BLEEDING AND SHOCK. Bleeding and Shock ¤ Lesson Objective: Identify the types of bleeding and shock and their treatments.

BLEEDING AND

SHOCK

BLEEDING AND

SHOCK

Bleeding and ShockBleeding and Shock

Lesson Objective: Identify the types Lesson Objective: Identify the types of bleeding and shock and their of bleeding and shock and their treatmentstreatments

Lesson Objective: Identify the types Lesson Objective: Identify the types of bleeding and shock and their of bleeding and shock and their treatmentstreatments

OVERVIEWOVERVIEW

Anatomy and PhysiologyAnatomy and PhysiologyExternal BleedingExternal Bleeding Internal BleedingInternal BleedingShockShockTypes of ShockTypes of Shock


Anatomy and PhysiologyAnatomy and Physiology

ContainerContainerHeartHeartArteriesArteriesArteriolesArteriolesCapillariesCapillariesVenulesVenulesVeinsVeins

ContainerContainerHeartHeartArteriesArteriesArteriolesArteriolesCapillariesCapillariesVenulesVenulesVeinsVeins

Anatomy and PhysiologyAnatomy and PhysiologyAnatomy and PhysiologyAnatomy and Physiology

ContentsBloodBloodSix litersSix liters

ContentsBloodBloodSix litersSix liters

Anatomy ReviewAnatomy Review

PerfusionPerfusionCirculation of blood through an Circulation of blood through an

organ structureorgan structureDelivers oxygen and nutrients and Delivers oxygen and nutrients and

removes waste productsremoves waste products

PerfusionPerfusionCirculation of blood through an Circulation of blood through an

organ structureorgan structureDelivers oxygen and nutrients and Delivers oxygen and nutrients and

removes waste productsremoves waste products

Jeopardy?Jeopardy?Jeopardy?Jeopardy?

Inadequate circulation of blood Inadequate circulation of blood through an organthrough an organ

Inadequate circulation of blood Inadequate circulation of blood through an organthrough an organ

HypoperfusionHypoperfusionHypoperfusionHypoperfusionOrgans susceptibleOrgans susceptible Heart Brain and spinal cord Kidneys Skeletal muscle GI system

Inadequate perfusion

results in shock

Organs susceptibleOrgans susceptible Heart Brain and spinal cord Kidneys Skeletal muscle GI system

Inadequate perfusion

results in shock

External BleedingExternal Bleeding

EMT SAFETYEMT SAFETY BSI Follow local protocol

EMT SAFETYEMT SAFETY BSI Follow local protocol

External BleedingExternal Bleeding

Significant blood lossSignificant blood loss1 liter - adult1/2 liter - child100 to 200 ml 100 to 200 ml - infant- infant

Result may be HYPOVOLEMIC shock

Significant blood lossSignificant blood loss1 liter - adult1/2 liter - child100 to 200 ml 100 to 200 ml - infant- infant

Result may be HYPOVOLEMIC shock

Types of BleedingTypes of BleedingTypes of BleedingTypes of Bleeding

ArterialArterial Bright red and spurts Difficult to control

ArterialArterial Bright red and spurts Difficult to control

Types of BleedingTypes of BleedingTypes of BleedingTypes of BleedingVenousVenous Darker and flows steady More easily managed

CapillaryCapillary Dark red and oozes Often clots spontaneously

VenousVenous Darker and flows steady More easily managed

CapillaryCapillary Dark red and oozes Often clots spontaneously

Jeopardy?Jeopardy?

Bright red and spurtsBright red and spurts

Controlling External Controlling External BleedingBleeding

Controlling External Controlling External BleedingBleeding

BSIBSI

Airway / BreathingAirway / Breathing

Bleeding ControlBleeding Control

BSIBSI

Airway / BreathingAirway / Breathing

Bleeding ControlBleeding Control

Bleeding ControlBleeding ControlBleeding ControlBleeding Control

Direct local pressureDirect local pressure

Most effective

Direct local pressureDirect local pressure

Most effective


Direct local pressureDirect local pressure Pressure dressings Do not remove dressings Additional dressings

Direct local pressureDirect local pressure Pressure dressings Do not remove dressings Additional dressings


ElevationElevation Use with direct pressure As little as 6”

