The document provides information about shock and external bleeding control. It defines shock as inadequate perfusion of blood to organs. It describes the signs and stages of shock from compensated to decompensated. Treatment for shock includes addressing the cause, placing the casualty flat and raising the legs, loosening clothing, covering with a blanket, establishing IV fluids, and monitoring vitals. The document also discusses types of bleeding, methods for control like direct pressure and tourniquets, and relates blood loss percentages to shock classes. Further, it outlines management of gunshot wounds, impaled objects, and amputated extremities.

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Shock
External Bleeding Control

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ObjectivesObjectives
 Understand the signs and symptoms of shock.Understand the signs and symptoms of shock.
 Understand basic treatment for shock.Understand basic treatment for shock.
 Understand blood loss as it relates to hypovolumic shock.Understand blood loss as it relates to hypovolumic shock.
 Understand and Practice Bleeding Control.Understand and Practice Bleeding Control.
 Be familiar with the injury patterns associated with gunshot wounds.Be familiar with the injury patterns associated with gunshot wounds.
 Understand what to do in case of an impaled objectUnderstand what to do in case of an impaled object
 Understand what to do in case of a severed extremityUnderstand what to do in case of a severed extremity
 Be familiar with the Emergency and ExcelArrest BandagesBe familiar with the Emergency and ExcelArrest Bandages

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 Red Blood CellsRed Blood Cells
 White Blood CellsWhite Blood Cells
 PlasmaPlasma
 PlateletsPlatelets
Components of BloodComponents of Blood

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PerfusionPerfusion
The supply of oxygen and the removal ofThe supply of oxygen and the removal of
wastes from the cells and tissues of the bodywastes from the cells and tissues of the body
as a result of the flow of blood.as a result of the flow of blood.

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PerfusionPerfusion
Signs of Adequate PerfusionSigns of Adequate Perfusion
 Normal skin signsNormal skin signs
 Normal Mental StatusNormal Mental Status
 Normal Vital SignsNormal Vital Signs
 RespirationsRespirations
 Adult 12 – 20 / minuteAdult 12 – 20 / minute
 Blood PressureBlood Pressure
 Adult 120/90Adult 120/90
 PulsePulse
 60 to 100 and regular60 to 100 and regular

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ShockShockThe Perfusion Triangle

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ShockShock
HypoperfusionHypoperfusion
Inadequate perfusion of blood to an organ or organs – also called shock.Inadequate perfusion of blood to an organ or organs – also called shock.
Compensated ShockCompensated Shock
When the patient is developing shock, but the body is still able to maintain perfusion.When the patient is developing shock, but the body is still able to maintain perfusion.
Signs includeSigns include – increased respirations, increased pulse rate, pale/cool/clammy skin and altered– increased respirations, increased pulse rate, pale/cool/clammy skin and altered
mental status.mental status.
Decompensated ShockDecompensated Shock
When the body can no longer compensate for low blood volume or lack of perfusion.When the body can no longer compensate for low blood volume or lack of perfusion.
Signs include – Decreased respirations, decreased pulse – periphery pulses absent, Decreased toSigns include – Decreased respirations, decreased pulse – periphery pulses absent, Decreased to
absent blood pressure, unresponsive mental statusabsent blood pressure, unresponsive mental status
“Hypovolumic shock: A rude unhinging in the machinery of life.”
Samuel G. Gross MD, 1872.

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UN Security Officers’
ETB/BFA Course8
ShockShock

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ShockShock
TreatmentTreatment
1.1. Treat any cause of shock you can remedy – bleeding controlTreat any cause of shock you can remedy – bleeding control
2.2. Lay the casualty down, keeping his/her head low, raise and support the legs.Lay the casualty down, keeping his/her head low, raise and support the legs.
3.3. Loosen tight clothing, braces, straps or belts to reduce constriction.Loosen tight clothing, braces, straps or belts to reduce constriction.
4.4. Cover with thermal blanket.Cover with thermal blanket.
5.5. Establish Intravenous Fluid TreatmentEstablish Intravenous Fluid Treatment
6.6. Monitor vital signs during transport or while waiting evacuationMonitor vital signs during transport or while waiting evacuation

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Blood Loss and ShockBlood Loss and Shock

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UN Security Officers’
ETB/BFA Course11
I II III IV
Blood loss (%) < 15 15 - 30 30 - 40 >40
Volume (ml) <750 800 - 1500 1500 - 2000 >2000
Pulse rate Slight Tachycardia 100 - 120/Min >120/Min Thready >140/Min V.
Thready
Blood Pressure
Systolic Unchanged Normal Reduced Very Low
Diastolic Unchanged Raised Reduced Very Low,
Unrecordable
Pulse Pressure Normal / Increased Decreased Decreased Decreased
Capillary Refill Normal Slow (>2 Sec) Slow (>2 Sec) Undetectable
Respiratory Rate Normal Normal Tachyponea Tachyponea
(14-20 Resp/Min) (20-30 Resp/Min) (30-40 Resp / Min) (>35 Resp/Min)
Urine Output >30ml/Hr 20 - 30 Ml/Hr 5 - 15 Ml/Hr 0 - 10ml/Hr
Extremities Normal Pale Pale Pale And Cold
Complexion Normal Pale Pale Ashen
Mental State Alert Anxious/Aggressive Anxious/Aggressive Drowsy
Lethargic Or
Unconscious
CLASS OF SHOCK

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BleedingBleeding
Types of bleedingTypes of bleeding
Arterial BleedingArterial Bleeding
-Highly pressurized - spurts, generally bright red.-Highly pressurized - spurts, generally bright red.
Venous BleedingVenous Bleeding
-Steady Flow and may appear darker than arterial blood.-Steady Flow and may appear darker than arterial blood.
Capillary bleedingCapillary bleeding
-Minor scrapes and abrasions.-Minor scrapes and abrasions.

