24)Bleeding And Shock

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24)Bleeding And Shock

  1. 1. Bleeding and Shock
  2. 2. The Circulatory System Function/Components <ul><li>Function </li></ul><ul><ul><li>Transport system of the body </li></ul></ul><ul><ul><li>Delivers O2 and nutrients to cells </li></ul></ul><ul><ul><li>Returns waste to liver/kidneys/lungs </li></ul></ul><ul><ul><li>Transports specialized cells to fight infection. </li></ul></ul><ul><li>Components </li></ul><ul><ul><li>Blood </li></ul></ul><ul><ul><li>Blood vessels </li></ul></ul><ul><ul><ul><li>60,000 – 100,000 miles </li></ul></ul></ul><ul><ul><li>Heart </li></ul></ul>
  3. 3. The Circulatory System The heart <ul><li>Location </li></ul><ul><ul><li>Just left of midline </li></ul></ul><ul><ul><li>Posterior to sternum </li></ul></ul><ul><ul><li>Anterior to T-spine </li></ul></ul><ul><li>Function </li></ul><ul><ul><li>Pump for driving of blood flow </li></ul></ul>
  4. 4. The Circulatory System Chambers of the Heart <ul><li>4 Chambers </li></ul><ul><ul><li>Divided by a septum </li></ul></ul><ul><ul><li>2 Atria </li></ul></ul><ul><ul><ul><li>Receiving chambers </li></ul></ul></ul><ul><ul><ul><li>Contract together </li></ul></ul></ul><ul><ul><ul><li>Superior to ventricles </li></ul></ul></ul><ul><ul><li>2 Ventricles </li></ul></ul><ul><ul><ul><li>Pumping Chambers </li></ul></ul></ul><ul><ul><ul><li>Contract together </li></ul></ul></ul><ul><ul><ul><li>Inferior to atria </li></ul></ul></ul>
  5. 5. The Circulatory System Valves of The Heart <ul><li>Function </li></ul><ul><ul><li>Prevents backflow of blood </li></ul></ul><ul><ul><li>Create heart sounds </li></ul></ul><ul><li>Atrioventricular Valvues </li></ul><ul><ul><ul><li>Between each atria and its ventricle </li></ul></ul></ul><ul><ul><li>Tricuspid Valve </li></ul></ul><ul><ul><ul><li>Between Right Atria/Ventricle </li></ul></ul></ul><ul><ul><li>Bicuspid/Mitral Valve </li></ul></ul><ul><ul><ul><li>Between Left Atria/Ventricle </li></ul></ul></ul><ul><li>Semilunar Valves </li></ul><ul><ul><ul><li>Between each ventricle and its artery </li></ul></ul></ul><ul><ul><li>Pulmonic Valve </li></ul></ul><ul><ul><ul><li>Right Ventricle and Pulmonary Artery </li></ul></ul></ul><ul><ul><li>Aortic Valve </li></ul></ul><ul><ul><ul><li>Left Ventricle and Aorta </li></ul></ul></ul>
  6. 6. The Circulatory System Types of Circulation <ul><li>Separate Systems </li></ul><ul><ul><li>Pulmonary </li></ul></ul><ul><ul><ul><li>Right ventricle </li></ul></ul></ul><ul><ul><ul><li>Blood to the lungs </li></ul></ul></ul><ul><ul><ul><ul><li>Oxygenation </li></ul></ul></ul></ul><ul><ul><li>Systemic </li></ul></ul><ul><ul><ul><li>Left ventricle </li></ul></ul></ul><ul><ul><ul><li>Blood to the body </li></ul></ul></ul><ul><ul><ul><ul><li>Perfusion </li></ul></ul></ul></ul>
  7. 7. The Circulatory System Conductive System <ul><li>Automaticity </li></ul><ul><ul><li>Ability to create own electrical signal </li></ul></ul><ul><ul><li>Pacemaker Sites </li></ul></ul><ul><ul><ul><li>Sinoatrail Node (SA) </li></ul></ul></ul><ul><ul><ul><ul><li>60-100 bpm </li></ul></ul></ul></ul><ul><ul><ul><li>Atrioventricular Node (AV) </li></ul></ul></ul><ul><ul><ul><ul><li>40-60 bpm </li></ul></ul></ul></ul><ul><ul><ul><li>Bundle of HIS </li></ul></ul></ul><ul><ul><ul><ul><li>40-60 bpm </li></ul></ul></ul></ul><ul><ul><ul><li>Purkinje Fibers </li></ul></ul></ul><ul><ul><ul><ul><li>20-40 bpm </li></ul></ul></ul></ul>