SplintsSplints Reduces motion of bone Control of bleeding

ElevationElevation Use with direct pressure As little as 6”

SplintsSplints Reduces motion of bone Control of bleeding


Air SplintsAir Splints Controls severe bleeding Stabilizes a fracture

Air SplintsAir Splints Controls severe bleeding Stabilizes a fracture


Pneumatic Antishock GarmentsPneumatic Antishock GarmentsCompresses abdomen and lower Compresses abdomen and lower

extremitiesextremitiesIncreases blood to vital organsIncreases blood to vital organs

Pneumatic Antishock GarmentsPneumatic Antishock GarmentsCompresses abdomen and lower Compresses abdomen and lower

extremitiesextremitiesIncreases blood to vital organsIncreases blood to vital organs

Jeopardy?Jeopardy?

Blood is dark red and oozesBlood is dark red and oozes


Proximal Arterial PressureProximal Arterial PressureRarely stops bleeding completelyRarely stops bleeding completelyPulse pointsPulse points

Proximal Arterial PressureProximal Arterial PressureRarely stops bleeding completelyRarely stops bleeding completelyPulse pointsPulse points

Jeopardy?Jeopardy?

Most effective way to control bleeding

Most effective way to control bleeding

TourniquetTourniquetLast resortLast resortCan cause permanent damageCan cause permanent damageProceduresProceduresBandage 4 inches wide and 6 to 8 Bandage 4 inches wide and 6 to 8

layers deeplayers deepWrap around extremity twice at a point Wrap around extremity twice at a point

proximal to bleeding but as distal on proximal to bleeding but as distal on the extremity as possiblethe extremity as possible

Last resortLast resortCan cause permanent damageCan cause permanent damageProceduresProceduresBandage 4 inches wide and 6 to 8 Bandage 4 inches wide and 6 to 8

layers deeplayers deepWrap around extremity twice at a point Wrap around extremity twice at a point

proximal to bleeding but as distal on proximal to bleeding but as distal on the extremity as possiblethe extremity as possible

TourniquetTourniquetTourniquetTourniquet Tie a knot and insert stickTie a knot and insert stick Twist until bleeding stopsTwist until bleeding stops Secure stick or rod in positionSecure stick or rod in position Write TK and time applied on foreheadWrite TK and time applied on forehead Document use of tourniquet and time Document use of tourniquet and time

appliedapplied May use BP cuffMay use BP cuff

Tie a knot and insert stickTie a knot and insert stick Twist until bleeding stopsTwist until bleeding stops Secure stick or rod in positionSecure stick or rod in position Write TK and time applied on foreheadWrite TK and time applied on forehead Document use of tourniquet and time Document use of tourniquet and time

appliedapplied May use BP cuffMay use BP cuff

Precautions with the use of Precautions with the use of a a

TourniquetTourniquet

Precautions with the use of Precautions with the use of a a

TourniquetTourniquet

PrecautionsPrecautionsPrecautionsPrecautions Use a wide bandage and secure Use a wide bandage and secure

tightlytightly Never use wire, rope, or beltNever use wire, rope, or belt Do not remove or loosen once Do not remove or loosen once

appliedapplied Leave in open viewLeave in open view Do not apply over jointDo not apply over joint

Use a wide bandage and secure Use a wide bandage and secure tightlytightly

Never use wire, rope, or beltNever use wire, rope, or belt Do not remove or loosen once Do not remove or loosen once

appliedapplied Leave in open viewLeave in open view Do not apply over jointDo not apply over joint

Special Areas - nose, ears, Special Areas - nose, ears, or mouthor mouth

Special Areas - nose, ears, Special Areas - nose, ears, or mouthor mouth

Potential CausesPotential CausesInjured skullInjured skullFacial traumaFacial traumaDigital traumaDigital trauma

Potential CausesPotential CausesInjured skullInjured skullFacial traumaFacial traumaDigital traumaDigital trauma

Special Areas - nose, ears, or Special Areas - nose, ears, or mouthmouth

Special Areas - nose, ears, or Special Areas - nose, ears, or mouthmouth

Potential Causes (cont.)Potential Causes (cont.)Sinusitis, or other URI infectionsHypertensionHypertensionCoagulation disordersCoagulation disorders

