Bleeding and Shock


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Bleeding and Shock

  1. 1. Chapter Bleeding and Shock Twenty-One
  2. 2. Chapter <ul><li>BSI when handling patients who are bleeding </li></ul><ul><li>Identification and control of external bleeding </li></ul><ul><li>Identification and treatment of internal bleeding </li></ul><ul><li>Shock (hypoperfusion) and its progressive stages </li></ul>Twenty-One CORE CONCEPTS
  3. 3. <ul><li>Heart </li></ul><ul><li>Blood </li></ul><ul><li>Blood vessels </li></ul><ul><li>Arteries </li></ul><ul><li>Capillaries </li></ul><ul><li>Veins </li></ul>Review of Circulatory System
  4. 4. Review of Circulatory System
  5. 5. Perfusion Circulation of blood through an organ Hypoperfusion Inadequate circulation of blood through an organ K EY TERMS
  7. 7. Arterial Capillary Venous 3 Types of External Bleeding
  8. 8. Take BSI precautions when controlling bleeding.
  9. 9. <ul><li>General impression of blood loss </li></ul><ul><li>Signs or symptoms of shock </li></ul><ul><li>(hypoperfusion) </li></ul>Severity of Blood Loss Is Determined by: (Continued)
  10. 10. <ul><li>1 liter of blood in an adult </li></ul><ul><li>Half a liter of blood in a child </li></ul><ul><li>100–200cc of blood in an infant </li></ul>IS SERIOUS! (Continued) Sudden loss of
  11. 11. Uncontrolled bleeding or significant blood loss leads to shock (hypoperfusion) and possibly death!
  12. 12. Emergency Care of External Bleeding
  13. 13. Direct Pressure
  14. 14. Elevation
  15. 15. Pressure Bandage
  16. 16. <ul><li>Brachial: Upper limbs </li></ul><ul><li>Femoral: Lower limbs </li></ul>Pressure Points
  17. 17. Pressure Point Brachial
  18. 18. Pressure Point Femoral
  19. 19. Supplemental Oxygen Since blood loss reduces perfusion and the supply of oxygen to the tissues, the use of supplemental oxygen is vital. Oxygen should be administered after bleeding has been controlled.
  20. 20. Supplemental Methods of Bleeding Control
  21. 21. Air Splinting
  22. 22. A tourniquet is a last resort.
  23. 23. Bleeding from the Nose, Ears, and Mouth
  24. 24. Managing a Simple Nosebleed
  25. 25. Skull Fracture <ul><li>May cause loss of blood or </li></ul><ul><li>Do not stop the flow of fluid. </li></ul>clear fluid (cerebrospinal fluid) from the nose and ears.
  27. 27. <ul><li>Mechanism of injury </li></ul><ul><li>Clinical signs and symptoms </li></ul>Base Judgment of Severity of Internal Bleeding on:
  28. 28. Consider mechanism of injury.
