Bleeding and Shock. Emergency Medial Services
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The document discusses various methods for controlling bleeding, both internal and external. It describes signs and symptoms of internal bleeding and shock based on estimated blood loss. Methods for controlling external bleeding include applying direct pressure, elevation, pressure dressings, hemostatic agents, and tourniquets as a last resort. Tourniquet application and wound packing are also summarized. The goal in managing bleeding is to stop blood loss through the described techniques and rapid transport to a medical facility.
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Bleeding and Shock. Emergency Medial Services
- 1. 1 Bleeding and Shock Pipes, pump, and fluid… really, it’s that simple!
- 2. 2 The Second Rule of Emergency medical services EMS…. …eventually the bleeding will stop!
- 4. 4 Cardiovascular System • Transports O2 and fuel to the cells, tissues, and organs. • Removes CO2 and wastes from the cells for elimination from the body. • Must be able to maintain sufficient flow through the capillary beds to meet the cell’s O2 and fuel needs
- 5. Sponsored Medical Lecture Notes – All Subjects USMLE Exam (America) – Practice
- 7. 7 Internal Bleeding Trauma Clotting disorders Rupture of blood vessels Fractures (injury to nearby vessels) Can result in rapid progression to hypovolemic shock & death!
- 8. 8 Internal Bleeding S/S Anxiety, restlessness, irritability Pale, diaphoretic skin Sustained tachycardia Hypotension Unstable vitals signs (postural changes)
- 9. 9 Internal Bleeding S/S Vomiting bright red blood or coffee ground material Bleeding form any body orifice Dark, tarry stools (melena) Tender, rigid, or distended abdomen Pain, discoloration, swelling, tenderness at injury site
- 10. 10 Managing Internal Bleeding ABC’s High concentration oxygen Assist ventilations Control external bleeding Stabilize fractures Transport rapidly to appropriate facility
- 11. 11 External Bleeding • Arterial Bleed –Bright red, spurting • Venous Bleed –Dark red, steady flow • Capillary Bleed –Dark red, oozing
- 12. 12 Control of External Bleeding Direct Pressure: Gloved hand Or Dressing and bandage
- 13. 13 Control of External Bleeding Elevation: Raise extremity above the level of the heart
- 14. 14 Control of External Bleeding Pressure Dressing: Use bandage to secure dressing in place
- 15. 15 Arterial Pressure Points • Upper extremity: – Brachial – Radial • Lower extremity: – Femoral – Popliteal
- 16. 16 Tourniquets Final resort when all else fails Used for amputations 3-4” wide (blood pressure cuffs) Write “TK” and time of application on forehead of patient Notify other personnel Once applied, DO NOT REMOVE
- 17. EMS Objectives 1. Identify methods/ techniques in prehospital bleeding control. 2. Indicate common issues associated with prehospital bleeding control.
- 18. In the United States
- 19. In the United States • Military Medical Corps – 1862
- 20. In the United States • Military Medical Corps – 1862 –integrated medical treatment
- 21. In the United States • Military Medical Corps – 1862 –integrated medical treatment –evacuation of personnel
- 22. US Special Forces Combat Medics First Assignments ************ US Army “Special Forces Units” “Green Beret’s” Dual Role Operators and Medics 1969 -70
- 23. 90% of combat deaths occur on the battlefield before the casualty ever reaches a medical treatment facility. - Col. Ron Bellamy
- 24. The hemorrhage that takes place when a main artery is divided is usually so rapid and so copious that the wounded man dies before help can reach him. - Col. H.M. Gray, 1919
- 25. The overwhelming cause of preventable combat death continues to be extremity hemorrhage
- 26. The American College of Surgeons and the Prehospital Trauma Life Support Guidelines no longer recommend elevation and pressure points for severe bleeding.
