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Chapter 23 Chapter 23 Bleeding
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Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Dec 23, 2015

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Page 1: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Chapter 23Chapter 23Chapter 23Chapter 23

Bleeding

Page 2: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

IntroductionIntroduction

• Important to be able to:– Recognize bleeding

– Understand how bleeding affects the body

• Bleeding can be external or internal.

• Bleeding can cause weakness, shock, and death.

Page 3: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Anatomy and Physiology of the Cardiovascular System

(1 of 3)

Anatomy and Physiology of the Cardiovascular System

(1 of 3)

• Functions of the cardiovascular system– Circulate blood to cells and tissues

– Deliver oxygen and nutrients

– Carry away metabolic waste products

Page 4: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Anatomy and Physiology of the

Cardiovascular System (2 of 3)

Anatomy and Physiology of the

Cardiovascular System (2 of 3)

Page 5: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Anatomy and Physiology of the Cardiovascular System

(3 of 3)

Anatomy and Physiology of the Cardiovascular System

(3 of 3)

• Three parts– Pump (heart)

– Container (blood vessels)

– Fluid (blood and body fluids)

Page 6: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

The Heart (1 of 4)The Heart (1 of 4)

• The heart is a hollow muscular organ about the size of a clenched fist.

• Has its own regulatory system

• Works as two paired pumps– Upper chamber (atrium)

– Lower chamber (ventricle)

Page 7: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

The Heart (2 of 4)The Heart (2 of 4)

• Blood leaves each chamber through a one-way valve.

• Right side receives oxygen-poor blood from veins

• Left side supplies oxygen-rich blood to arteries

Page 8: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

The Heart (3 of 4)The Heart (3 of 4)

Page 9: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

The Heart (4 of 4)The Heart (4 of 4)

Page 10: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Blood Vessels (1 of 4)Blood Vessels (1 of 4)

• Arteries– Small blood vessels that carry blood away from

the heart

• Arterioles– Smaller vessels that connect the arteries and

capillaries

Page 11: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Blood Vessels (2 of 4)Blood Vessels (2 of 4)

• Capillaries– Small tubes that link arterioles and venules

• Venules– Very small, thin-walled vessels that empty into

the veins

• Veins– Blood vessels that carry blood from the tissues

to the heart

Page 12: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Blood Vessels (3 of 4)Blood Vessels (3 of 4)

• As blood flows out of the heart, it passes into the aorta, the largest artery in the body.

• Oxygen and nutrients easily pass from the capillaries into the cells, and waste and carbon dioxide diffuse from the cells into the capillaries.

Page 13: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Blood Vessels (4 of 4)Blood Vessels (4 of 4)

Page 14: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Blood (1 of 3)Blood (1 of 3)

• Red blood cells– Responsible for the transportation of oxygen to

the cells

– Responsible for transporting carbon dioxide away from the cells to the lungs

• White blood cells

Page 15: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Blood (2 of 3)Blood (2 of 3)

Source: © Phototake/Alamy Images

Page 16: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Blood (3 of 3)Blood (3 of 3)

• Platelets– Responsible for

forming clots

– A blood clot forms depending on blood stasis, changes in the vessel walls, and the body’s ability to clot.

• Plasma

Page 17: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Autonomic Nervous SystemAutonomic Nervous System

• Constantly adapting to maintain homeostasis and perfusion

• Monitors the body’s needs

• Adjusts blood flow and vascular tone

• Automatically redirects blood away from other organs to the heart, brain, lungs, and kidneys in an emergency

Page 18: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Pathophysiology and Perfusion (1 of 5)

Pathophysiology and Perfusion (1 of 5)

• Blunt trauma can cause injury and significant bleeding that is unseen inside a body cavity or region.

• Significant amounts of blood loss cause hypoperfusion, or shock.– In penetrating trauma, the patient may have

only a small amount of bleeding that is visible.