  8. 8. The Circulatory System Blood Vessels <ul><li>Arteries Arterioles Capillaries </li></ul><ul><li>Venules Veins </li></ul>
  9. 9. The Circulatory System Arteries <ul><li>Function </li></ul><ul><ul><li>Conduct blood away from heart </li></ul></ul><ul><ul><li>High pressure </li></ul></ul><ul><li>Structure </li></ul><ul><ul><li>Endothelial lining </li></ul></ul><ul><ul><li>Connective tissue </li></ul></ul><ul><ul><li>THICK Smooth muscle </li></ul></ul><ul><ul><li>Connective tissue </li></ul></ul><ul><ul><ul><li>Allows for great expansion of vessels </li></ul></ul></ul>
  10. 10. The Circulatory System Major Arteries <ul><ul><li>Coronary </li></ul></ul><ul><ul><ul><li>Supply heart with blood </li></ul></ul></ul><ul><ul><li>Aorta </li></ul></ul><ul><ul><ul><li>Major artery from the heart to the body </li></ul></ul></ul><ul><ul><ul><li>1” diameter </li></ul></ul></ul><ul><ul><li>Pulmonary </li></ul></ul><ul><ul><ul><li>Carries O2 poor blood to lungs </li></ul></ul></ul><ul><ul><li>Umbilical </li></ul></ul><ul><ul><ul><li>Carries O2 poor blood to lungs </li></ul></ul></ul><ul><ul><li>Carotid </li></ul></ul><ul><ul><ul><li>Major artery of the neck </li></ul></ul></ul><ul><ul><ul><li>Supplies the head with blood </li></ul></ul></ul><ul><ul><li>Femoral </li></ul></ul><ul><ul><ul><li>Major artery of the thigh </li></ul></ul></ul><ul><ul><ul><li>Supplies lower extremities with blood </li></ul></ul></ul><ul><ul><ul><li>Bifurcation of aorta at navel </li></ul></ul></ul><ul><ul><li>Radial </li></ul></ul><ul><ul><ul><li>Major artery of the lower arm </li></ul></ul></ul><ul><ul><li>Brachial </li></ul></ul><ul><ul><ul><li>Artery of the upper arm </li></ul></ul></ul><ul><ul><li>Posterior tibial </li></ul></ul><ul><ul><ul><li>Artery running posterior to ankle </li></ul></ul></ul><ul><ul><li>Dorsalis pedis </li></ul></ul><ul><ul><ul><li>Artery of the foot </li></ul></ul></ul><ul><ul><ul><li>Anterior </li></ul></ul></ul>
  11. 12. The Circulatory System Arterioles <ul><li>Smallest branch of an artery </li></ul><ul><ul><li>Leads to a capillary </li></ul></ul><ul><li>Structure </li></ul><ul><ul><li>Thin smooth muscle wall (1-2 layers) </li></ul></ul><ul><li>Function </li></ul><ul><ul><li>Main site of vascular resistance </li></ul></ul><ul><ul><li>Important in blood pressure </li></ul></ul>
  12. 13. The Circulatory System Capillaries <ul><li>Structure </li></ul><ul><ul><li>Tiny blood vessel </li></ul></ul><ul><ul><ul><li>5-10 μ m diameter </li></ul></ul></ul><ul><ul><li>1 endothelial cell thick </li></ul></ul><ul><li>Function </li></ul><ul><ul><li>Connect arterioles to venules </li></ul></ul><ul><ul><li>Exchange of gases, nutrients, etc. </li></ul></ul><ul><ul><li>Decrease pressure </li></ul></ul><ul><ul><li>Usually carries no more than 50% of the volume it could </li></ul></ul>
