BLEEDING & SHOCK

TRAUMA is the Leading Cause of Death in the U.S., Ages 1 - 44

OBJECTIVES

• List Components of the Circulatory System
• Differentiate Types of Bleeding
• Use MOI to Identify Potential Internal Injury
• List Signs of Internal Bleeding
• List S & S of Shock
• List Steps of Emergency Care for Internal Bleeding
• List Steps of Emergency Care for Shock

SKILLS OBJECTIVES

• Demonstrate External Bleeding Control Methods
• Direct Pressure, Elevation, Pressure Points
• Tourniquet
• Demonstrate Care of Patient w/ Internal Bleed
• Demonstrate Care of Patient w/ S & S of Shock

AFFECT

• Understand and explain the urgency to transport patients that are bleeding and showing signs and symptoms of shock

CIRCULATORY SYSTEM

• Heart
• Arteries
• Veins
• Capillaries
• Blood

CIRCULATORY SYSTEM

• Pump
• Heart
• Pipes
• Arteries / Veins
• Hot Water
• Arterial Blood
• Cool Water
• Venous Blood
• Boiler
• Body / Capillaries

FUNCTION of BLOOD

• Transports Gases
• O2 : Lungs to Cells / CO2 : Cells to Lungs
• Nutrition
• From Digestive System to Cells
• Excretion
• Waste from Cells to Filtering Organs
• Protection
• WBC Fights Infection
• Regulation
• Temperature, Hormones, Chemicals

DEFINITIONS

• PERFUSION:
• Adequate Circulation of Blood
• Supplies All Cells
• HYPOPERFUSION:
• Inadequate Circulation of Blood
• Waste Products Build-up
• SHOCK:
• Hypoperfusion

FIRST THINGS FIRST

• Protect yourself - Scene Safe? BSI?
• Do the ABC’s
• Treat life-threatening problems
• Oxygen
• Assess the whole patient

GENERAL GUIDELINES of EMERGENCY CARE

• BODY SUBSTANCE ISOLATION (BSI)
• Gloves
• Gown
• Eye Protection
• Hand Washing

SEVERITY of BLOOD LOSS

• Adult - 1 Liter (1000ml)
• Volume 5 Liters
• Child - 1/2 Liter (500ml)
• Volume 3 Liters
• Infant - 100 - 200ml
• Volume 500 - 800ml
• Approximate Human Blood Volume
• 70 ml/Kg

SEVERITY of BLOOD LOSS

• General Impression
• If S&S of Shock, Consider Bleeding Serious
• Body’s Response to Bleeding
• Vessel Contractions
• Clotting - Platelets
• Death
• If Bleeding is Not Controlled

TYPES of BLEEDING

• Arterial
• Spurts
• Bright Red
• Most Difficult to Control

TYPES of BLEEDING

• Venous
• Steady Stream
• Dark Red
• Maroon
• Easier to Control

TYPES of BLEEDING

• Capillary
• Oozes
• Dark Red
• Clots Spontaneously
• Easiest to Control

GENERAL GUIDELINES

• Remember first things first
• Protect yourself - Scene Safe?, B.S.I.?
• Airway? O2? Ventilate?
• Get a General Impression

EXTERNAL BLEEDING CONTROL

• Direct Pressure
• Fastest
• Usually Effective
• Gloved Hand
• Dressing if Available
• Finger Pressure - Small

EXTERNAL BLEEDING CONTROL

• Elevate
• Above the Heart
• Maintain Direct Pressure
• Don’t use if:
• Bone Fx
• Impaled Object
• Spinal Injury

EXTERNAL BLEEDING CONTROL

• Pressure Points
• Brachial Arteries
• Femoral Arteries
• Artery Occluded Against Bone
• Can You Find Yours?