Page 19: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Pathophysiology and Perfusion (2 of 5)

Pathophysiology and Perfusion (2 of 5)

• Perfusion is the circulation of blood within an organ or tissue to meet the cells’ needs for oxygen, nutrients, and waste removal.

Page 20: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Pathophysiology and Perfusion (3 of 5)

Pathophysiology and Perfusion (3 of 5)

• Some tissues need a constant supply of blood while others can survive with very little.

Page 21: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Pathophysiology and Perfusion (4 of 5)

Pathophysiology and Perfusion (4 of 5)

• All organs and organ systems are dependent on adequate perfusion to function properly.– Death of an organ system can quickly lead to

death of the person.

Page 22: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Pathophysiology and Perfusion (5 of 5)

Pathophysiology and Perfusion (5 of 5)

• The heart requires a constant supply of blood.– Brain and spinal cord may last 4 to 6 minutes.

– Kidneys may survive 45 minutes.

– Skeletal muscles may last 2 hours.

– Times are based on a normal body temperature.

Page 23: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

External BleedingExternal Bleeding

• Hemorrhage means bleeding.

• Examples include nosebleeds and bleeding from open wounds.

• As an EMT, you must understand how to control external bleeding.

Page 24: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Significance of External Bleeding (1 of 4)

Significance of External Bleeding (1 of 4)

• With serious external bleeding, it may be difficult to tell the amount of blood loss.

• Presentation and assessment of the patient will direct care and treatment.

• Body will not tolerate a blood loss greater than 20% of blood volume.

Page 25: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Significance of External Bleeding (2 of 4)

Significance of External Bleeding (2 of 4)

• Significant changes in vital signs may occur if the typical adult loses more than 1 L of blood.– Increase in heart rate

– Increase in respiratory rate

– Decrease in blood pressure

Page 26: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Significance of External Bleeding (3 of 4)

Significance of External Bleeding (3 of 4)

• How well people compensate for blood loss is related to how rapidly they bleed.– An adult can comfortably donate 1 unit

(500 mL) of blood over 15 to 20 minutes.

– If a similar blood loss occurs in a much shorter time, the person may rapidly develop hypovolemic shock.

– Consider age and preexisting health.

Page 27: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Significance of External Bleeding (4 of 4)

Significance of External Bleeding (4 of 4)

• Serious conditions with bleeding:– Significant MOI

– Patient has a poor general appearance and is calm.

– Signs and symptoms of shock

– Significant blood loss

– Rapid blood loss

– Uncontrollable bleeding

Page 28: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Characteristics of External Bleeding (1 of 2)

Characteristics of External Bleeding (1 of 2)

• Arterial bleeding– Pressure causes blood to spurt and makes

bleeding difficult to control.

– Typically brighter red and spurts in time with the pulse

• Venous bleeding– Dark red, flows slowly or severely

– Does not spurt and is easier to manage

Page 29: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Characteristics of External Bleeding (2 of 2)

Characteristics of External Bleeding (2 of 2)

• Capillary bleeding– Bleeding from damaged capillary vessels

– Dark red, oozes steadily but slowly

Capillary

Venous Arterial

Page 30: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Clotting (1 of 2)Clotting (1 of 2)

• Bleeding tends to stop rather quickly, within about 10 minutes.– When a person is cut, blood flows rapidly.

– The cut end of the vessel begins to narrow, reducing the amount of bleeding.

– Then a clot forms.

– Bleeding will not stop if a clot does not form.

Page 31: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Clotting (2 of 2)Clotting (2 of 2)

• Despite the efficiency of the system, it may fail in certain situations.– Movement

– Medications

– Removal of bandages

– External environment

– Body temperature

– Severe injury

Page 32: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

HemophiliaHemophilia

• Patient lacks blood clotting factors.

• Bleeding may occur spontaneously.

• All injuries, no matter how trivial, are potentially serious.

• Patients should be transported immediately.

Page 33: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Internal Bleeding (1 of 2)Internal Bleeding (1 of 2)

• Bleeding in a cavity or space inside the body

• Can be very serious, yet with no outward signs– Injury or damage to internal organs commonly

results in extensive internal bleeding.

