Bleeding and Shock:

1
Bleeding and Shock
2
Circulatory/Plumbers System

• Pump Heart
• Pipes Blood Vessels.
• Fluid Blood.
• Average person weighing about 150 lbs..has about
  10-12 pints of blood.

3
Perfusion

• Delivery of oxygen and other nutrients to the
  cells of all organ systems and the effective
  elimination of carbon dioxide and other waste
  products.

4
Shock/Hypoperfusion

• Insufficient supply of oxygen and other nutrients
  to some of the bodys cells and ineffective
  elimination of carbon dioxide and other waste
  products.

5
Levels of Perfusion

• Heart - requires constant perfusion.
• Brain Spinal cord - 4 to 6 minutes.
• Kidneys - 45 minutes.
• Skeletal muscles - 2 hours.

6
External Bleeding

• Severity.
• 1 liter (1000 cc) loss in adult patient.
• Half a liter (500 cc) loss in children.
• 100-200 cc in infants is considered serious.
• If the patient exhibits signs symptoms of
  shock, the bleeding is to be considered serious.

7
Types of Bleeding.

• Arterial
• Venous
• Capillary

8
Arterial

• Bright red, spurting blood.
• Usually indicates severed or damaged artery.
• Most difficult to stop.
• As patients Blood Pressure decreases, so will the
  spurting.

9
Venous

• Steady flow of dark red blood.
• Usually indicates severed or damaged vein.
• Easier to control due to lower pressure.

10
Capillary

• Dark red blood which oozes.
• Indicates damaged capillaries.
• Most easily controlled.
• Bleeding clots spontaneously.

11
Assessment

• Serious external bleeding should be found and
  treated during the initial assessment.
• If possible the airway and serious bleeding may
  be controlled at the same time.

12
Dressings Bandages

• Dressings are applied to the wound.
• Bandages hold dressings in place.

13
Controlling Bleeding

• BSI precautions.
• Apply direct pressure immediately with gloved
  hand.
• Apply dressings 4x4 gauze. (never remove, if
  blood soaks through apply more 4x4s).
• Apply pressure bandage.
• Elevate above level of the heart. (do not elevate
  if possible bone or joint injury).
• Pressure point.
• Tourniquet (only as a last resort).

14
Splints

• Splinting the extremity may allow prompt bleeding
  control.
• Limits movement and diminishes the threat of more
  tissue damage.

15
Pressure Splints/PASG

• Exert pressure for extra bleeding control.
• PASG can be used to control bleeding in the lower
  extremities.
• Inflate to where you can indent the PASG with
  thumb pressure.

16
Tourniquet

• Apply 4 inch wide bandage as close to injury as
  possible.
• Tie a knot and twist a stick until bleeding
  stops.
• Secure the stick.
• Notify the E.R personnel of tourniquet.
• Apply the letters TK on the patients forehead and
  the time it was applied.
• Document on the PCR.

17
Bleeding from Mouth,Nose or Ears

• Possible Causes
• Skull fracture.
• Facial trauma.
• Digital trauma.
• Sinusitis
• Hypertension.
• Clotting disorders.

18
Bleeding from Mouth or Nose

• Suspect a skull fracture.
• Do not attempt to stop the bleeding.
• Apply loose dressings around the area.

19
Epistaxis

• Nosebleed.
• Can develop hypoperfusion from extreme blood
  loss.
• Place patient in a sitting position and have them
  lean forward.
• Pinch the nostrils together.
• Apply 2x2s inside upper lip and press.

20
Internal Bleeding

• Internal bleeding can result in severe blood loss
  with rapid progression to shock and death, all in
  a matter of minutes.

21
Severity

• Two most common sources.
• Injured internal organs.
• Fractured extremities.
• Always suspect internal bleeding in cases of
  unexplained hypoperfusion.

22
Signs Symptoms

• Pain, tenderness, swelling, discoloration of
  suspected injury site.
• Bleeding from mouth, rectum, vagina, or other
  orifice.
• Vomiting bright red blood or blood the color of
  dark coffee grounds.
• Dark, tarry stools, or stools with bright red
  blood.
• Tender, rigid and/or distended abdomen.

23
Late Signs Symptoms

• Anxiety, restlessness, combativeness, or altered
  mental status.
• Weakness, faintness, or dizziness.
• Thirst.
• Shallow rapid breathing.
• Rapid, weak pulse.
• Pale cool clammy skin.
• Capillary refill gt 2 sec. (infants children
  under 6).
• Dropping blood pressure.
• Dilated pupils sluggish in response to light.
• Nausea and vomiting.

24
Treatment

• BSI.
• Provide Big Os.
• Control bleeding.
• Elevate the lower extremities 8 to 12 inches.
• Keep patient warm.
• Transport immediately.

25
Causes of Shock

• Pump failure.
• Pipe failure.
• Fluid loss.
• Hypoxia

26
Types of Shock

• Respiratory
• Neurogenic/Vasogenic
• Cardiogenic
• Hypovolemic
• Anaphylactic
• Metabolic
• Psychogenic
• Septic

27
Stages of Shock

• Compensatory
• Progressive ( decompensated)
• Irreversible

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Compensatory Shock

• 1st. Stage of shock.
• Bodies normal defense mechanisms kick in.
• Detection of drop in B.P.
• Heart rate increases and blood vessels constrict.
• Slightly decreased body temp.

29
Progressive/Decompensated Shock

• Apathy, confusion, slowed speech.
• Slowed, irregular, weak thready pulse.
• Decreased B.P.
• Cool clammy skin.
• Shunting.
• Rapid breathing.
• Dilated pupils.

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Irreversible Shock

• Organs begin to die.
• Cannot be reversed.
• Shock is bad no matter what type it is. Do not
  let shock get to this stage.