Potential Causes (cont.)Potential Causes (cont.)Sinusitis, or other URI infectionsHypertensionHypertensionCoagulation disordersCoagulation disorders

TreatmentTreatmentSkull FXSkull FX

TreatmentTreatmentSkull FXSkull FX

Do not stop blood flowDo not stop blood flow Loose, dry sterile dressingLoose, dry sterile dressing Wrap dressing loosely around headWrap dressing loosely around head

Do not stop blood flowDo not stop blood flow Loose, dry sterile dressingLoose, dry sterile dressing Wrap dressing loosely around headWrap dressing loosely around head

Treatment for epistaxis Treatment for epistaxis (nose bleed)(nose bleed)




Place in sitting position, leaning forward

Apply direct pressure by pinching nostrils together, or

Gauze between upper lip and gum Ice over nose Keep patient calm and quiet

Place in sitting position, leaning forward

Apply direct pressure by pinching nostrils together, or

Gauze between upper lip and gum Ice over nose Keep patient calm and quiet

Internal BleedingInternal BleedingInternal BleedingInternal Bleeding SeveritySeverityHypovolemic shockHypovolemic shockBleeding may be concealedBleeding may be concealed

SeveritySeverityHypovolemic shockHypovolemic shockBleeding may be concealedBleeding may be concealed

Internal BleedingInternal BleedingInternal BleedingInternal Bleeding

SeveritySeverity Broken bones - serious internal

bleedingLocal swellingBruising

SeveritySeverity Broken bones - serious internal

bleedingLocal swellingBruising

Mechanism of InjuryMechanism of InjuryMechanism of InjuryMechanism of Injury Blunt traumaBlunt traumaFallsFallsMotorcycle crashes, pedestrian Motorcycle crashes, pedestrian

impacts, automobile collisionsimpacts, automobile collisions

Blunt traumaBlunt traumaFallsFallsMotorcycle crashes, pedestrian Motorcycle crashes, pedestrian

impacts, automobile collisionsimpacts, automobile collisions

Mechanism of InjuryMechanism of InjuryBlunt trauma cont...Blunt trauma cont...Mechanism of InjuryMechanism of InjuryBlunt trauma cont...Blunt trauma cont...

Blast injuriesBlast injuriesLook for contusions, abrasions, Look for contusions, abrasions,

deformity, impact marks, and deformity, impact marks, and swellingswelling

PenetratingPenetrating traumatrauma- Knife orKnife or gunshotgunshot

Blast injuriesBlast injuriesLook for contusions, abrasions, Look for contusions, abrasions,

deformity, impact marks, and deformity, impact marks, and swellingswelling

PenetratingPenetrating traumatrauma- Knife orKnife or gunshotgunshot

S & S of Internal BleedingS & S of Internal Bleeding

Pain, tenderness, swelling, or Pain, tenderness, swelling, or discolorationdiscoloration

Bleeding from mouth, rectum, or Bleeding from mouth, rectum, or vaginavagina

Pain, tenderness, swelling, or Pain, tenderness, swelling, or discolorationdiscoloration

Bleeding from mouth, rectum, or Bleeding from mouth, rectum, or vaginavagina

S & S of Internal BleedingS & S of Internal Bleeding

HematuriaHematuria HematemesisHematemesis MelenaMelena

HematuriaHematuria HematemesisHematemesis MelenaMelena

S&S Internal BleedingS&S Internal BleedingS&S Internal BleedingS&S Internal Bleeding HemoptysisHemoptysis Pain, tenderness, bruising, or Pain, tenderness, bruising, or

swelling around injured siteswelling around injured site

HemoptysisHemoptysis Pain, tenderness, bruising, or Pain, tenderness, bruising, or

swelling around injured siteswelling around injured site

S&S Internal BleedingS&S Internal BleedingS&S Internal BleedingS&S Internal Bleeding

Broken ribs, bruises over lower Broken ribs, bruises over lower chest, tender, rigid, or distended chest, tender, rigid, or distended abdomenabdomenLacerated spleen or liverLacerated spleen or liverReferred painReferred pain

Broken ribs, bruises over lower Broken ribs, bruises over lower chest, tender, rigid, or distended chest, tender, rigid, or distended abdomenabdomenLacerated spleen or liverLacerated spleen or liverReferred painReferred pain

