul><ul><li>Pump failure </li></ul><ul><li>Abnormalities of peripheral circulation (when all small blood vessels dilate) </li></ul><ul><li>Mechanical blockage of outflow from the heart </li></ul>
  4. 5. <ul><li>Most common type of shock </li></ul><ul><ul><li>Insufficient circulating volume </li></ul></ul><ul><ul><ul><li>Primary cause = loss of blood or body fluids from an internal or external source </li></ul></ul></ul><ul><ul><ul><li>Hemorrhage, severe burns, severe dehydration </li></ul></ul></ul>Scalp laceration 3 rd degree/full thickness burn
  5. 6. <ul><li>Failure of the heart to pump effectively </li></ul><ul><ul><li>Due to damage to the heart muscle </li></ul></ul><ul><ul><li>Large myocardial infarction </li></ul></ul><ul><ul><li>Arrhythmias (too fast or too slow) </li></ul></ul><ul><ul><li>Cardiomyopathy </li></ul></ul><ul><ul><li>Congestive heart failure (CHF) </li></ul></ul><ul><ul><li>Cardiac valve problems </li></ul></ul>
  6. 7. <ul><li>Mechanical block to heart’s outflow </li></ul><ul><ul><ul><li>Pulmonary embolus </li></ul></ul></ul><ul><ul><ul><li>Cardiac tamponade </li></ul></ul></ul><ul><ul><ul><li>Tension pneumothorax </li></ul></ul></ul>Pulmonary embolus Cardiac tamponade
  7. 8. <ul><li>Similar to hypovolemic shock - insufficient intravascular volume of blood or “relative&quot; hypovolemia </li></ul><ul><ul><li>result of dilation of all blood vessels so the “tank” is much larger </li></ul></ul>Urticaria/anaphylaxis Meningococcic sepsis
  8. 9. <ul><li>Septic shock </li></ul><ul><ul><li>Overwhelming infection leading to profound systemic vasodilation </li></ul></ul><ul><li>Anaphylactic shock </li></ul><ul><ul><li>Severe reaction to an allergen, antigen, drug or foreign protein, releasing histamine causing widespread vasodilation, hypotension and increased capillary permeability </li></ul></ul><ul><li>Neurogenic shock </li></ul><ul><ul><li>Rarest form of shock. </li></ul></ul><ul><ul><li>Trauma to spinal cord resulting in loss of autonomic and motor reflexes below injury level. Vessel walls relax uncontrolled, decreasing peripheral vascular resistance, result = vasodilation and hypotension </li></ul></ul>
  9. 10. <ul><li>If shock is “inadequate tissue perfusion with oxygenated blood,” then . . . </li></ul><ul><li>. . . look at the tissues! </li></ul>
  10. 11. <ul><li>Cardiovascular </li></ul><ul><li>Respiratory </li></ul><ul><li>Skin </li></ul><ul><li>CNS </li></ul><ul><li>Renal </li></ul><ul><li>Global signs and symptoms: </li></ul><ul><li>Anxiety, restlessness, altered mental state </li></ul><ul><li>Hypotension </li></ul><ul><li>Rapid, weak, thready pulse </li></ul><ul><li>Cool, clammy skin </li></ul><ul><li>Capillary refill > 3 seconds </li></ul><ul><li>Rapid and deep respirations </li></ul><ul><li>Hypothermia </li></ul><ul><li>Fatigue </li></ul><ul><li>Cold and mottled skin </li></ul><ul><li>Thirst and dry mouth </li></ul><ul><li>Vasoconstriction </li></ul><ul><li>Low urine output </li></ul>
  11. 12. <ul><li>Compensated - early </li></ul><ul><ul><li>Initial stage, body progressively compensated for blood loss </li></ul></ul><ul><ul><ul><li>↑ pulse, vasoconstriction </li></ul></ul></ul><ul><ul><ul><li>Weak pulse, cool clammy skin, anxiety, thirst, weak </li></ul></ul></ul><ul><li>Decompensated – late </li></ul><ul><ul><li>Body’s compensatory mechanisms no longer maintain system </li></ul></ul><ul><ul><ul><li>Loss of radial pulse, ↓ BP, loss of consciousness, ↓ respirations </li></ul></ul></ul>
  12. 13. <ul><li>“ All bleeding stops eventually” </li></ul><ul><li>Rapid, simple interventions are highly advantageous to the patient </li></ul>