EXTERNAL BLEEDING CONTROL

EXTERNAL BLEEDING CONTROL

• Pressure Bandage
• Splint
• Keep Bone Ends From Causing More Damage
• Air Splint
• Added Pressure
• Pneumatic Anti-shock Garment (PASG)
• Military Anti-shock Trousers (MAST)

TOURNIQUET

• LAST RESORT
• WILL Cause Permanent Damage
• If Done - Tighten Until All Blood Stops
• No Tourniquet Distal to Elbow or Knee

TOURNIQUET

• Cravat - Folded to 4" Wide
• Wrap Twice
• Tie Knot
• Tie Stick On Top of Knot
• Turn Until Blood Stops
• Secure Stick
• DOCUMENT TIME ON PATIENT

TOURNIQUET

• NO Wire, Rope, Thin Belt
• Nothing That Will Cut Skin
• Do Not Remove / Loosen
• Unless Ordered by Medical Command
• Do Not Apply Directly Over Joint
• But as Close To Injury as Possible

BLEEDING
NOSE, EARS & MOUTH

• Potential Causes:
• Injured Skull
• Facial Trauma
• Boogie Picking
• Infection
• Hypertension
• Coagulation Disorder
• Hemophilia
• Coumadin (Warafin)

BLEEDING
NOSE, EARS & MOUTH

• Result of Trauma
• Do Not Stop Bleeding - Loose Dressing
• Protect Airway
• Skull Fracture
• Clear Fluid from Nose / Ears
• Cerebrospinal Fluid
• Usually Mixed with Blood

BLEEDING
NOSE, EARS & MOUTH

• Epistaxis (Nose Bleed)
• Sit Leaning Forward
• Pinch Nostrils
• Do Not Swallow Blood

INTERNAL BLEEDING

• Concealed Bleeding
• Profuse
• Shock
• Death
• Organs or Extremities
• Mechanism of Injury Along w/ S & S

INTERNAL BLEEDING

• Penetrating Trauma
• Blunt Trauma
• MVA
• Motorcycle
• Pedestrians
• Blasts / Explosions
• Falls

INTERNAL BLEEDING

• Look For:
• Deformity, Contusions, Abrasions, Penetrations, Tenderness, Swelling
• Almost DCAP-BTLS
• Impact Marks
• Steering Wheel
• Seat Belt

INTERNAL BLEEDING

• Pain
• Tenderness
• Swelling
• Discoloration
• Abdomen
• Tender
• Rigid
• Distended

INTERNAL BLEEDING

• Bleeding

• Vomiting

• Stools

INTERNAL BLEEDING

• Capillary refill time > 2 seconds
• Infants and children only: Nausea and vomiting
• Decreasing blood pressure (late sign)
• Dilated pupils (late sign)

INTERNAL BLEEDING

• BSI, ABC, O2
• Extremity
• Splint
• Pressure
• Pelvic or Abdominal Region
• PASG / MAST
• Load & Go (S&G Method) - If Shocky

SHOCK

• Hypovolemic - Loss of Fluid
• Cardiogenic - Damaged Pump
• Neurogenic - Loss of Vascular Tone
• Septic - Infection
• Anaphylactic - Allergic Reaction

SHOCK
HYPOPERFUSION SYNDROME

• Mental State
• Restless
• Anxiety
• Altered Level of Consciousness

SHOCK
HYPOPERFUSION SYNDROME

• Peripheral Perfusion
• Pale, Cool, Clammy Skin
• Diaphoretic
• Weak, Thready, Absent Pulses
• Delayed Capillary Refill
• Pulse Oximetry Not Reliable

SHOCK
HYPOPERFUSION SYNDROME

• Vital Signs
• Increased Pulse Rate - Weak/Thready
• Decreased BP - Late Sign
• Rapid Breathing - Shallow/Labored

SHOCK
HYPOPERFUSION SYNDROME

• Other S&S
• Pupils Dilated
• Thirst
• Nausea / Vomiting
• Lips Cyanotic

SHOCK
HYPOPERFUSION SYNDROME

SHOCK
HYPOPERFUSION SYNDROME

• What’s First?
• Control External Bleed
• Elevate Lower Extremities
• Raise Feet End of Long Board
• Splint Orthopedic Injuries
• Prevent Heat Loss
• Get Going