Late S & S of hypovolemic Late S & S of hypovolemic shockshock


Anxiety, restlessness, Anxiety, restlessness, combativeness, or altered mental combativeness, or altered mental statusstatus

Weakness, faintness, or dizzinessWeakness, faintness, or dizziness

Anxiety, restlessness, Anxiety, restlessness, combativeness, or altered mental combativeness, or altered mental statusstatus

Weakness, faintness, or dizzinessWeakness, faintness, or dizziness



ThirstThirst Shallow, rapid breathingShallow, rapid breathing Rapid weak pulseRapid weak pulse Pale, cool, clammy skinPale, cool, clammy skin

ThirstThirst Shallow, rapid breathingShallow, rapid breathing Rapid weak pulseRapid weak pulse Pale, cool, clammy skinPale, cool, clammy skin

S & S of Hypovolemic Shock

S & S of Hypovolemic Shock

Capillary refill greater than 2 secondsCapillary refill greater than 2 seconds Dropping blood pressure (late sign)Dropping blood pressure (late sign) Dilated pupils that are sluggish to Dilated pupils that are sluggish to

respondrespond Nausea and vomitingNausea and vomiting

Capillary refill greater than 2 secondsCapillary refill greater than 2 seconds Dropping blood pressure (late sign)Dropping blood pressure (late sign) Dilated pupils that are sluggish to Dilated pupils that are sluggish to

respondrespond Nausea and vomitingNausea and vomiting

TreatmentTreatment BSIBSI AirwayAirway O2O2 Treat internal and external bleedingTreat internal and external bleeding Treat uncontrolled hypovolemic Treat uncontrolled hypovolemic

shockshock

BSIBSI AirwayAirway O2O2 Treat internal and external bleedingTreat internal and external bleeding Treat uncontrolled hypovolemic Treat uncontrolled hypovolemic

shockshock

TreatmentTreatment

Vitals at least every 10 minutesVitals at least every 10 minutes NPONPO Elevate legsElevate legs Immediate TransportImmediate Transport

Vitals at least every 10 minutesVitals at least every 10 minutes NPONPO Elevate legsElevate legs Immediate TransportImmediate Transport

Shock (Hypoperfusion)Shock (Hypoperfusion)Shock (Hypoperfusion)Shock (Hypoperfusion)

PhysiologyPhysiology Insufficient circulation Body redirects blood

PhysiologyPhysiology Insufficient circulation Body redirects blood

Causes of HypoperfusionCauses of HypoperfusionCauses of HypoperfusionCauses of HypoperfusionPoor pump functionPoor pump functionDamage to the heartDamage to the heartHeart attackHeart attack

Poor pump functionPoor pump functionDamage to the heartDamage to the heartHeart attackHeart attack

Causes of HypoperfusionCauses of HypoperfusionCauses of HypoperfusionCauses of Hypoperfusion

Blood or fluid loss from blood Blood or fluid loss from blood vesselsvesselsTrauma to vessels or tissuesTrauma to vessels or tissuesFluid loss from GI tractFluid loss from GI tract

Blood or fluid loss from blood Blood or fluid loss from blood vesselsvesselsTrauma to vessels or tissuesTrauma to vessels or tissuesFluid loss from GI tractFluid loss from GI tract

Causes of HypoperfusionCauses of HypoperfusionCauses of HypoperfusionCauses of Hypoperfusion

Blood vessels dilateBlood vessels dilateInfectionInfectionDrug overdoseDrug overdoseSpinal cord injurySpinal cord injury

Blood vessels dilateBlood vessels dilateInfectionInfectionDrug overdoseDrug overdoseSpinal cord injurySpinal cord injury

S&S early (compensated) S&S early (compensated) shock shock

S&S early (compensated) S&S early (compensated) shock shock

Agitation, anxiety, restlessness, Agitation, anxiety, restlessness, altered level of consciousnessaltered level of consciousness

Weak, rapid (thready) pulseWeak, rapid (thready) pulse Pale, ashen, cool, moist (clammy) Pale, ashen, cool, moist (clammy)

skinskin PallorPallor Profuse sweatingProfuse sweating

Agitation, anxiety, restlessness, Agitation, anxiety, restlessness, altered level of consciousnessaltered level of consciousness

