shock and hemmorhage

1. Hemorrhage and Shock
Chandan Pradhan

2. Introduction
• Hemorrhage
– Abnormal internal or external loss of blood
• Homeostasis
– Tendency of the body to maintain a steady
and normal internal environment
• Shock
– INADEQUATE TISSUE PERFUSION
– Transition between homeostasis and death
Chandan Pradhan

3. Defining Shock
• Shock is best defined as inadequate tissue
perfusion.
– Can result from a variety of disease states
and injuries.
– Can affect the entire organism, or it can occur
at a tissue or cellular level.
Chandan Pradhan

4. Hemorrhage Classification
Chandan Pradhan

5. External Hemorrhage
• Results from soft tissue injury.
• Most soft tissue trauma is accompanied by mild
hemorrhage and is not life threatening.
– Can carry significant risks of patient morbidity and
disfigurement
• The injury dependents on:
– Anatomical source of the hemorrhage (arterial, venous,
capillary)
– Degree of vascular disruption
– Amount of blood loss that can be tolerated by the patient
Chandan Pradhan

6. Internal Hemorrhage
• Can result from:
– Blunt or penetrating trauma
– Acute or chronic medical illnesses
• Internal bleeding that can cause hemodynamic
instability. Usually occurs in one of four body cavities:
– Chest
– Abdomen
– Pelvis
– Peritoneum
Chandan Pradhan

7. Internal Hemorrhage
• Signs and symptoms of internal
hemorrhage include:
– Bright red blood from mouth, rectum, or other
orifice
– Coffee-ground appearance of vomitus
– Melena (black, tarry stools)
– Dizziness or syncope on sitting or standing
– Orthostatic hypotension
Chandan Pradhan

8. Internal hemorrhage is associated
with higher morbidity and
mortality than external
hemorrhage.
Chandan Pradhan

9. External Hemorrhage Control
• External Hemorrhage management
– Direct pressure and pressure dressing
– General management
• Direct pressure
• Elevation
• Ice
• Pressure points
• Constricting band
• Tourniquet
Chandan Pradhan

10. Internal Hemorrhage Control
• General Management
– Immobilization,
– stabilization,
– elevation
Types:
– Epistaxis: Nose Bleed
– Hemoptysis
– Esophageal Varices
– Melena
– Chronic Hemorrhage
Chandan Pradhan

11. S/S of Hemorrhagic Shock
– Weak, thready, rapid pulse
• Narrowing pulse pressure
– Tachypnea
– Anxiety, restlessness
– Decreased LOC and Altered MS
– Pale, cool, and clammy skin
Chandan Pradhan

12. Hemorrhage Assessment
• Initial Assessment
–General Impression
• Obvious bleeding
–CABD
–Mental Status
–Interventions
– O2
– Bleeding control
– Shock
– BLS
Chandan Pradhan

13. Hemorrhage Assessment
– Rapid Trauma Assessment
• Full head to toe
– Focused Physical Exam
– Vitals
– Additional Assessment
• Orthostatic hypotension
• Tilt test: BP or P from supine to sitting
Chandan Pradhan

14. Shock Management
Chandan Pradhan

15. Specific Wound Considerations
• Head Wounds
– Presentation
• Severe bleeding
• Skull fracture
– Management
• Gentle direct
pressure
• Fluid drainage from
ears and nose
– Do not pack
– Cover and bandage
loosely
• Neck Wounds
– Presentation
• Large vessel can
entrap air
– Management
• Consider direct
digital pressure
• Occlusive dressing
Chandan Pradhan

16. Specific Wound Considerations
• Crush Injury
– Presentation
• Difficult to locate source of bleeding
• Normal hemorrhage control mechanism
nonfunctional
– Management
• Consider pressure dressing
• Consider tourniquet
Chandan Pradhan

17. Shock Management
• Airway and Breathing
• Hemorrhage Control
• Fluid Resuscitation
– Catheter size and length
– Large bore
– Stabilize
• Temperature Control
– Conserve core temperature
– Warm IV fluids
Chandan Pradhan
Any injury to the
head or torso is also
considered an injury
to the spine.