Bleeding and Shock
- 1. Chapter Bleeding and Shock Twenty-One
- 2. Chapter BSI when handling patients who are bleeding Identification and control of external bleeding Identification and treatment of internal bleeding Shock (hypoperfusion) and its progressive stages Twenty-One CORE CONCEPTS
- 3. Heart Blood Blood vessels Arteries Capillaries Veins Review of Circulatory System
- 4. Review of Circulatory System
- 5. Perfusion Circulation of blood through an organ Hypoperfusion Inadequate circulation of blood through an organ K EY TERMS
- 6. E XTERNAL BLEEDING
- 7. Arterial Capillary Venous 3 Types of External Bleeding
- 8. Take BSI precautions when controlling bleeding.
- 9. General impression of blood loss Signs or symptoms of shock (hypoperfusion) Severity of Blood Loss Is Determined by: (Continued)
- 10. 1 liter of blood in an adult Half a liter of blood in a child 100–200cc of blood in an infant IS SERIOUS! (Continued) Sudden loss of
- 11. Uncontrolled bleeding or significant blood loss leads to shock (hypoperfusion) and possibly death!
- 12. Emergency Care of External Bleeding
- 13. Direct Pressure
- 14. Elevation
- 15. Pressure Bandage
- 16. Brachial: Upper limbs Femoral: Lower limbs Pressure Points
- 17. Pressure Point Brachial
- 18. Pressure Point Femoral
- 19. 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.
- 20. Supplemental Methods of Bleeding Control
- 21. Air Splinting
- 22. A tourniquet is a last resort.
- 23. Bleeding from the Nose, Ears, and Mouth
- 24. Managing a Simple Nosebleed
- 25. Skull Fracture May cause loss of blood or Do not stop the flow of fluid. clear fluid (cerebrospinal fluid) from the nose and ears.
- 27. Mechanism of injury Clinical signs and symptoms Base Judgment of Severity of Internal Bleeding on:
- 28. Consider mechanism of injury.
- 29. Falls Auto, motorcycle, or pedestrian accidents Penetrating trauma Possible Mechanisms of Injury
- 30. Patient ASSESSMENT Internal Bleeding Signs and Symptoms Significant mechanism of injury Pain, tenderness, deformity, swelling, discoloration (Continued)
- 31. Patient ASSESSMENT Internal Bleeding Signs and Symptoms Bleeding from the mouth, rectum, vagina, or other orifice Tender, rigid, and/or distended abdomen (Continued)
- 32. Patient ASSESSMENT Internal Bleeding Signs and Symptoms Vomiting blood Bright red Coffee-ground color and consistency Blood in stool Bright red Dark, tarry (Continued)
- 33. Patient ASSESSMENT Internal Bleeding Signs and Symptoms Capillary refill time > 2 seconds (infants and children only) Nausea and vomiting Decreasing blood pressure Dilated pupils (late sign) (late sign)
- 34. Patient CARE Internal Bleeding Emergency Care Steps BSI Airway care and oxygen Immediate transport to appropriate facility (Continued)
- 35. Patient CARE Internal Bleeding Emergency Care Steps Apply direct pressure if injured area is on an extremity. Splint extremity.
- 37. 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
- 38. Inadequate perfusion of cells with oxygen and nutrients Inadequate removal of metabolic waste products (Continued) Shock (Hypoperfusion)
- 39. May develop from internal or external blood loss (or both). Peripheral perfusion is reduced due to the reduction in circulating blood volume. (Continued) Shock (Hypoperfusion)
- 40. Reduced perfusion results in malfunction of cells and organs. Shock that is not recognized and treated may result in death. (Continued) Shock (Hypoperfusion)
- 41. The body tries to compensate for shock by shunting blood away from areas of lesser need to areas of greater need. (This explains the order in which signs and symptoms occur.) Shock (Hypoperfusion)
- 42. Patient ASSESSMENT Shock Signs and Symptoms Restlessness, changes in mental status Pale, cool, and clammy skin Nausea and vomiting (Continued)
- 43. Patient ASSESSMENT Shock Signs and Symptoms Increased pulse rate Increased respiratory rate (decreasing blood pressure is a LATE sign) (Continued)
- 44. Patient ASSESSMENT Shock Signs and Symptoms Dilated pupils Thirst Cyanosis Capillary refill time > 2 seconds (infants and children only) (Continued)
- 45. Patient ASSESSMENT Shock Signs and Symptoms Patients may maintain their blood pressure until their blood volume is half gone. By the time an infant’s or child’s blood pressure drops, he or she is NEAR DEATH !
- 46. Patient CARE Shock Emergency Care Steps
- 47. 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
- 48. Use BSI. Maintain airway and administer oxygen.
- 50. Apply pneumatic anti-shock garment if indicated. Elevate lower extremities 8–12 inches.
- 51. Prevent loss of body heat. Transport immediately.
- 52. Patient CARE Shock Emergency Care Steps Splint suspected bone or joint injuries. Do not delay transportation. A backboard may be used to splint the entire body.
- 53. 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?