Weak, rapid (thready) pulseWeak, rapid (thready) pulse Pale, ashen, cool, moist (clammy) Pale, ashen, cool, moist (clammy)

skinskin PallorPallor Profuse sweatingProfuse sweating

S&S of early (compensated) S&S of early (compensated) shockshock

S&S of early (compensated) S&S of early (compensated) shockshock

Shallow, labored, or irregular Shallow, labored, or irregular breathingbreathing

Shortness of breathShortness of breath Nausea or vomitingNausea or vomiting Capillary refill longer than 2 secondsCapillary refill longer than 2 seconds Marked thirstMarked thirst

Shallow, labored, or irregular Shallow, labored, or irregular breathingbreathing

Shortness of breathShortness of breath Nausea or vomitingNausea or vomiting Capillary refill longer than 2 secondsCapillary refill longer than 2 seconds Marked thirstMarked thirst

S&S of Late S&S of Late (decompensated) Shock (decompensated) Shock

S&S of Late S&S of Late (decompensated) Shock (decompensated) Shock

Gradual and steadily falling blood pressure

Poor urinary output Dull eyes, dilated pupils Weak or absent peripheral pulses

Gradual and steadily falling blood pressure

Poor urinary output Dull eyes, dilated pupils Weak or absent peripheral pulses

Emergency Medical CareEmergency Medical CareEmergency Medical CareEmergency Medical Care

BSIBSIAirwayAirwayControl external bleedingControl external bleedingElevate lower extremities 6 to 12 Elevate lower extremities 6 to 12

inchesinches

BSIBSIAirwayAirwayControl external bleedingControl external bleedingElevate lower extremities 6 to 12 Elevate lower extremities 6 to 12

inchesinches

Splint any bone or joint injuriesSplint any bone or joint injuriesNPONPOPrevent loss of body heatPrevent loss of body heatmonitor vital signsmonitor vital signsTransportTransport

Splint any bone or joint injuriesSplint any bone or joint injuriesNPONPOPrevent loss of body heatPrevent loss of body heatmonitor vital signsmonitor vital signsTransportTransport

Emergency Medical CareEmergency Medical CareEmergency Medical CareEmergency Medical Care

Types of ShockTypes of ShockTypes of ShockTypes of Shock

Anaphylactic Anaphylactic --

Most severe form of allergic Most severe form of allergic reaction due to vascular dilationreaction due to vascular dilation

Anaphylactic Anaphylactic --

Most severe form of allergic Most severe form of allergic reaction due to vascular dilationreaction due to vascular dilation

Types of ShockTypes of ShockTypes of ShockTypes of ShockAnaphylacticAnaphylactic - - S & SMild itchingBurning skinGeneralized edemaComaRapid death

AnaphylacticAnaphylactic - - S & SMild itchingBurning skinGeneralized edemaComaRapid death

TreatmentTreatmentTreatmentTreatment

O2O2Determine causeDetermine causeEpinephrineEpinephrineTransport promptlyTransport promptly

O2O2Determine causeDetermine causeEpinephrineEpinephrineTransport promptlyTransport promptly

Types of ShockTypes of ShockTypes of ShockTypes of ShockCardiogenic Cardiogenic - poor pump functionpoor pump functionS&SS&SChest painsChest painsIrregular, weak pulseIrregular, weak pulseLow blood pressureLow blood pressureCyanosis (lips, nails)Cyanosis (lips, nails)AnxietyAnxiety

Cardiogenic Cardiogenic - poor pump functionpoor pump functionS&SS&SChest painsChest painsIrregular, weak pulseIrregular, weak pulseLow blood pressureLow blood pressureCyanosis (lips, nails)Cyanosis (lips, nails)AnxietyAnxiety


PositionPositionO2O2Transport promptlyTransport promptly

PositionPositionO2O2Transport promptlyTransport promptly

Types of ShockTypes of ShockTypes of ShockTypes of ShockHypovolemic Hypovolemic - Loss of blood or fluid- Loss of blood or fluidS&SS&SRapid, weak pulseRapid, weak pulseLow blood pressureLow blood pressureChange in mental statusChange in mental statusCyanosis (lips, nails)Cyanosis (lips, nails)Cool, clammy skin Cool, clammy skin

