© 2011 National Safety Council 16-1
BLEEDING AND SHOCKLESSON 16
© 2011 National Safety Council 16-2
Introduction
• External or internal bleeding common with trauma patients
• Control bleeding quickly to prevent shock
© 2011 National Safety Council 16-3
Trauma Overview
• Frequently results in bleeding and shock, and other injuries
• Trauma care by EMRs includes a range of specific care skills
• The National Trauma Triage Protocol guides where to transport trauma patients
• With significant forces, increased risk for injuries to multiple organs
• Multi-trauma patients at greater risk for developing shock
• Suspect multi-system trauma in any patient subjected to significant external forces
© 2011 National Safety Council 16-4
Anatomy and Physiology Review
• Arteries: carry oxygenated blood to body
• Veins: carry deoxygenated blood back to heart
• Capillaries: exchange nutrients, oxygen and carbon dioxide between blood and tissue cells
• Perfusion: adequate flow of blood to body tissues
• Pulmonary artery: carries deoxygenated blood to lungs
• Pulmonary veins: carry oxygenated blood back to heart
© 2011 National Safety Council 16-5
Bleeding
• Risk of infectious disease from contact with patient’s blood or body fluids
• Follow standard precautions
• Serious injury may prevent effective clotting
• Significant blood loss will cause shock and possibly death
• Bleeding may be external or internal either can result in severe blood loss
• Difficult to estimate how much blood a patient has lost pay close attention to signs and symptoms
© 2011 National Safety Council 16-6
Types of External Bleeding
© 2011 National Safety Council 16-7
Assessing External Bleeding
• Perform standard assessment
• Estimate severity of blood loss, based on patient’s signs and symptoms and your general impression
• Assess patient for shock
© 2011 National Safety Council 16-8
Skill: Controlling External Bleeding
© 2011 National Safety Council 16-9
1. Place sterile dressing on wound
2. Apply direct pressure with gloved hand
© 2011 National Safety Council 16-10
3. After 5 minutes re-evaluate bleeding
4. If needed, put another dressing on top of first and keep applying pressure
© 2011 National Safety Council 16-11
5. If needed, apply pressure bandage
6. If appropriate, treat for shock
© 2011 National Safety Council 16-12
Tourniquet
• Tourniquet use carries high risk of complications
• Should only be used as extreme last resort by rescuers trained in its use
© 2011 National Safety Council 16-13
Internal Bleeding
© 2011 National Safety Council 16-14
Internal Bleeding
• Commonly occurs with blunt trauma
• Suspect based on mechanism of injury
• Internal organs may be injured
• Bleeding is concealed
• Can cause shock and be life-threatening
• Long bone fractures and pelvic fractures may cause serious internal bleeding
• Cannot control internal bleeding
© 2011 National Safety Council 16-15
Signs and Symptoms of Internal Bleeding
• Discolored, tender, swollen or hard skin, rigid abdomen
• Absence of distal pulse
• Increased respiratory and pulse rates
• Pale, cool, moist skin
• Nausea and vomiting
• Thirst
• Mental status changes
• Bleeding from body orifices
© 2011 National Safety Council 16-16
Emergency Care for Internal Bleeding
• Perform standard patient care
• Manage any external bleeding
• Position patient lying on back
• Keep patient from becoming chilled or overheated
• Limit movement of deformed extremity
• Treat for shock
• Administer high-flow oxygen
© 2011 National Safety Council 16-17
Shock
© 2011 National Safety Council 16-18
Shock (Hypoperfusion)
• Results from inadequate delivery of oxygenated blood to body tissues
• May result from any condition involving:
- Failure of heart to provide oxygenated blood (pump failure)
- Abnormal dilation of vessels (pipe failure)
- Blood volume loss (fluid failure)
© 2011 National Safety Council 16-19
© 2011 National Safety Council 16-20
Shock
• Progressive and may occur slowly or quickly
• Body attempts to compensate by increasing heart and breathing rates
• With continued reduced perfusion, body can no longer compensate and vital organs begin to fail
• Definitive treatment is critical
• Transport patient for treatment as soon as possible
• Consider possibility of shock in any serious injury or illness
© 2011 National Safety Council 16-21
Causes of Shock
• Severe bleeding
• Severe burns
• Heart failure
• Heart attack
• Head or spinal injuries
• Chest injuries
• Allergic Reactions
• Dehydration
• Electrocution
• Serious infection
• Extreme emotional reactions (temporary and less dangerous)
© 2011 National Safety Council 16-22
Signs and Symptoms of Shock
• Restlessness, anxiety
• Extreme thirst
• Rapid, weak pulse
• Rapid, shallow respirations
• Mental status changes
• Pale, cool, moist skin
• Decreased blood pressure (late sign)
© 2011 National Safety Council 16-23
Emergency Care for Shock
• Perform standard patient care
• Prevent further blood loss
• Put patient in shock position
© 2011 National Safety Council 16-24
1. Position patient on back and raise feet 6-12 inches (unless spinal or pelvic injury)
2. Maintain normal body temperature
Emergency Care for Shock (continued)
© 2011 National Safety Council 16-25
Emergency Care for Shock (continued)
3. Do not give patient anything to eat or drink
4. Provide care for specific injuries
5. Administer high-flow oxygen if available
6. Monitor patient’s breathing and vital signs every 5 minutes