Hypovolemic Shock and Blood Circulation Quiz

Hemorrhage Control

• The average adult has approximately 6 liters of blood circulating (65-70mL/kg).
• Blood loss affects all body systems.
• Acute blood loss causes significant changes in vital signs (increased heart rate and respirations, decreased blood pressure).
• Without adequate blood supply, tissues and organs are starved for oxygen and nutrients.

Hemorrhage Terms

• Stroke Volume (SV): Amount of blood ejected per contraction.
• Cardiac Output (CO): Amount of blood pumped through the circulatory system per minute (Heart Rate x Stroke Volume).
• Blood: Consists of plasma, red blood cells (RBCs), white blood cells (WBCs), and platelets.
• Systemic Vascular Resistance: Resistance to blood flow in the vasculature.
• Perfusion: Delivery of oxygen and nutrients to cells, organs, and tissues.
• Hypovolemia: Low blood volume.

Basic Anatomy

• The heart circulates oxygenated blood throughout the body.
• The left ventricle pumps blood through arteries and back to the heart via the vena cava.

Physiological Response to Blood Loss - Compensation

• Arterial blood (bright red, high oxygen) spurts from wounds.

• Venous blood (darker red, low oxygen) flows steadily.

• Arterial bleeds are harder to manage than venous bleeds.

• Hemostasis: Platelets aggregate at the injury site, plugging the hole, but may not stop bleeding quickly enough.

• External aid helps reduce blood loss while the body compensates.

• When blood is lost, the body compensates to maintain perfusion.

• Increased heart rate and respiratory rate help circulate more oxygen.

• Blood vessels constrict to maintain blood pressure while blood volume drops.

• The body's ability to compensate depends on how quickly blood is lost and other factors (illness, injuries, age, fitness level).

• Hypovolemic shock occurs when the cardiovascular system fails due to inadequate circulation and tissue perfusion due to reduced blood volume.

External vs Internal Hemorrhage

• External: Bleeding that breaks through the skin; easily recognized and managed in pre-hospital settings.

• Internal: Bleeding within a body cavity; harder to recognize; often requires surgical intervention.

• Internal hemorrhage can be significant and contained in some body cavities (e.g., each thigh can hold up to 1.5 liters).

• Signs of internal hemorrhage may include pain, tenderness, and the presence of hematoma, which can appear later.

• Blood loss is more difficult to estimate with external hemorrhage based on different surfaces (e.g., saturated clothing, pooling on flat surfaces).

External Hemorrhage - Patient Assessment and Management

• Scene assessment is crucial.
• Severity and type of bleeding may necessitate additional personal protective equipment (PPE) like eye protection, gowns, face shields, procedural masks, and extra gloves..
• The primary concern is still the ABCs (airway, breathing, circulation).
• Major hemorrhage is a part of circulation and needs to be managed immediately.
• If basic maneuvers don't control bleeding, rapid transport is needed.
• Other injuries may be ignored until bleeding is controlled..
• Continuous monitoring of patient condition and vital signs is necessary during transport.

External Hemorrhage - Management

• Standard first aid treatment remains the basic method.
• Follow the RED pneumonic (rest, elevate, direct pressure).
• For minor hemorrhages, moderate direct pressure and simple dressings are often sufficient.
• Major hemorrhages require more aggressive control.
• Techniques differ based on injury location (tourniquets, hemostatic dressings, direct pressure).

External Hemorrhage - Dressings and Equipment

• Dressings and equipment vary.

• Consider specific requirements when deciding between moist or dry sterile dressings (occlusive vs non-occlusive).

• Common examples include gauze pads (2x2, 4x4), pressure dressings (large and small), abdominal pads (8x10), and Kling dressings (rolled gauze).

• Tourniquets: Used for major extremity hemorrhages that can't be controlled with direct pressure; different brands exist. Apply proximal to the injury and tighten to occlude flow distal to the device. Document application time; do not remove or cover it in-situ..

• Hemostatic dressings: Saturated with chemical agents to aid clotting, used when regular dressings are ineffective, or tourniquets are contraindicated.

Internal Hemorrhage - Dressings and Equipment

• Pelvic binder: Used to apply direct pressure externally to a pelvic fracture.

External Hemorrhage - Additional Equipment

• Trauma shears: Used for cutting clothing, bandages, or other materials.
• Medical tape: Used to secure dressings, IV lines, advanced airways, etc.

MAST Pants (PASG)

• Inflatable garment for the legs and abdomen to counteract shock.
• A controversial piece of equipment.

Hemorrhage Management - BLS PCS Pg/111

• Clear pathways; expose wounds.
• Apply direct pressure on the bleeding area, including extremities and junctions (e.g.,. head, neck, shoulders, groin, pelvis). A tourniquet may be needed on extremities in extreme cases.
• If the wound is in a hollow space (e.g., skull, chest abdomen), pack with dressings. The time of application must always be documented and communicated to the receiving facility.
• Do not insert fingers or other objects into hollow spaces.

Hemorrhage Management - Methods

• Direct pressure, tourniquet application, and hemostatic dressing procedures and applications.

• Methods, such as direct pressure on bleeding sites, and using tourniquets, or hemostatic dressings, must be done continuously until the bleeding is stopped and/or controlled.

• The correct placement and method in managing hemorrhages are essential to prevent further injury.

• IV fluid therapy may be helpful but not for hypotensive patients.