Hypovolemic Hypovolemic - Loss of blood or fluid- Loss of blood or fluidS&SS&SRapid, weak pulseRapid, weak pulseLow blood pressureLow blood pressureChange in mental statusChange in mental statusCyanosis (lips, nails)Cyanosis (lips, nails)Cool, clammy skin Cool, clammy skin


O2O2Control external bleedingControl external bleedingElevate legsElevate legsPASGPASGTransportTransport

O2O2Control external bleedingControl external bleedingElevate legsElevate legsPASGPASGTransportTransport


MetabolicMetabolic--

Excessive loss of fluid and Excessive loss of fluid and electrolyteselectrolytes

MetabolicMetabolic--

Excessive loss of fluid and Excessive loss of fluid and electrolyteselectrolytes

Types of ShockTypes of ShockTypes of ShockTypes of ShockMetabolic - S&S Rapid, weak pulseLow blood pressureChange in mental statusCyanosis (lips, nails)Cool, clammy skin

Metabolic - S&S Rapid, weak pulseLow blood pressureChange in mental statusCyanosis (lips, nails)Cool, clammy skin


O2O2Determine illnessDetermine illnessTransport promptlyTransport promptly

O2O2Determine illnessDetermine illnessTransport promptlyTransport promptly

Types of ShockTypes of ShockTypes of ShockTypes of Shock Neurogenic Neurogenic - Damaged- Damaged cervical cervical

spinespine, causing blood vessels to causing blood vessels to dilatedilateS&SS&SBradycardiaBradycardiaLow blood pressureLow blood pressureSigns of neck injurySigns of neck injury

Neurogenic Neurogenic - Damaged- Damaged cervical cervical spinespine, causing blood vessels to causing blood vessels to dilatedilateS&SS&SBradycardiaBradycardiaLow blood pressureLow blood pressureSigns of neck injurySigns of neck injury

TreatmentTreatmentTreatmentTreatmentO2O2Conserve body heatConserve body heatPASGPASGTransportTransport

O2O2Conserve body heatConserve body heatPASGPASGTransportTransport

Jeopardy?Jeopardy?

Temporary vascular dilation, due Temporary vascular dilation, due to anxiety, sight of blood, severe to anxiety, sight of blood, severe pain, etc.pain, etc.

Temporary vascular dilation, due Temporary vascular dilation, due to anxiety, sight of blood, severe to anxiety, sight of blood, severe pain, etc.pain, etc.


PsychogenicPsychogenic S&SS&SRapid pulseRapid pulseNormal or low blood pressureNormal or low blood pressure

PsychogenicPsychogenic S&SS&SRapid pulseRapid pulseNormal or low blood pressureNormal or low blood pressure


Duration of unconsciousnessDuration of unconsciousness Record vital signs and mental statusRecord vital signs and mental status If confused, suspect head injury If confused, suspect head injury TransportTransport

Duration of unconsciousnessDuration of unconsciousness Record vital signs and mental statusRecord vital signs and mental status If confused, suspect head injury If confused, suspect head injury TransportTransport

Types of ShockTypes of ShockTypes of ShockTypes of ShockSepticSeptic - combined vessel and - combined vessel and

fluid loss due to severe bacterial fluid loss due to severe bacterial infectionsinfectionsS&SS&SWarm skinWarm skinTachycardiaTachycardiaLow B/PLow B/P

SepticSeptic - combined vessel and - combined vessel and fluid loss due to severe bacterial fluid loss due to severe bacterial infectionsinfectionsS&SS&SWarm skinWarm skinTachycardiaTachycardiaLow B/PLow B/P

TXTXTXTX

O2O2Elevate legsElevate legsKeep patient warmKeep patient warmTransport promptlyTransport promptly

O2O2Elevate legsElevate legsKeep patient warmKeep patient warmTransport promptlyTransport promptly

SummarySummarySummarySummary



QUESTIONS?QUESTIONS?

BLEEDING AND SHOCK. Bleeding and Shock ¤ Lesson Objective: Identify the types of bleeding and shock and their treatments.

Documents

organ slide

effective slide

fracture slide

treatments slide

severe bleeding

hypovolemic shock slide

local protocol slide

bleeding control air