– Can cause hypovolemic shock

Page 34: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Internal Bleeding (2 of 2)Internal Bleeding (2 of 2)

• Possible conditions causing internal bleeding:– Stomach ulcer

– Lacerated liver

– Ruptured spleen

– Broken bones, especially the ribs or femur

– Pelvic fracture

Page 35: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

MOI for Internal Bleeding (1 of 3)MOI for Internal Bleeding (1 of 3)

• High-energy MOI

• Internal bleeding is possible whenever the MOI suggests that severe forces affected the body.– Blunt trauma

– Penetrating trauma

Page 36: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

MOI for Internal Bleeding (2 of 3)MOI for Internal Bleeding (2 of 3)

• Signs of injury (DCAP-BTLS)– Deformities

– Contusions

– Abrasions

– Punctures/penetrations

Page 37: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

MOI for Internal Bleeding (3 of 3)MOI for Internal Bleeding (3 of 3)

• Signs of injury (DCAP-BTLS) (cont’d)– Burns

– Tenderness

– Lacerations

– Swelling

Page 38: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

NOI for Internal Bleeding (1 of 3)NOI for Internal Bleeding (1 of 3)

• Bleeding is not always caused by trauma.

• Nontraumatic causes include:– Bleeding ulcers

– Bleeding from colon

– Ruptured ectopic pregnancy

– Aneurysms

Page 39: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

NOI for Internal Bleeding (2 of 3)NOI for Internal Bleeding (2 of 3)

• Frequent signs– Abdominal tenderness

– Guarding

– Rigidity

– Pain

– Distention

Page 40: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

NOI for Internal Bleeding (3 of 3)NOI for Internal Bleeding (3 of 3)

• In older patients, signs include:– Dizziness

– Faintness

– Weakness

• Ulcers or other GI problems may cause:– Vomiting of blood

– Bloody diarrhea or urine

Page 41: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Signs and Symptoms of Internal Bleeding (1 of 4)

Signs and Symptoms of Internal Bleeding (1 of 4)

• Pain (most common)

• Swelling in the area of bleeding

• Distention

• Bruising

• Dyspnea, tachycardia, hypotension

• Hematoma

• Bleeding from any body opening

Page 42: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Signs and Symptoms of Internal Bleeding (2 of 4)

Signs and Symptoms of Internal Bleeding (2 of 4)

• Hematemesis

• Melena

• Hemoptysis

• Broken ribs, bruises over the lower part of the chest, or a rigid, distended abdomen

• Hypoperfusion

Page 43: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Signs and Symptoms of Internal Bleeding (3 of 4)

Signs and Symptoms of Internal Bleeding (3 of 4)

• Later signs of hypoperfusion:– Tachycardia

– Weakness, fainting, or dizziness at rest

– Thirst

– Nausea and vomiting

– Cold, moist (clammy) skin

– Shallow, rapid breathing

Page 44: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Signs and Symptoms of Internal Bleeding (4 of 4)

Signs and Symptoms of Internal Bleeding (4 of 4)

• Later signs of hypoperfusion (cont’d):– Dull eyes

– Slightly dilated pupils

– Capillary refill of more than 2 seconds in infants and children

– Weak, rapid (thready) pulse

– Decreasing blood pressure

– Altered level of consciousness

Page 45: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Patient Assessment for External and Internal Bleeding

Patient Assessment for External and Internal Bleeding

• Patient assessment steps– Scene size-up

– Primary assessment

– History taking

– Secondary assessment

– Reassessment

Page 46: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Scene Size-up (1 of 2)Scene Size-up (1 of 2)

• Scene safety– Be alert to potential hazards.

– At vehicle crashes, ensure the absence of leaking fuel and energized electrical lines.

– In violent incidents, make sure the police are on the scene.

– Follow standard precautions.

Page 47: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Scene Size-up (2 of 2)Scene Size-up (2 of 2)

• Mechanism of injury/nature of illness– Determine the NOI or MOI.