  13. 14. The Circulatory System Venule <ul><li>Smallest branch of a vein leading from a capillary </li></ul><ul><li>Structure </li></ul><ul><ul><li>A vein on small scale </li></ul></ul><ul><ul><li>Internal valves </li></ul></ul><ul><li>Function </li></ul><ul><ul><li>Conducts deoxygenated blood out of capillaries into veins </li></ul></ul>
  14. 15. The Circulatory System Veins <ul><li>Function </li></ul><ul><ul><li>Return blood to the heart </li></ul></ul><ul><ul><li>Low pressure system </li></ul></ul><ul><li>Structure </li></ul><ul><ul><ul><li>Endothelial lining </li></ul></ul></ul><ul><ul><ul><li>Connective tissue </li></ul></ul></ul><ul><ul><ul><li>Thinner Smooth muscle </li></ul></ul></ul><ul><ul><ul><li>Connective tissue </li></ul></ul></ul><ul><ul><ul><li>Internal Valves </li></ul></ul></ul>
  15. 16. The Circulatory System Major Veins <ul><ul><li>Pulmonary </li></ul></ul><ul><ul><ul><li>Carries O2 rich blood from lungs to left atrium </li></ul></ul></ul><ul><ul><li>Umbilical </li></ul></ul><ul><ul><ul><li>Carries O2 rich blood from lungs to left atrium </li></ul></ul></ul><ul><ul><li>Vena Cava </li></ul></ul><ul><ul><ul><li>Superior </li></ul></ul></ul><ul><ul><ul><ul><li>Drains head/upper extremities </li></ul></ul></ul></ul><ul><ul><ul><li>Inferior </li></ul></ul></ul><ul><ul><ul><ul><li>Drains trunk/lower extremities </li></ul></ul></ul></ul>
  16. 18. The Circulatory System Blood <ul><li>5-6 Liters </li></ul><ul><li>Components </li></ul><ul><li>Plasma </li></ul><ul><ul><li>Fluid that carries blood cells/nutrients </li></ul></ul><ul><ul><li>55% </li></ul></ul><ul><li>Formed Elements </li></ul><ul><ul><li>40% </li></ul></ul><ul><ul><li>Red Blood Cells </li></ul></ul><ul><ul><ul><li>Carry O2 to organs & CO2 away </li></ul></ul></ul><ul><ul><ul><li>Give blood its color </li></ul></ul></ul><ul><ul><ul><li>Hemoglobin </li></ul></ul></ul><ul><ul><ul><li>45%, 4.2-6.1 million/mL </li></ul></ul></ul><ul><ul><li>White Blood Cells </li></ul></ul><ul><ul><ul><li>Defense </li></ul></ul></ul><ul><ul><ul><li>4,3000-10,800 WBC/mL </li></ul></ul></ul><ul><ul><li>Platelets </li></ul></ul><ul><ul><ul><li>Clotting </li></ul></ul></ul><ul><ul><ul><li>150,000 - 350,000/mL </li></ul></ul></ul>
  17. 19. The Circulatory System Physiology Perfusion <ul><li>Perfusion </li></ul><ul><ul><li>In an organ system: </li></ul></ul><ul><ul><ul><li>Delivery of O2/nutrients </li></ul></ul></ul><ul><ul><ul><li>Removal of waste products </li></ul></ul></ul>
  18. 20. Cardiac Output <ul><li>Stroke Volume </li></ul><ul><ul><li>Amount of blood ejected in one contraction of heart </li></ul></ul><ul><ul><li>Approx 70 ml </li></ul></ul><ul><li>Cardiac Output </li></ul><ul><ul><li>Heart Rate X Stroke Volume </li></ul></ul><ul><ul><ul><li>i.e. (70 beats/min)X(70 ml/beat) = 4900 ml =5 L/min </li></ul></ul></ul><ul><ul><ul><li>Decrease Stoke Volume= Decreases Cardiac Output </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Leads to Hypoperfusion/Shock!!!!! </li></ul></ul></ul></ul></ul>