  29. 29. <ul><li>Falls </li></ul><ul><li>Auto, motorcycle, or </li></ul><ul><li>pedestrian accidents </li></ul><ul><li>Penetrating trauma </li></ul>Possible Mechanisms of Injury
  30. 30. Patient ASSESSMENT Internal Bleeding Signs and Symptoms <ul><li>Significant mechanism of injury </li></ul><ul><li>Pain, tenderness, deformity, </li></ul>swelling, discoloration (Continued)
  31. 31. Patient ASSESSMENT Internal Bleeding Signs and Symptoms <ul><li>Bleeding from the mouth, rectum, vagina, or other orifice </li></ul><ul><li>Tender, rigid, and/or distended abdomen </li></ul>(Continued)
  32. 32. Patient ASSESSMENT Internal Bleeding Signs and Symptoms <ul><li>Vomiting blood </li></ul><ul><li>Bright red </li></ul><ul><li>Coffee-ground color and consistency </li></ul><ul><li>Blood in stool </li></ul><ul><li>Bright red </li></ul><ul><li>Dark, tarry </li></ul>(Continued)
  33. 33. Patient ASSESSMENT Internal Bleeding Signs and Symptoms <ul><li>Capillary refill time > 2 seconds </li></ul>(infants and children only) <ul><li>Nausea and vomiting </li></ul><ul><li>Decreasing blood pressure </li></ul><ul><li>Dilated pupils (late sign) </li></ul>(late sign)
  34. 34. Patient CARE Internal Bleeding Emergency Care Steps <ul><li>BSI </li></ul><ul><li>Airway care and oxygen </li></ul><ul><li>Immediate transport to </li></ul>appropriate facility (Continued)
  35. 35. Patient CARE Internal Bleeding Emergency Care Steps <ul><li>Apply direct pressure if injured area is on an extremity. </li></ul><ul><li>Splint extremity. </li></ul>
  37. 37. Signs of shock (hypoperfusion) appear LATE! Waiting for signs of shock to appear before recognizing and treating may result in the DEATH of your patient
  38. 38. <ul><li>Inadequate perfusion of cells </li></ul><ul><li>with oxygen and nutrients </li></ul><ul><li>Inadequate removal of metabolic </li></ul><ul><li>waste products </li></ul>(Continued) Shock (Hypoperfusion)
  39. 39. <ul><li>May develop from internal or </li></ul><ul><li>external blood loss (or both). </li></ul><ul><li>Peripheral perfusion is reduced </li></ul>due to the reduction in circulating blood volume. (Continued) Shock (Hypoperfusion)
  40. 40. <ul><li>Reduced perfusion results in </li></ul><ul><li>malfunction of cells and organs. </li></ul><ul><li>Shock that is not recognized and </li></ul><ul><li>treated may result in death. </li></ul>(Continued) Shock (Hypoperfusion)
  41. 41. <ul><li>The body tries to compensate for </li></ul><ul><li>shock by shunting blood away </li></ul><ul><li>from areas of lesser need to </li></ul><ul><li>areas of greater need. </li></ul>(This explains the order in which signs and symptoms occur.) Shock (Hypoperfusion)
  42. 42. Patient ASSESSMENT Shock Signs and Symptoms <ul><li>Restlessness, changes in mental status </li></ul><ul><li>Pale, cool, and clammy skin </li></ul><ul><li>Nausea and vomiting </li></ul>(Continued)
  43. 43. Patient ASSESSMENT Shock Signs and Symptoms <ul><li>Increased pulse rate </li></ul><ul><li>Increased respiratory rate </li></ul>(decreasing blood pressure is a LATE sign) (Continued)
  44. 44. Patient ASSESSMENT Shock Signs and Symptoms <ul><li>Dilated pupils </li></ul><ul><li>Thirst </li></ul><ul><li>Cyanosis </li></ul><ul><li>Capillary refill time > 2 seconds (infants and children only) </li></ul>(Continued)
  45. 45. Patient ASSESSMENT Shock Signs and Symptoms <ul><li>Patients may maintain their blood pressure until their blood volume is half gone. </li></ul><ul><li>By the time an infant’s or child’s blood pressure drops, he or she is NEAR DEATH ! </li></ul>
  46. 46. Patient CARE Shock Emergency Care Steps
  47. 47. Tell new EMT-B that shock (hypoperfusion) should be recognized and managed in its early phase. They should never wait to see if the blood pressure drops to decide to manage the patient with suspected bleeding loss! This is especially true in pediatric patients, who have the ability to compensate in the absence of approximately 30% of their blood volume! P RECEPTOR P EARL
  48. 48. Use BSI. Maintain airway and administer oxygen.
  49. 49. Control external bleeding.
  50. 50. Apply pneumatic anti-shock garment if indicated. Elevate lower extremities 8–12 inches.
  51. 51. Prevent loss of body heat. Transport immediately.
  52. 52. Patient CARE Shock Emergency Care Steps <ul><li>Splint suspected bone or joint injuries. </li></ul><ul><li>Do not delay transportation. </li></ul><ul><li>A backboard may be used to splint the entire body. </li></ul>
  53. 53. R EVIEW QUESTIONS 1. What BSI precautions should be taken when dealing with a patient who is actively bleeding? 2. How is external bleeding controlled? 3. How is internal bleeding identified? 4. What are the stages of hypoperfusion?