Bleeding and Shock Temple College ECA Blood Flow Heart

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Bleeding and Shock

• Temple College
• ECA

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BloodFlow
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Heart
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Anatomy

• Arteries
• Carry oxygenated blood away from the heart
• Thick, muscular walls to withstand pressure
• Dilate and contract
• Arterioles
• Smaller arteries which connect to capillaries

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Major Arteries
Subclavian
Carotid
Axillary
Brachial
Aorta
Radial
Iliac
Ulnar
Femoral
Popliteal
Dorsal Pedal
Posterior Tibial
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Anatomy

• Capillaries
• Small blood vessels where gas exchange actually
  take place.
• O2 CO2
• Venules
• Smaller veins that connect to the capillaries
• Veins
• Carry deoxygenated blood to the heart. R. atrium

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Major Veins
Internal Jugular
External Jugular
Subclavian
Superior Vena Cava
Axillary
Inferior Vena Cava
Iliac
Femoral
Saphenous
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Perfusion
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CellularLevel
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External Hemorrhage

• Bleeding outside of body
• Causes
• Blunt Trauma
• Penetrating Trauma

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What the difference?

• Arterial (high pressure)
• Bright red spurting
• Venous (lower pressure)
• Darker red flowing
• Capillary
• Oozes often clots spontaneously

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Management

• Protect Mucus Membranes
• Eye protection
• Gloves
• Gown
• Mask
• Hand washing following each run.

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Controlling External Hemorrhage

• Direct pressure
• Elevate
• Pressure dressing
• If bandages become blood soaked, add more.

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Controlling External Hemorrhage

• Pressure points
• Brachial arteries
• biceps
• Femoral arteries
• groin

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Controlling External Hemorrhage

• Splinting aids coagulation
• Use caution as not to aggravate a fx.

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Controlling External Hemorrhage

• Pneumatic Anti-Shock Garment
• Stabilizes bilateral femur fx and pelvic fx
• Shock due to internal hemorrhage

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Tourniquet

• Use a cravat or other wide cloth device
• Place 2 above injury, but not on a joint.
• Use stick/handle
• Turn until bleeding has slowed or stopped
• Write TK on pt. w/ time place on pt.

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Bleeding from Ears, Nose, Mouth

• May indicate injury to Skull and/or Brain

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Internal Hemorrhage

• Bleeding inside of body
• Causes
• Blunt Trauma
• Penetrating Trauma
• Medical Conditions
• Ulcers/GI
• Cancer
• Disease

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Indications of Internal Bleeding

• Pain, tenderness, swelling at injured site
• Tender, rigid and/or distended abdomen
• Increased HR RR, pale cool clammy skin, AMS
• Bruising
• Cullens Sign
• Turners Sign
• Bleeding from any orifice
• Hematemsis blood in vomit
• Melena black, tarry stools
• Hemoptysis coughing up blood

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Management of Internal Bleeding

• BSI
• ABCs
• Oxygen via NRB _at_ 15 lpm
• Appropriate Assessment
• Spine Motion Restriction (if needed)
• Rapid Transport to appropriate hospital

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Circulation vs. Perfusion

• Circulation is the movement of blood through the
  circulatory system
• Perfusion is providing tissues with oxygenated
  blood
• You must have good circulation to have adequate
  perfusion, but they are not the same

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Definitions of Shock

• Inadequate perfusion of tissues with oxygenated
  blood
• Failure of the cardiovascular system to
  adequately perfuse the body

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If there is a problem with any portion of the
circulatory system- pump, pipes or fluid, then
shock may manifest.
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Hemorrhage Severity

• gt 20 blood loss is not tolerated by body
• Average adult male has 6 L of blood
• Average adult female has 5 L of blood
• Significant blood loss
• Adult 1 L
• Pediatric 100-200 mL

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Poor Perfusion

• Inadequate removal of cellular waste products
• Inadequate delivery of nutrients
• Death results quickly
• Prompt recognition and treatment vital to patient
  survival

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Stages of Shock

• Compensated early stage
• Decompensated
• Irreversible

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Compensated Shock

• Mental Status
• Restlessness, Anxiety
• Altered Mental Status
• Peripherial Perfusion
• Pale, cool, clammy skin
• Delayed capillary refil
• Vital Signs
• Normal or slightly increased B/P
• Weak rapid thready pulse
• Increased RR (shallow, labor, irregular)
• Other
• Dilated Pupils
• Marked Thirst
• Nausea/Vomiting

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Decompensated Shock

• Significant Change in LOC
• Severe Tachycardia
• Increasing RR
• B/P is starting to fall

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Irreversible Shock

• Late stage
• Terminal
• Unconscious
• Bradycardia/pulseless
• Decreased RR/apneic
• Hypotension
• B/P may be difficult to obtain at this point.

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Shock Treatment

• Body Substance Isolation
• Maintain Airway/Breathing
• Control external hemorrhage
• Spine Motion Restriction as needed
• Consider MAST
• Shock position (if no contraindications)
• Cover with Blanket
• Rapid transport
• ALS intercept