– Consider the need for spinal stabilization and additional resources.

– Consider environmental factors such as weather.

Page 48: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Primary Assessment (1 of 4)Primary Assessment (1 of 4)

• Do not be distracted from identifying life threats.

• Form a general impression.– Note important indicators of the patient’s

condition.

– Be aware of obvious signs of injury.

– Determine gender and age.

– Assess skin color and the LOC.

Page 49: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Primary Assessment (2 of 4)Primary Assessment (2 of 4)

• Airway and breathing– Consider the need for spinal stabilization.

– Ensure a patent airway.

– Look for adequate breathing.

– Check for breath sounds.

– Provide high-flow oxygen or assist ventilations with a bag-mask device or nonrebreathing mask.

Page 50: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Primary Assessment (3 of 4)Primary Assessment (3 of 4)

• Circulation– Assess pulse rate and quality.

– Determine skin condition, color, and temperature.

– Check capillary refill time.

– Control external bleeding.

– Treat for shock.

Page 51: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Primary Assessment (4 of 4)Primary Assessment (4 of 4)

• Transport decision– Assessment of ABCs

and life threats will determine the transport priority.

– Signs that imply rapid transport:

• Tachycardia or tachypnea

• Low blood pressure

• Weak pulse• Clammy skin

Tachycardia

Page 52: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

History Taking (1 of 3)History Taking (1 of 3)

• Investigate the chief complaint.– Look for signs and symptoms of other injuries

due to the MOI and/or NOI.

– You may have identified severe bleeding in the primary assessment.

– Note obvious signs of internal bleeding.

– Determine if there are any preexisting illnesses.

Page 53: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

History Taking (2 of 3)History Taking (2 of 3)

Page 54: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

History Taking (3 of 3)History Taking (3 of 3)

• SAMPLE history– Ask the patient about blood-thinning

medications.

– If the patient is unresponsive, obtain history from medical alert tags or bystanders.

– Look for signs and symptoms of shock.

– Determine the amount of blood loss.

Page 55: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Secondary Assessment (1 of 5)Secondary Assessment (1 of 5)

• Record vital signs.

• Complete a focused assessment of pain.

• Attach appropriate monitoring devices.

• With a critically injured patient or a short transport time, there may not be time to conduct a secondary assessment.

Page 56: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Secondary Assessment (2 of 5)Secondary Assessment (2 of 5)

• Physical examinations– Should include a systematic full-body scan

– Assess the respiratory system.

– Assess the airway for patency.

– Determine the rate and quality of respirations.

– Look for distended neck veins and a deviated trachea.

Page 57: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Secondary Assessment (3 of 5)Secondary Assessment (3 of 5)

• Physical examinations (cont’d)– Check for paradoxical movement of the chest

wall and bilateral breath sounds.

– Assess the cardiovascular, neurologic, and musculoskeletal systems.

– Determine the level of consciousness.

– Examine pupil size and reactivity.

– Assess motor and sensory response.

Page 58: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Secondary Assessment (4 of 5)Secondary Assessment (4 of 5)

• Assess all anatomic regions.– Check the head for raccoon eyes, Battle’s sign,

and drainage of blood or fluid from the ears or nose.

– Feel all four quadrants of the abdomen for tenderness or rigidity.

– Record pulse, motor, and sensory function in all four extremities.

Page 59: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Secondary Assessment (5 of 5)Secondary Assessment (5 of 5)

• Vital signs– Assess vital signs to observe the changes that

may occur during treatment.

– A systolic blood pressure of less than 100 mm Hg with a weak, rapid pulse should suggest the presence of hypoperfusion.

– Cool, moist skin that is pale or gray is an important sign.

Page 60: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Reassessment (1 of 3)Reassessment (1 of 3)

• Repeat the primary assessment in areas that showed abnormal findings.– Signs and symptoms of internal bleeding are

often slow to present.

• Assess interventions and treatments.

• Vital signs show how well your patient is doing internally.– In severe cases, assess every 5 minutes.

