This document discusses bleeding, internal bleeding, and shock. It provides guidance on assessing and controlling external bleeding through direct pressure and tourniquets. Internal bleeding is harder to detect but causes shock and can be life-threatening. Signs of internal bleeding include pain, swelling, and bleeding from orifices. Shock results from inadequate blood flow and can be caused by blood loss, burns, or injuries. Its signs include a rapid, weak pulse and pale, cool skin. Emergency care for shock involves preventing further blood loss, elevating legs, and providing oxygen.

1. LESSON
12

2. BLEEDING
External or internal
bleeding common
with trauma
patients
Control bleeding
quickly to prevent
shock

3. BLEEDING, CONTINUED
Risk of infectious disease from contact
with the patient’s blood or body fluids
Follow standard precautions
Serious injury may prevent effective
clotting
Significant blood loss will cause shock and
possibly death

4. TYPES OF EXTERNAL BLEEDING

5. ASSESSING EXTERNAL BLEEDING
Perform the standard assessment
Estimate severity of blood loss
Assess the patient for shock

6. SKILL:BLEEDING
CONTROL

7. Place sterile dressing on
wound.
Apply direct pressure
with hand.

8. If needed, put another
dressing on top of first.

9. Apply roller bandage.

10. TOURNIQUET
Used rarely as an extreme last resort
A “life or limb” decision
Use a wide band just above the wound;
tighten only enough to stop bleeding
Record time of application
Once applied, do not loosen or remove
Do not cover

12. INTERNAL BLEEDING
Commonly occurs with blunt trauma
Suspect based on the mechanism of injury
Bleeding is concealed
Causes shock and is life threatening
Cannot control internal bleeding

13. SIGNS AND SYMPTOMS OF
INTERNAL BLEEDING
Discolored, tender, swollen or hard skin,
rigid abdomen
Absence of distal pulse
Increased respiratory and pulse rates
Pale, cool, moist skin
Nausea and vomiting
Thirst
Mental status changes
Bleeding from body orifices

14. CARE FOR INTERNAL BLEEDING
Perform standard patient care
Manage any external bleeding
Keep patient in a position of comfort
Keep patient warm
Limit movement of a deformed extremity
Treat for shock
Administer high-flow oxygen

17. SHOCK (HYPOPERFUSION)
Results from the inadequate delivery of
oxygenated blood to body tissues
May result from any condition involving:
Failure of the heart to provide oxygenated blood
(pump failure)
Abnormal dilation of the vessels (pipe failure)
Blood volume loss (fluid failure)

18. Severe bleeding
Severe burns
Heart failure
Heart attack
Head or spinal
injuries
Allergic reactions
Dehydration
Electrocution
Serious infection
Extreme
emotional
reactions
(temporary/less
dangerous)
CAUSES OF SHOCK

19. Restlessness,
anxiety
Extreme thirst
Rapid, weak pulse
Rapid, shallow
respirations
Mental status
changes
Pale, cool, moist
skin
Decreased blood
pressure (late sign)
SIGNS AND SYMPTOMS OF SHOCK

20. EMERGENCY CARE FOR SHOCK
Perform standard patient care
Prevent further blood loss
Put patient in shock position

21. • Have patient lie on
back and raise legs 8
– 12 inches
• Loosen any tight
clothing
• Maintain normal body
temperature

22. CARE FOR SHOCK – CONTINUED
Do not give the patient anything to eat or drink.
Provide care for specific injuries.
Administer high-flow oxygen if available
Monitor the patient’s breathing and vital signs every 5 minutes