  19. 21. Bleeding and Shock Factors Affecting BP <ul><li>Cardiac Output </li></ul><ul><ul><li>Volume of blood circulating </li></ul></ul><ul><ul><li>Increase = Raise BP </li></ul></ul><ul><ul><li>Decrease = Lowe BP </li></ul></ul><ul><li>Vascular Space </li></ul><ul><ul><li>Size of total space within circulatory system: </li></ul></ul><ul><ul><ul><li>Arteries </li></ul></ul></ul><ul><ul><ul><li>Veins </li></ul></ul></ul><ul><ul><ul><li>Capillaries </li></ul></ul></ul><ul><ul><ul><ul><li>Increase (vasodilation/hemorrhage) </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Lowers BP </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Decrease( vasoconstriction) </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Raises BP </li></ul></ul></ul></ul></ul>
  20. 22. Severity of blood loss <ul><li>Serious </li></ul><ul><ul><li>Adult = 1 liter (1000 ml) </li></ul></ul><ul><ul><li>Child = ½ liter (500 ml) </li></ul></ul><ul><ul><li>Infant = 100-200 ml </li></ul></ul><ul><li>Based on </li></ul><ul><ul><li>S/S </li></ul></ul><ul><ul><li>General impression of volume lost </li></ul></ul><ul><ul><li>S/S of shock </li></ul></ul><ul><li>Compensation </li></ul><ul><ul><li>Vasoconstriction </li></ul></ul><ul><ul><li>Clotting </li></ul></ul><ul><li>Pathophysiology </li></ul><ul><ul><li>Uncontrolled bleeding = Hypoperfusion = Shock </li></ul></ul>
  21. 23. Effects of blood loss <ul><li>Loss of blood cells </li></ul><ul><ul><li>Less able to perfuse tissues with less hemoglobin </li></ul></ul><ul><li>Loss of blood volume </li></ul><ul><ul><li>Less volume = less pressure </li></ul></ul><ul><ul><li>Circulatory collapse </li></ul></ul>
  22. 24. Sources of Bleeding <ul><li>Arterial </li></ul><ul><ul><li>Spurting </li></ul></ul><ul><ul><li>Bright red (O2 rich) </li></ul></ul><ul><ul><li>Most difficult to control due to pressure </li></ul></ul><ul><ul><li>As BP drops so does amount of spurting </li></ul></ul><ul><li>Venous </li></ul><ul><ul><li>Steady flow </li></ul></ul><ul><ul><li>Dark red (O2 poor) </li></ul></ul><ul><ul><li>Can be profuse </li></ul></ul><ul><ul><li>Generally easier to control </li></ul></ul><ul><li>Capillary </li></ul><ul><ul><li>Oozes </li></ul></ul><ul><ul><li>Dark red </li></ul></ul><ul><ul><li>Often clots spontaneously </li></ul></ul>
  23. 25. External Bleeding: BSI <ul><li>BSI </li></ul><ul><ul><li>Eye protection </li></ul></ul><ul><ul><li>Gloves </li></ul></ul><ul><ul><li>Gown </li></ul></ul><ul><ul><li>Mask </li></ul></ul><ul><ul><li>Hand washing </li></ul></ul>
  24. 26. Bleeding Control <ul><li>BSI </li></ul><ul><li>Maintain airway control </li></ul><ul><li>Direct pressure </li></ul><ul><ul><ul><li>Gloved Hand </li></ul></ul></ul><ul><ul><ul><li>Pressure Dressing </li></ul></ul></ul><ul><li>Elevate area </li></ul><ul><ul><li>Raise area above level of pt heart </li></ul></ul><ul><li>Packing </li></ul><ul><ul><li>Large gaping wounds may require sterile dressing packing </li></ul></ul><ul><ul><li>If this fails, remove and apply direct pressure to bleeding site </li></ul></ul><ul><li>Pressure points </li></ul><ul><ul><li>Place pressure on the artery proximal to bleeding site </li></ul></ul><ul><ul><li>Brachial artery – Compress with fingers </li></ul></ul><ul><ul><li>Femoral artery – Compress with heel of hand </li></ul></ul><ul><ul><li>Etc… </li></ul></ul>