  13. 14. <ul><li>Internal </li></ul><ul><ul><li>Blunt force trauma </li></ul></ul><ul><ul><ul><li>Contusions, lacerations, shear, fractures </li></ul></ul></ul><ul><ul><li>Penetrating trauma </li></ul></ul><ul><ul><ul><li>Punctures </li></ul></ul></ul><ul><li>External </li></ul><ul><ul><li>General trauma </li></ul></ul><ul><ul><ul><li>Contusions, abrasions, lacerations, incisions, avulsions, amputation </li></ul></ul></ul>
  14. 15. <ul><li>Arterial bleeding </li></ul><ul><ul><li>Usually bright red in color, rich in oxygen </li></ul></ul><ul><ul><li>Often profuse and spurting </li></ul></ul><ul><ul><li>Often hard to control - continuous direct pressure required </li></ul></ul><ul><li>Venous bleeding </li></ul><ul><ul><li>Usually dark red/maroon in color, does not contain much oxygen </li></ul></ul><ul><ul><li>Usually easy to control because veins are under low pressure </li></ul></ul><ul><ul><li>Venous bleeding in neck can draw in air and cause further complications </li></ul></ul><ul><li>Capillary bleeding </li></ul><ul><ul><li>Usually slow, oozing, small size and low pressure </li></ul></ul><ul><ul><li>Generally minor and easy to control </li></ul></ul>
  15. 16. <ul><li>STOP the bleeding </li></ul><ul><li>Supportive care measures </li></ul><ul><ul><li>Positioning of victim </li></ul></ul><ul><ul><li>Ensuring A-B-C’s </li></ul></ul><ul><ul><li>Maintenance of body temp </li></ul></ul><ul><li>Definitive management </li></ul>
  16. 17.
  17. 18. <ul><li>Apply direct pressure : </li></ul><ul><li>with gloved hand, </li></ul><ul><li>sterile dressing(s). </li></ul>Bleeding stopped? Yes No <ul><li>Elevate extremity : </li></ul><ul><li>above victim’s heart, </li></ul><ul><li>continue direct pressure </li></ul><ul><li>Locate pressure point, </li></ul><ul><li>apply pressure : </li></ul><ul><li>maintain direct pressure </li></ul><ul><li>over wound </li></ul><ul><li>Treat for shock : </li></ul><ul><li>care for wound, </li></ul><ul><li>seek definitive care </li></ul>Bleeding stopped? Bleeding stopped? No Bleeding from extremity? No Apply tourniquet (last resort) Yes No Definitive therapy
  18. 19. <ul><li>Apply pressure directly to wound site: </li></ul><ul><ul><li>Gloved hand, dressing </li></ul></ul><ul><ul><li>If dressing soaks thru, add more gauze on top and press harder </li></ul></ul><ul><li>Apply direct pressure : </li></ul><ul><li>with gloved hand, </li></ul><ul><li>sterile dressing(s). </li></ul>Bleeding stopped? Yes No <ul><li>Elevate extremity : </li></ul><ul><li>above victim’s heart, </li></ul><ul><li>continue direct pressure </li></ul><ul><li>Locate pressure point, </li></ul><ul><li>apply pressure : </li></ul><ul><li>maintain direct pressure </li></ul><ul><li>over wound </li></ul><ul><li>Treat for shock : </li></ul><ul><li>care for wound, </li></ul><ul><li>seek definitive care </li></ul>Bleeding stopped? Bleeding stopped? No Bleeding from extremity? No Apply tourniquet (last resort) Yes No Definitive therapy
  19. 20. <ul><li>If possible, raise wound site above level of victim’s heart </li></ul><ul><li>Apply direct pressure : </li></ul><ul><li>with gloved hand, </li></ul><ul><li>sterile dressing(s). </li></ul>Bleeding stopped? Yes No <ul><li>Elevate extremity : </li></ul><ul><li>above victim’s heart, </li></ul><ul><li>continue direct pressure </li></ul><ul><li>Locate pressure point, </li></ul><ul><li>apply pressure : </li></ul><ul><li>maintain direct pressure </li></ul><ul><li>over wound </li></ul><ul><li>Treat for shock : </li></ul><ul><li>care for wound, </li></ul><ul><li>seek definitive care </li></ul>Bleeding stopped? Bleeding stopped? No Bleeding from extremity? No Apply tourniquet (last resort) Yes No Definitive therapy