- 27. National Registry of Emergency Medical Technicians (NREMT) – February 2009
- 28. Figure 2
- 32. Types of Bleeding to Consider
- 33. • Bleeding from an arm or leg can usually be controlled by:
- 34. • Bleeding from an arm or leg can usually be controlled by: –trauma dressing
- 35. • Bleeding from an arm or leg can usually be controlled by: –trauma dressing –emergency trauma dressing
- 36. • Bleeding from an arm or leg can usually be controlled by: –manual direct pressure and elevation
- 37. • Bleeding from an arm or leg can usually be controlled by: –manual direct pressure and elevation –tourniquet (last resort?)
- 38. • In some situations, a tourniquet is applied first – since other methods will not be adequate to control the bleeding
- 40. Hemorrhage and Shock • What happens when you start to bleed?
- 41. Hemorrhage and Shock • What happens when you start to bleed? – it depends on how much blood you lose
- 42. Normal Adult Blood Volume 5 Liters Blood Volume
- 44. Recognizing Shock • Most useful in tactical combat casualty care (TCCC)
- 45. Recognizing Shock –mental status –radial pulse –heart rate (HR) –blood pressure (BP) –respiratory rate (RR) –likelihood of death
- 46. Recognizing Shock • May be difficult to judge blood loss in combat except by mental status and radial pulse
- 47. Recognizing Shock • Heart rate and respiratory rate may be affected by exertion and combat stress as well as shock
- 48. 500 cc Blood Loss 4.5 Liters Blood Volume
- 49. • Mental state – alert • Radial pulse – full • Heart rate – normal or somewhat increased • Systolic blood pressure – normal 500 cc Blood Loss
- 50. • Respiratory Rate – normal • Is he going to die from this? NO 500 cc Blood Loss
- 51. 1000cc Blood Loss 4.0 Liters Blood Volume
- 52. • Mental state – alert 1000cc Blood Loss
- 53. • Mental state – alert • Radial pulse – full 1000cc Blood Loss
- 54. • Mental state – alert • Radial pulse – full • Heart rate – 100+ 1000cc Blood Loss
- 55. • Systolic blood pressure – normal lying down • Respiratory rate – may be normal • Is he going to die from this? NO 1000cc Blood Loss
- 56. 1500cc Blood Loss 3.5 Liters Blood Volume
- 57. • Mental state – alert but anxious • Radial pulse – may be weak • Heart rate – 100+ 1500cc Blood Loss
- 58. • Systolic blood pressure – may be decreased 1500cc Blood Loss
- 59. • Systolic blood pressure – may be decreased • Respiratory rate – 30 1500cc Blood Loss
- 60. • Systolic blood pressure – may be decreased • Respiratory rate – 30 • Is he going to die from this? PROBABLY NOT 1500cc Blood Loss
- 61. 2000cc Blood Loss 3.0 Liters Blood Volume
- 62. • Mental state – confused/lethargic • Radial pulse – weak • Heart Rate – 120+ 2000cc Blood Loss
- 63. • Systolic blood pressure – decreased • Respiratory rate – >35 • Is he going to die from this? MAYBE 2000cc Blood Loss
- 64. 2.5 Liters Blood Volume 2500cc Blood Loss
- 65. • Mental state – unconscious • Radial pulse – absent • Heart rate – 140+ 2500cc Blood Loss
- 66. • Systolic blood pressure – markedly decreased • Respiratory rate – over 35 • Is he going to die from this? PROBABLY 2500cc Blood Loss
- 67. Expose the Wound
- 68. Expose the Wound • Push or cut away loose clothing
- 69. Expose the Wound • Push or cut away loose clothing • DO NOT remove clothing that is stuck to the wound
- 70. Expose the Wound • DO NOT attempt to clean the wound
- 71. Expose the Wound • DO NOT attempt to clean the wound • DO NOT probe the wound in order to remove an object from the wound
- 72. Expose the Wound
- 73. Apply a Bandage or Combined Trauma Bandage
- 74. Apply a Bandage or Combined Trauma Bandage • Israeli bandage/pressure dressing
- 76. Apply an Emergency Trauma Dressing
- 77. Apply an Emergency Trauma Dressing
- 78. Apply Pressure Dressing Over First Aid Dressing
- 79. Apply Pressure Dressing Over First Aid Dressing • When blood continues to seep from the field first aid dressing