Page 61: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Reassessment (2 of 3)Reassessment (2 of 3)

• Interventions– Provide high-flow oxygen.

– Provide treatment for shock and transport rapidly.

– Do not delay transport of a patient to complete an assessment.

Page 62: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Reassessment (3 of 3)Reassessment (3 of 3)

• Communication and documentation– Communicate all relevant information to the

staff at the receiving hospital.

– Give an estimate of the amount of blood loss that has occurred.

– Describe the MOI/NOI and the signs and symptoms.

– Document all injuries, the care provided, and the patient’s response.

Page 63: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Emergency Medical Care for External Bleeding (1 of 2)

Emergency Medical Care for External Bleeding (1 of 2)

• Follow standard precautions.– Wear gloves, eye protection, and possibly a

mask or gown.

– Make sure the patient has an open airway and is breathing adequately.

– Provide high-flow oxygen.

Page 64: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Emergency Medical Care for External Bleeding (2 of 2)

Emergency Medical Care for External Bleeding (2 of 2)

• Several methods are available to control external bleeding.– Direct, even pressure and elevation

– Pressure dressings and/or splints

– Tourniquets

• It will often be useful to combine these methods.

Page 65: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Direct Pressure (1 of 2)Direct Pressure (1 of 2)

• Most effective way to control external bleeding

• Pressure stops the flow of blood and permits normal coagulation to occur.

• Apply pressure with your gloved fingertip or hand over the top of a sterile dressing.

Page 66: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Direct Pressure (2 of 2)Direct Pressure (2 of 2)

• Never remove an impaled object from a wound.

• Hold uninterrupted pressure for at least 5 minutes.

Page 67: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

ElevationElevation

• Elevate a bleeding extremity by as little as 6" while applying direct pressure.

• Never elevate an open fracture to control bleeding.– Fractures can be elevated after splinting.

– Splinting helps control bleeding.

Page 68: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Pressure Dressing (1 of 2)Pressure Dressing (1 of 2)

• Firmly wrap a sterile, self-adhering roller bandage around the entire wound.

• Cover the entire dressing above and below the wound.

• Stretch the bandage tight enough to control bleeding.– You should still be able to palpate a distal pulse.

Page 69: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Pressure Dressing (2 of 2)Pressure Dressing (2 of 2)

• Do not remove a dressing until a physician has evaluated the patient.

• Bleeding will almost always stop when the pressure of the dressing exceeds arterial pressure.

• Follow the steps in Skill Drill 23-1.

Page 70: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Tourniquet (1 of 3)Tourniquet (1 of 3)

• If direct pressure fails, apply a tourniquet above the level of bleeding.

• It should be applied quickly and not released until a physician is present.

• Follow the steps in Skill Drill 23-2 to apply a commercial tourniquet.

Page 71: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Tourniquet (2 of 3)Tourniquet (2 of 3)

• Observe the following precautions:– Do not apply a tourniquet directly over any joint.

– Make sure the tourniquet is tightened securely.

– Never use wire, rope, a belt, or any other narrow material.

– Use wide padding under the tourniquet.

Page 72: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Tourniquet (3 of 3)Tourniquet (3 of 3)

• Precautions (cont’d):– Never cover a

tourniquet with a bandage.

– Do not loosen the tourniquet after you have applied it.

Page 73: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Splints (1 of 4)Splints (1 of 4)

• Air splints– Can control internal or external bleeding

associated with severe injuries

– Stabilize fractures

– Act like a pressure dressing

– Commonly referred to as soft splints or pressure splints

Page 74: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Splints (2 of 4)Splints (2 of 4)

• Air splints (cont’d)– Once the splint is

applied, monitor circulation in the distal extremity.

– Use only approved, clean, or disposable valve stems.

Page 75: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Splints (3 of 4)Splints (3 of 4)

• Rigid splints– Can help stabilize fractures

– Reduce pain

– Prevent further damage to soft-tissue injuries

– Once the splint is applied, monitor circulation in the distal extremity.