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Stopping the bleeding:Stopping the bleeding:
Anti-Shock PostureAnti-Shock Posture
Elevate the WoundElevate the Wound
Direct PressureDirect Pressure
–– with compressing bandagewith compressing bandage
if available (up to 10 minutes)if available (up to 10 minutes)
Indirect Pressure (for limbs)Indirect Pressure (for limbs)
Brachial/Femoral (up to 10 minutes)Brachial/Femoral (up to 10 minutes)
Tourniquet – USUALLY A LAST RESORTTourniquet – USUALLY A LAST RESORT
Establish I.V. Fluid ResuscitationEstablish I.V. Fluid Resuscitation
Cover the casualtyCover the casualty
Follow the line
of a jacket
sleeve to find
the brachial
pressure point
The femoral
pressure point lies
where a trouser
crease crosses
the bottom edge of
a pair of briefs

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Scenario 1Scenario 1
You come upon a staff member screaming in front his tent with bright redYou come upon a staff member screaming in front his tent with bright red
blood coming from his forearm (between his wrist and his elbow).blood coming from his forearm (between his wrist and his elbow).
 SafetySafety
 Scene?Scene?
 TraumaTrauma
 Immediate phone callImmediate phone call
 Situation?Situation?
 Consciousness?Consciousness?
 Airway?Airway?
 Anti-shock posture?Anti-shock posture?
 Direct Pressure with compressing bandageDirect Pressure with compressing bandage
 Indirect pressure:Indirect pressure:
 Brachial arteryBrachial artery
 Open airwayOpen airway
 Apply TourniquetApply Tourniquet
 What else can you do to prevent shock?What else can you do to prevent shock?

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Scenario 1Scenario 1
You come upon a staff member screaming in front his tent with bright redYou come upon a staff member screaming in front his tent with bright red
blood coming from his calve (between his ankle and his knee).blood coming from his calve (between his ankle and his knee).
 SafetySafety
 Scene?Scene?
 TraumaTrauma
 Immediate phone callImmediate phone call
 Situation?Situation?
 Consciousness?Consciousness?
 Airway?Airway?
 Anti-shock posture?Anti-shock posture?
 Direct Pressure with compressing bandageDirect Pressure with compressing bandage
 Indirect pressure:Indirect pressure:
 Femoral arteryFemoral artery
 Open airwayOpen airway
 Apply TourniquetApply Tourniquet
 What else can you do to prevent shock?What else can you do to prevent shock?

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Gunshot WoundsGunshot Wounds
1.1. Ensure personal safety before attempting to provide careEnsure personal safety before attempting to provide care
2.2. An ideal safe place provides both:An ideal safe place provides both:
 CoverCover – something thought capable of providing ballistic protection– something thought capable of providing ballistic protection
 ConcealmentConcealment – something thought capable of concealing one from view– something thought capable of concealing one from view

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Gunshot WoundsGunshot Wounds
All Firearms fall into one of the following basic categories:All Firearms fall into one of the following basic categories:
 HandgunsHandguns
 Single shot weaponsSingle shot weapons
 RevolversRevolvers
 Semi-Automatic pistolsSemi-Automatic pistols
 RiflesRifles
 ShotgunsShotguns
 Full Automatic WeaponsFull Automatic Weapons

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Gunshot WoundsGunshot Wounds
What Happens when the Trigger is Pulled?What Happens when the Trigger is Pulled?
1.1. Primer ignitesPrimer ignites
2.2. Intense flame created by the primer fills the chamberIntense flame created by the primer fills the chamber
3.3. Powder burnsPowder burns
4.4. Pressure created by the burning powder pushes out thePressure created by the burning powder pushes out the
bullet (or shot)bullet (or shot)
Shotgun
Handgun Rifle
Primer
Flash Hole
Powder
bullet
Primer
Wad
Shot
Action
Chamber
Barrel
Magazine
(Clip)

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Gunshot WoundsGunshot Wounds
What damage do bullets cause?What damage do bullets cause?
 Damage from the bullet itselfDamage from the bullet itself
 Permanent CavityPermanent Cavity
 Damage from the energy of the bullet – shock wavesDamage from the energy of the bullet – shock waves
 Temporary CavityTemporary Cavity

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Impaled ObjectsImpaled Objects
• Expose and Examine
•Control hemorrhage
• Stabilize object in place with
bulky dressings

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UN Security Officers’
ETB/BFA Course24
Amputated ExtremitiesAmputated Extremities
 Wrap part in sterile dressing.Wrap part in sterile dressing.
 Place wrapped part in sealed plasticPlace wrapped part in sealed plastic
bagbag
 Place bag on cold packPlace bag on cold pack Your care affects possibility of
reattachment

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ObjectivesObjectives
 Understand the signs and symptoms of shock.Understand the signs and symptoms of shock.
 Understand basic treatment for shock.Understand basic treatment for shock.
 Understand blood loss as it relates to hypovolumic shock.Understand blood loss as it relates to hypovolumic shock.
 Understand and Practice Bleeding Control.Understand and Practice Bleeding Control.
 Be familiar with the injury patterns associated with gunshot wounds.Be familiar with the injury patterns associated with gunshot wounds.
 Understand what to do in case of an impaled objectUnderstand what to do in case of an impaled object
 Understand what to do in case of a severed extremityUnderstand what to do in case of a severed extremity
 Be familiar with the Emergency and ExcelArrest BandagesBe familiar with the Emergency and ExcelArrest Bandages

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Thank You!Thank You!