  25. 28. Direct pressure Direct pressure with dressing Pressure Dressing Elevation Pressure Point
  26. 29. Bleeding Control cont’d <ul><li>If direct pressure fails… </li></ul><ul><ul><li>Splints </li></ul></ul><ul><ul><ul><li>Reduced motion of bone ends </li></ul></ul></ul><ul><ul><ul><li>Reduces aggravation of damage and blood loss </li></ul></ul></ul><ul><ul><li>Pressure Splints </li></ul></ul><ul><ul><ul><li>Helps control soft tissue injuries and bleeding assoc with broken bones </li></ul></ul></ul><ul><ul><ul><li>Pneumatic Anti shock garments can be used to sever bleeding due to MASSIVE soft tissue injuries </li></ul></ul></ul><ul><ul><ul><ul><li>Lower extremities = Leg compartments only </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Pelvic injury = ALL compartments </li></ul></ul></ul></ul>
  27. 30. Tourniquet <ul><ul><li>Use as a LAST resort to control bleeding in an amputated extremity when ALL other methods have failed… </li></ul></ul><ul><ul><li>Can result in PERMENANT damage to nerves, muscle and blood vessels </li></ul></ul><ul><ul><li>Loss of extremity… </li></ul></ul>
  28. 32. Tourniquet Precautions <ul><ul><li>Use a wide bandage and secure it </li></ul></ul><ul><ul><li>NEVER use wire, rope, belts or anything else that may cut into the skin and underlying tissue </li></ul></ul><ul><ul><li>Do not remove/loosen it once in place unless told by medical control </li></ul></ul><ul><ul><li>Leave the tourniquet in open view </li></ul></ul><ul><ul><li>Do not apply a tourniquet over a joint </li></ul></ul><ul><ul><li>Apply it as close to the injury as possible </li></ul></ul>
  29. 33. Application of a Tourniquet <ul><li>Bandage : 4 “ wide and 6-8 layers deep </li></ul><ul><li>Wrap around extremity X 2 at a location proximal to bleeding but distal on the extremity as possible </li></ul><ul><li>Tie 1 knot in the bandage </li></ul><ul><li>Place a rod/stick over knot and tie square knot over stick/rod </li></ul><ul><li>Twist stick until bleeding has stopped </li></ul><ul><li>Secure the stick/rod in place </li></ul><ul><li>Let other providers know that a tourniquet has been applied </li></ul><ul><li>DOCUMENT the time!!! </li></ul><ul><li>A continuously inflated BP cuff can be used as a tourniquet until bleeding stops. </li></ul>
  30. 35. Special Areas <ul><li>Bleeding from the: </li></ul><ul><ul><li>Nose </li></ul></ul><ul><ul><li>Mouth </li></ul></ul><ul><ul><li>Ears </li></ul></ul><ul><li>Possible causes </li></ul><ul><ul><li>Injured skull </li></ul></ul><ul><ul><li>Facial injury </li></ul></ul><ul><ul><li>Digital trauma (nose picking) </li></ul></ul><ul><ul><li>Sinusitis </li></ul></ul><ul><ul><li>Other upper resp tract infections </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Coagulation disorders </li></ul></ul>
  31. 36. Special Areas Treatment <ul><li>Nose/Ears </li></ul><ul><ul><li>If bleeding is a result of trauma do not attempt to stop blood flow </li></ul></ul><ul><ul><li>Collect blood with loose dressing </li></ul></ul><ul><ul><li>May be result of skull fracture </li></ul></ul><ul><li>Epistaxis (Nosebleed) </li></ul><ul><ul><li>Place pt in seated post </li></ul></ul><ul><ul><li>Lean pt forward </li></ul></ul><ul><ul><li>Apply direct pressure </li></ul></ul><ul><ul><ul><li>Pinch the fleshy part of the nostrils together </li></ul></ul></ul><ul><ul><li>Keep pt calm and quiet </li></ul></ul>