Page 76: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Splints (4 of 4)Splints (4 of 4)

• Traction splints– Designed to stabilize femur fractures

– When the EMT pulls traction to the ankle, countertraction is applied to the ischium and groin.

– Once the splint is applied, monitor circulation in the distal extremity.

Page 77: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Bleeding From the Nose, Ears, and Mouth (1 of 3)

Bleeding From the Nose, Ears, and Mouth (1 of 3)

• Several conditions:– Skull fracture

– Facial injuries

– Sinusitis, infections, use and abuse of nose drops, dried or cracked nasal mucosa

– High blood pressure

– Coagulation disorders

– Digital trauma

Page 78: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Bleeding From the Nose, Ears, and Mouth (2 of 3)

Bleeding From the Nose, Ears, and Mouth (2 of 3)

• Epistaxis (nosebleed) is a common emergency.– Occasionally it can cause enough blood loss to

send a patient into shock.

– Can usually be controlled by pinching the nostrils together

• Follow the steps in Skill Drill 23-3 to control epistaxis.

Page 79: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Bleeding From the Nose, Ears, and Mouth (3 of 3)

Bleeding From the Nose, Ears, and Mouth (3 of 3)

• Bleeding from the nose or ears following a head injury:– May indicate a skull fracture

– May be difficult to control

– Do not attempt to stop blood flow.

– Loosely cover the bleeding site with a sterile gauze pad.

– Apply light compression with a dressing.

Page 80: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Emergency Medical Care for Internal Bleeding (1 of 2)

Emergency Medical Care for Internal Bleeding (1 of 2)

• Usually requires surgery or other hospital procedures

• Keep the patient calm, reassured, and as still and quiet as possible.

• If spinal injury is not suspected, place the patient in the shock position.

• Provide high-flow oxygen.

Page 81: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Emergency Medical Care for Internal Bleeding (2 of 2)

Emergency Medical Care for Internal Bleeding (2 of 2)

• Maintain body temperature.

• Splint the injured extremity (usually with an air splint).

• Never use a tourniquet to control bleeding from closed, internal, soft-tissue injuries.

• Follow the steps in Skill Drill 23-4.

Page 82: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Summary Summary (1 of 6)(1 of 6)Summary Summary (1 of 6)(1 of 6)

• Perfusion is the circulation of blood in adequate amounts to meet the cells’ current needs for oxygen, nutrients, and waste removal.

Page 83: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Summary Summary (2 of 6)(2 of 6)Summary Summary (2 of 6)(2 of 6)

• The cardiovascular system has three main components:– Pump (heart)

– Container (blood vessels)

– Fluid (blood and bodily fluids)

Page 84: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Summary Summary (3 of 6)(3 of 6)Summary Summary (3 of 6)(3 of 6)

• Hypoperfusion (shock) occurs when the cardiovascular system fails to provide adequate perfusion.

• Both internal and external bleeding can cause shock. You must know how to recognize and control both.

Page 85: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Summary Summary (4 of 6)(4 of 6)Summary Summary (4 of 6)(4 of 6)

• The methods to control bleeding, in order, are:– Direct, even pressure

– Elevation

– Pressure dressings

– Tourniquets

– Splinting device

Page 86: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Summary Summary (5 of 6)(5 of 6)Summary Summary (5 of 6)(5 of 6)

• Bleeding around the face always presents a risk of airway obstruction or aspiration.

• Any patient you suspect of having internal bleeding or significant external bleeding should be transported promptly.

Page 87: Chapter 23 Bleeding. Introduction Important to be able to: –Recognize bleeding –Understand how bleeding affects the body Bleeding can be external or internal.

Summary Summary (6 of 6)(6 of 6)Summary Summary (6 of 6)(6 of 6)

• Signs of serious internal bleeding:– Vomiting blood (hematemesis)

– Black tarry stools (melena)

– Coughing up blood (hemoptysis)

– Distended abdomen

– Broken ribs