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Chapter Bleeding and Shock Twenty-One
Chapter ,[object Object],[object Object],[object Object],[object Object],Twenty-One CORE CONCEPTS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Review of  Circulatory System
Review of  Circulatory System
Perfusion Circulation of blood through an organ Hypoperfusion Inadequate circulation of blood through an organ K EY TERMS
E XTERNAL  BLEEDING
Arterial Capillary Venous 3 Types of External Bleeding
Take BSI precautions when controlling bleeding.
[object Object],[object Object],[object Object],Severity of Blood Loss Is Determined by: (Continued)
[object Object],[object Object],[object Object],IS SERIOUS! (Continued) Sudden loss of
Uncontrolled bleeding or significant  blood loss leads to shock  (hypoperfusion) and possibly death!
Emergency Care of External Bleeding
Direct Pressure
Elevation
Pressure Bandage
[object Object],[object Object],Pressure Points
Pressure Point  Brachial
Pressure Point  Femoral
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.
Supplemental Methods of Bleeding Control
Air Splinting
A tourniquet is a last resort.
Bleeding from the Nose, Ears, and Mouth
Managing a Simple Nosebleed
Skull Fracture ,[object Object],[object Object],clear fluid (cerebrospinal fluid)  from the nose and ears.
I NTERNAL BLEEDING
[object Object],[object Object],Base Judgment of Severity of Internal Bleeding on:
Consider mechanism of injury.
[object Object],[object Object],[object Object],[object Object],Possible Mechanisms of Injury
Patient  ASSESSMENT Internal Bleeding Signs and Symptoms ,[object Object],[object Object],swelling, discoloration (Continued)
Patient  ASSESSMENT Internal Bleeding Signs and Symptoms ,[object Object],[object Object],(Continued)
Patient  ASSESSMENT Internal Bleeding Signs and Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Continued)
Patient  ASSESSMENT Internal Bleeding Signs and Symptoms ,[object Object],(infants and children only) ,[object Object],[object Object],[object Object],(late sign)
Patient  CARE Internal Bleeding Emergency Care Steps ,[object Object],[object Object],[object Object],appropriate facility (Continued)
Patient  CARE Internal Bleeding Emergency Care Steps ,[object Object],[object Object]
S HOCK (HYPOPERFUSION)
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
[object Object],[object Object],[object Object],[object Object],(Continued) Shock (Hypoperfusion)
[object Object],[object Object],[object Object],due to the reduction in  circulating blood volume. (Continued) Shock (Hypoperfusion)
[object Object],[object Object],[object Object],[object Object],(Continued) Shock (Hypoperfusion)
[object Object],[object Object],[object Object],[object Object],(This explains the order in which  signs and symptoms occur.) Shock (Hypoperfusion)
Patient  ASSESSMENT Shock Signs and Symptoms ,[object Object],[object Object],[object Object],(Continued)
Patient  ASSESSMENT Shock Signs and Symptoms ,[object Object],[object Object],(decreasing blood pressure is a  LATE  sign) (Continued)
Patient  ASSESSMENT Shock Signs and Symptoms ,[object Object],[object Object],[object Object],[object Object],(Continued)
Patient  ASSESSMENT Shock Signs and Symptoms ,[object Object],[object Object]
Patient  CARE Shock Emergency Care Steps
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
Use BSI. Maintain airway and administer oxygen.
Control external bleeding.
Apply pneumatic  anti-shock garment if indicated. Elevate lower  extremities 8–12 inches.
Prevent loss of body heat. Transport immediately.
Patient  CARE Shock Emergency Care Steps ,[object Object],[object Object],[object Object]
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?

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