  32. 37. Bleeding Control/Treatment <ul><li>BSI </li></ul><ul><li>Maintain airway </li></ul><ul><li>Administer O2 </li></ul><ul><li>Control bleeding </li></ul><ul><ul><li>Direct pressure </li></ul></ul><ul><ul><li>Pressure dressing </li></ul></ul><ul><ul><li>Elevation </li></ul></ul><ul><ul><li>Pressure point </li></ul></ul><ul><ul><li>Splinting </li></ul></ul><ul><ul><li>Tourniquet </li></ul></ul><ul><ul><li>Etc… </li></ul></ul><ul><li>IMMEDIATE transport!!! </li></ul><ul><li>ALS </li></ul>
  33. 38. Internal Bleeding <ul><ul><li>Can result is SEVERE blood loss </li></ul></ul><ul><ul><li>Shock/hypoperfusion results </li></ul></ul><ul><ul><li>Injured organs </li></ul></ul><ul><ul><ul><li>Extensive concealed bleeding </li></ul></ul></ul><ul><ul><li>Swollen, deformed, painful extremities may also lead to bleeding </li></ul></ul><ul><ul><li>Suspicion and severity are base on MOI and S/S </li></ul></ul>
  34. 39. Causes <ul><li>Trauma </li></ul><ul><ul><li>Blunt </li></ul></ul><ul><ul><ul><li>Falls </li></ul></ul></ul><ul><ul><ul><li>MVA </li></ul></ul></ul><ul><ul><ul><li>Motorcycles </li></ul></ul></ul><ul><ul><ul><li>Pedestrian impacts </li></ul></ul></ul><ul><ul><ul><li>Blast injuries </li></ul></ul></ul><ul><ul><ul><li>DCAP-BTLS </li></ul></ul></ul><ul><ul><li>Penetrating </li></ul></ul><ul><ul><ul><li>Stabbing </li></ul></ul></ul><ul><ul><ul><li>GSW </li></ul></ul></ul><ul><ul><li>Fractures </li></ul></ul><ul><li>Medical conditions </li></ul><ul><ul><li>Ulcers (stomach/duodenal) </li></ul></ul><ul><ul><li>Aortic aneurysm </li></ul></ul><ul><ul><li>Ruptured ectopic pregnancy </li></ul></ul>Abdominal Aortic Aneurysm
  35. 40. Shock/Hypoperfusion Syndrome <ul><li>Shock/Hypoperfusion </li></ul><ul><ul><li>Failure of the circulatory system to adequately perfuse and oxygenate the tissues of the body </li></ul></ul><ul><li>Problems with either: </li></ul><ul><ul><li>The Heart - Pump </li></ul></ul><ul><ul><li>The Blood Volume - Fluid </li></ul></ul><ul><ul><li>The Vascular System - Pipes </li></ul></ul><ul><li>Pathophysiology </li></ul><ul><ul><li>Inadequate perfusion of cells with O2 and nutrients </li></ul></ul><ul><ul><li>Inadequate removal of waste products </li></ul></ul><ul><li>Consequences </li></ul><ul><ul><li>Peripheral perfusion is drastically reduced </li></ul></ul><ul><ul><li>Reduction in circulating blood volume </li></ul></ul><ul><ul><li>Death </li></ul></ul>
  36. 41. The Circulatory System Pathology Shock <ul><li>Signs/Symptoms </li></ul><ul><ul><li>Pale, cool, cyanotic, clammy skin </li></ul></ul><ul><ul><li>Rapid/shallow breathing </li></ul></ul><ul><ul><li>Restlessness/anxiety </li></ul></ul><ul><ul><li>Nausea/vomiting </li></ul></ul><ul><ul><li>Weak pulse </li></ul></ul><ul><ul><li>Low blood pressure/volume </li></ul></ul>