- 80. Apply an Agent to a Wound
- 82. Chitosan (ki’ to san) Dressing
- 87. Addition to Chitosan Dressing • Apply manual pressure
- 88. Addition to Chitosan Dressing • Apply manual pressure • A bandage may be applied to the chitosan dressing to prevent it from being dislodged
- 89. Wound Stat
- 91. QuikClot®
- 92. CELOX™
- 93. Figure 3
- 95. • Uses pressure from the fingers, thumbs, or the heel of the hand applied to an artery supplying the wound Apply Digital Pressure
- 96. • Temporal • Carotid • Brachial • Radial • Femoral • Posterior/anterior tibialis Apply Digital Pressure
- 98. Tourniquet
- 99. Tourniquet • A constricting band placed around an extremity to stop arterial bleeding
- 100. Tourniquet • A constricting band placed around an extremity to stop arterial bleeding • Only used on an arm, forearm, thigh, or leg
- 101. Tourniquet • Used when there is no time to control bleeding • Used on an amputation of the arm, forearm, thigh, or leg
- 102. Core Skills Control Bleeding 102 Combat Application Tourniquet WINDLASS OMNI TAPE BAND WINDLASS STRAP
- 103. Applying a CAT
- 104. Core Skills Control Bleeding 104 Tourniquet Application • Place tourniquet between the heart and wound • Wrap tourniquet around extremity • Tighten UNTIL BLEEDING STOPS
- 105. Core Skills Control Bleeding 105 Tourniquet Etiquette • Never cover a tourniquet with another dressing, etc. • Write “T” on the casualty's forehead with pen or blood • Never loosen or remove a tourniquet once placed
- 107. Core Skills Control Bleeding 107 Injured Internal Organs
- 108. Core Skills Control Bleeding 108 Brachial Pressure Point
- 109. Core Skills Control Bleeding 109 Brachial Pressure Point
- 110. Core Skills Control Bleeding 110 Femoral Pressure Point • To control severe bleeding of thigh and lower leg • Located at front, center part of crease in the groin
- 112. Dressing an Amputation • Place a dressing (soft/absorbent) over the end of the stump • Secure the dressing with bandages
- 113. Dressing an Amputation • Prevents contamination • Protects from additional injury
- 115. • Gather materials Applying an Improvised Tourniquet
- 116. • Rigid object (windlass) such as a strong stick Applying an Improvised Tourniquet
- 117. • Rigid object (windlass) such as a strong stick • Tourniquet band (cravat) at least two inches wide Applying an Improvised Tourniquet
- 118. • Rigid object (windlass) such as a strong stick • Tourniquet band (cravat) at least two inches wide • Securing material (cravat) Applying an Improvised Tourniquet
- 119. • Twist windlass until bright red bleeding has stopped • Wrap second cravat around limb Applying an Improvised Tourniquet
- 120. • Wrap tails around end of windlass so the tourniquet will not unwind • Tie tails in a non-slip knot Applying an Improvised Tourniquet
- 123. The Special Operations Forces Tactical Tourniquet (SOFT)
- 124. Wound Packing
- 127. • Slow the bleeding first with point pressure or tourniquet, depending on the location of the insult Wound Packing
- 128. • Pack and pack and pack until there is no more room, filling all the voids you can Wound Packing
- 129. • Using a gauze with a blood stopping agent will make the pack more effective Wound Packing
- 130. • Using a gauze with a blood stopping agent will make the pack more effective • Check and recheck during transport or with movement Wound Packing
- 132. • Wound packing with a clotting agent can be helpful Wound Packing
- 133. 133 Treatment • ABC’s • Apply O2, assist ventilations as needed • Keep patient in position of comfort • Control bleeding, stabilize fractures • Prevent loss of body heat • Assist with medications • Nothing by mouth • Calm and reassure
- 134. Core Skills Control Bleeding 134 Splints • Immobilization of the injured extremity is one of the best ways to stop bleeding • Broken bone fragments may lacerate blood vessels • Muscular activity will increase rate of blood flow