CHAPTER 26

Bleeding and Shock

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and Shock

Review of Circulatory

System

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System

Review of Circulatory System

Heart

Blood

Blood Vessels

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Arteries

Capillaries

Veins

Circulatory System

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Perfusion

Key Term

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Circulation of blood through an organ

Hypoperfusion

Key Term

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Inadequate circulation of blood

through an organ

ExternalBleeding

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Bleeding

Take BSI precautions when controlling Take BSI precautions when controlling bleeding.bleeding.

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3 Types of 3 Types of External External BleedingBleeding

Arterial

Capillary

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Capillary

Venous

Severity of Blood LossDetermined by:

General impression of blood loss

Signs or symptoms of

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Signs or symptoms of

hypoperfusion

Sudden loss of...

One liter of blood in an adult

Half a liter of blood in a child

100-200cc of blood in an infant

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...is serious!

Uncontrolled bleeding or

significant blood loss leads to

shock (hypoperfusion) and

possibly death!

Blood Loss

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Do not wait for signs and

symptoms to appear before

beginning treatment!

Direct PressureDirect Pressure

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ElevationElevation

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Pressure Pressure BandageBandage

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Pressure Point Pressure Point –– BrachialBrachial

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Pressure Point Pressure Point –– FemoralFemoral

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Supplemental Methods ofBleeding

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BleedingControl

SplintingSplinting

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Air SplintingAir Splinting

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A tourniquet is a last resort.A tourniquet is a last resort.

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Bleeding fromthe Nose, Ears,

and Mouth

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and Mouth

Managing Managing a Simple a Simple NosebleedNosebleed

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Skull Fracture

May cause loss of blood or clear

fluid (cerebrospinal fluid) from the

nose and ears.

Do not stop the flow of fluid.

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Do not stop the flow of fluid.

Internal BleedingInternal Bleeding

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Severity of Internal Bleeding Should Be Based on:

Mechanism of injury

Clinical signs and symptoms

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Consider Consider mechanismmechanismof injury.of injury.

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Mechanism of Injury May Include:

Falls

Auto, motorcycle, or pedestrian

accidents

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accidents

Penetrating trauma

Blast Injuries

Signs & Symptomsof Internal Bleeding

Significant MOI

Pain, tenderness, deformity, swelling,

discoloration

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discoloration

Bleeding from the mouth, rectum, or

vagina

Tender, rigid, or distended abdomen

Signs & Symptoms of InternalBleeding

Vomiting blood

Bright red

Coffee-ground color and consistency

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Coffee-ground color and consistency

Blood in stool

Bright red

Dark, tarry

Signs & Symptoms of Internal Bleeding

Capillary refill time > 2 seconds

Infants and children only: Nausea

and vomiting

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and vomiting

Decreasing blood pressure (late

sign)

Dilated pupils (late sign)

Emergency Care of Internal Bleeding

BSI

Maintain airway; administer

oxygen.

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oxygen.

Control any external bleeding.

Emergency Care of Internal Bleeding

Splint if injured area is on an

extremity.

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Transport immediately.

Signs of shock

(hypoperfusion) appear

LATE!

Waiting for signs of shock to

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Waiting for signs of shock to

appear before recognizing and

treating may result in the DEATH of

your patient.

ShockShock

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Inadequate perfusion of cells with

oxygen and nutrients

AND

Inadequate removal of metabolic

Shock (Hypoperfusion)

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Inadequate removal of metabolic

waste products

Inability of heart to pump

Decreased supply of blood

Lack of integrity in blood vessels

Causes of Shock

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Failure of vessels to dilate &

constrict

To compensate for shock, the body shunts blood away from areas of lesser need to areas of

Early Shock

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areas of lesser need to areas of greater need.

Reduced perfusion results in

malfunction of cells and organs.

When this is not recognized and

Late Shock

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When this is not recognized and

treated, death may result.

Signs & Symptoms of Shock

Restlessness, changes in

mental status

Pale, cool, and clammy skin

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Increased pulse rate

Increased respiratory rate

Continued…

Signs & Symptoms of Shock

Decreasing blood pressure is a

LATE sign.

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Continued…

Signs & Symptoms of Shock

Pulse oximetry may be unreliable

Nausea and vomiting

Dilated pupils

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Dilated pupils

Thirst

Cyanosis

Continued…

Signs & Symptoms of Shock(Infants & Children)

Capillary refill time > 2 seconds

May maintain blood pressure until

blood volume is half gone

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blood volume is half gone

By the time an infant’s or child’s

blood pressure drops, they are

NEAR DEATH!

Emergency Care of Shock

Rapid transport is goal.

Golden Hour

Platinum Ten Minutes

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Platinum Ten Minutes

Take BSI precautions.Take BSI precautions.

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Maintain airway; administer oxygen.Maintain airway; administer oxygen.

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Control external bleeding.Control external bleeding.

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Emergency Care of Shock

Splint suspected bone or joint

injuries.

Do not delay transportation.

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Backboard can be used to splint

the entire body.

Apply PASG if indicated.Apply PASG if indicated.

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Elevate lower extremities 8Elevate lower extremities 8--12 inches.12 inches.

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Prevent loss of body heat.Prevent loss of body heat.

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Transport immediately.Transport immediately.

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1. Describe the following types of

bleeding:

Arterial

Capillary

Review Questions

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Capillary

Venous

2. Describe the emergency care for

external bleeding.

3. List the signs and symptoms of

internal bleeding.

4. Describe the emergency care for

internal bleeding.

Review Questions

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internal bleeding.

5. Define shock (hypoperfusion).

6. List the signs and symptoms

of shock in the order in which

they are likely to appear.

Review Questions

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they are likely to appear.

7. Describe the emergency care

for shock (hypoperfusion).

What is the priority for this patient?

Does an initial assessment still need

STREET SCENESSTREET SCENES

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Does an initial assessment still need

to be done?

What assessment information do you

want to receive from Squad 31?

Is the mechanism of injury important

information for this patient?

STREET SCENESSTREET SCENES

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information for this patient?

What is the treatment priority for this

patient?

How often should you get a new set

of vital signs?

STREET SCENESSTREET SCENES

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of vital signs?

Sample DocumentationSample Documentation

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