  37. 43. Compensation Mechanisms Effects of Epinephrine <ul><li>Cardiac Output increases </li></ul><ul><ul><li>Heart rate </li></ul></ul><ul><ul><li>Force of contractions </li></ul></ul><ul><li>Blood flow to brain is increased </li></ul><ul><ul><li>Alertness </li></ul></ul><ul><ul><li>Apprehension/Anxiety </li></ul></ul><ul><li>Pupils dilate </li></ul><ul><li>Blood flow is redistributed </li></ul><ul><ul><li>Blood is shunted away from less vital organs </li></ul></ul><ul><ul><li>Blood is sent to brain, heart, and muscles on priority basis </li></ul></ul><ul><ul><li>Pale, cool, clammy, sweaty skin </li></ul></ul><ul><ul><li>Nausea </li></ul></ul><ul><li>Resp. rate increased </li></ul><ul><ul><li>Rate </li></ul></ul><ul><ul><li>Depth </li></ul></ul>
  38. 44. S/S <ul><li>Anxiety </li></ul><ul><li>Restlessness </li></ul><ul><li>AMS </li></ul><ul><li>Combativeness </li></ul><ul><li>Weakness, faintness, dizziness </li></ul><ul><li>Thirst </li></ul><ul><li>Shallow, rapid breathing </li></ul><ul><li>Pale, cool, clammy skin </li></ul><ul><li>Capillary refill greater than 2 seconds (infant/child) </li></ul><ul><li>Dropping BP </li></ul><ul><li>Raising pulse rate </li></ul><ul><li>Rapid, weak pulse – late </li></ul><ul><li>Elevated BP – early compensation </li></ul><ul><li>Dilated sluggish pupils </li></ul><ul><li>Nausea and vomiting </li></ul>
  39. 48. Shock/Hypoperfusion Children <ul><li>Can loose up to half their blood volume and maintain BP </li></ul><ul><li>The infant/child in shock has less reserve </li></ul><ul><li>By the time their BP drops they are close to death </li></ul>
  40. 49. Treatment <ul><li>BSI </li></ul><ul><li>Maintain airway/ventilation </li></ul><ul><li>Admin O2 </li></ul><ul><li>Control external bleeding </li></ul><ul><li>Apply pneumatic anti shock garment </li></ul><ul><ul><li>S/S of shock </li></ul></ul><ul><ul><li>Abd tender </li></ul></ul><ul><ul><li>Pelvic injury suspected </li></ul></ul><ul><ul><li>No evidence of chest injury </li></ul></ul><ul><ul><li>Medical direction approval </li></ul></ul><ul><li>Elevate feet 8-12” </li></ul><ul><ul><li>If pt atraumatic </li></ul></ul><ul><li>Splint suspected bone/joint injuries </li></ul><ul><li>Cover pt with blanket to prevent heat loss </li></ul><ul><li>IMMEDIATE transport </li></ul>
  41. 50. Applying Pneumatic Anti Shock Garment (PASG) <ul><li>Examine pt abd and legs for injury </li></ul><ul><ul><li>They will be covered and inaccessible one PASG is applied </li></ul></ul><ul><li>Remove pt clothing if possible </li></ul><ul><li>Lay PASG on stretcher </li></ul><ul><li>Lay pt on PASG with log roll </li></ul><ul><li>Top of abd section of the PASG should like below the ribs </li></ul><ul><li>Fasten the Velcro straps </li></ul><ul><ul><li>At least ¾ of Velcro surface should be covered </li></ul></ul><ul><li>Connect the foot pump to the PASG </li></ul><ul><li>Open the stopcock valves </li></ul><ul><li>Inflate legs and (if not contraindicated) abdominal sections </li></ul><ul><li>Check for S/S of response </li></ul><ul><ul><li>Improved vitals </li></ul></ul><ul><ul><li>Cap refill, Skin color, Mental status </li></ul></ul>
  42. 52. Remember Direct pressure!!! Prevent shock…

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