  20. 21. <ul><li>Find proximal “pressure point” and press on it </li></ul><ul><li>(radial, ulnar, brachial, axillary, femoral arteries—not carotid) </li></ul><ul><li>Apply direct pressure to site </li></ul><ul><li>Apply direct pressure : </li></ul><ul><li>with gloved hand, </li></ul><ul><li>sterile dressing(s). </li></ul>Bleeding stopped? Yes No <ul><li>Elevate extremity : </li></ul><ul><li>above victim’s heart, </li></ul><ul><li>continue direct pressure </li></ul><ul><li>Locate pressure point, </li></ul><ul><li>apply pressure : </li></ul><ul><li>maintain direct pressure </li></ul><ul><li>over wound </li></ul><ul><li>Treat for shock : </li></ul><ul><li>care for wound, </li></ul><ul><li>seek definitive care </li></ul>Bleeding stopped? Bleeding stopped? No Bleeding from extremity? No Apply tourniquet (last resort) Yes No Definitive therapy
  21. 22. <ul><li>Apply band above injury site, tighten to stop bleeding: </li></ul><ul><ul><li>Last resort—risky </li></ul></ul><ul><ul><li>Note time of application </li></ul></ul><ul><ul><li>Reassess frequently </li></ul></ul><ul><li>Apply direct pressure : </li></ul><ul><li>with gloved hand, </li></ul><ul><li>sterile dressing(s). </li></ul>Bleeding stopped? Yes No <ul><li>Elevate extremity : </li></ul><ul><li>above victim’s heart, </li></ul><ul><li>continue direct pressure </li></ul><ul><li>Locate pressure point, </li></ul><ul><li>apply pressure : </li></ul><ul><li>maintain direct pressure </li></ul><ul><li>over wound </li></ul><ul><li>Treat for shock : </li></ul><ul><li>care for wound, </li></ul><ul><li>seek definitive care </li></ul>Bleeding stopped? Bleeding stopped? No Bleeding from extremity? No Apply tourniquet (last resort) Yes No Definitive therapy
  22. 23. <ul><li>Goal: improve perfusion of brain and heart </li></ul><ul><li>Position patient: Have patient lie down and elevate legs (moves blood into chest and head) </li></ul><ul><li>Keep warm if blanket available </li></ul><ul><li>Give nothing by mouth if any possibility of internal injuries (may need emergency surgery) </li></ul>
  23. 24. <ul><li>Administer supplemental oxygen </li></ul><ul><li>Obtain vascular access </li></ul><ul><ul><li>Administer fluid/blood to “fill up the tank” </li></ul></ul><ul><li>Wound closure/management </li></ul><ul><li>Immobilization </li></ul><ul><li>Special situations </li></ul><ul><ul><li>Release cardiac tamponade </li></ul></ul><ul><ul><li>Tension pneumothorax </li></ul></ul><ul><li>Find hidden sources of bleeding </li></ul>
  24. 25. <ul><li>BP 90, P < 120 </li></ul><ul><li>O 2 saturation > 92% </li></ul><ul><li>Warm, moist skin, < 2 sec capillary refill </li></ul><ul><li>Consciousness, no agitation </li></ul><ul><li>Urine output 0.5 cc/kg/hr </li></ul>
  25. 26. <ul><li>Shock = inadequate tissue perfusion </li></ul><ul><li>Find shock by looking at tissue perfusion </li></ul><ul><li>Categories of shock </li></ul><ul><ul><li>Hypovolemic </li></ul></ul><ul><ul><li>Obstructive </li></ul></ul><ul><ul><li>Distributive </li></ul></ul><ul><ul><li>Cardiogenic </li></ul></ul>
  26. 27. <ul><li>Most common source of shock = hemorrhage </li></ul><ul><li>Management of hemorrhagic shock </li></ul><ul><ul><li>Stop the bleeding </li></ul></ul><ul><ul><li>Vascular access </li></ul></ul><ul><ul><li>Volume </li></ul></ul><ul><ul><li>Reassess </li></ul></ul>
  27. 28. “ Chance favors the prepared mind.” Louis Pasteur
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