Bleeding Chapter 26 PDF

Bleeding Chapter 26 Circulatory System Review Heart (pump)- all organs are dependent on the heart to supply them with oxygen rich blood Blood vessels (pipes): Arteries- carry blood away from the heart Capillaries- gas exchange Veins- return blood to the heart Function of blood (fluid): Tr...

Bleeding Chapter 26 Circulatory System Review Heart (pump)- all organs are dependent on the heart to supply them with oxygen rich blood Blood vessels (pipes): Arteries- carry blood away from the heart Capillaries- gas exchange Veins- return blood to the heart Function of blood (fluid): Transportation of gases Nutrition Excretion Protection Regulation Bleeding Hemorrhage (severe bleeding) is the major cause of shock (hypoperfusion) Can be external or internal Leads to cell, tissue and organ death Brain, spinal cord and kidneys are most sensitive to inadequate perfusion Pathophysiology & Perfusion Perfusion- circulation of blood in an organ or tissue Without oxygen organs will die within: Heart: requires constant perfusion to prevent damage Brain & Spinal Cord: 4-6 min Lungs: 15-20 min Kidneys: 45 min Skeletal muscles: 2-3 hrs Signs of Severe Bleeding 1. Poor general appearance- no response to stimuli 2. S/S of shock 3. Significant amount of blood noted 4. Blood loss is rapid and ongoing 5. Cannot control bleeding 6. Associated with significant MOI External Bleeding Arterial bleeding is characterized by spurting, bright red blood Venous bleeding is characterized by darker colored, steady flow Capillary bleeding is slow, oozing flow Most bleeding can be controlled by “compression” especially if it is initiated quickly Underlying conditions that affect bleeding Blood thinners ○ Aspirin, Warfarin, Plavix, Pradaxa, Xarelto Hypothermia ○ Affects the bodyʼs ability to clot ○ Affects perfusion Possible sites of internal bleeding Internal bleeding occurs when bleeding is inside a cavity or space 1. Liver 2. Spleen 3. Bleeding ulcer 4. Broken bones (especially femur and pelvis) Patient Assessment High energy MOI should increase your level of suspicion of internal bleeding Non-traumatic causes of internal bleeding: 1. Ulcers 2. Colon 3. Ectopic pregnancy rupture 4. Aneurysm Patient Assessment MOI Blunt trauma is leading cause of internal bleeding ○ Falls ○ MVA or motorcycle crashes ○ Auto-peds ○ Blast injuries Penetrating injury ○ Gunshot wounds ○ Stab wounds ○ Impaled objects **Assess patient for exit wounds Patient Assessment Identify massive external hemorrhage ○ Can usually be seen ○ Check clothing, ground, carpet Control life threatening bleeding before moving on to any other assessment or treatment- XABC You may not be able to complete primary assessment if bleeding is difficult to control Massive external bleeding is rare in civilian life; generally you will follow ABCʼs No matter how small the blood loss is; S/S of shock is automatically considered serious Internal Bleeding Caused by: Damage to internal organs Injuries to extremities Often canʼt be seen but patients can die from internal bleeding Signs of Internal Bleeding Pain is the most common sign of internal bleeding Swelling is a sign of significant internal bleeding but is often undetected until massive blood loss has occurred Hemoptysis is coughing up blood and is associated with trauma to the chest cavity A hematoma is mass of blood collected in soft tissues Vocabulary Hematemesis- vomiting blood Melena- black, foul smelling tarry stool Hematuria- blood in urine Late Signs of Hypovolemic Shock Tachycardia Weakness, dizziness, fainting Thirst Nausea/vomiting Cold, moist skin Dilated pupils Capillary refill greater than 2 seconds Weak, rapid thready pulse Patient Care for Internal Bleeding 1. Maintain ABCʼs 2. Control any external bleeding 3. Administer oxygen if signs of shock or hypoxia are present 4. Apply splint for suspected internal bleeding of an extremity 5. Take steps to preserve temperature 6. Prompt transport to appropriate facility Controlling External Bleeding Single most important elements in the prevention and management of shock Ensure scene safety and don PPE Patient Care 1. Direct pressure 2. Hemostatic Agent 3. Tourniquet Direct Pressure 1. Apply pressure with gloved hand or sterile dressing 2. Hold pressure until bleeding is controlled 3. Bandage a dressing to form a pressure dressing 4. Do not remove a dressing once itʼs been placed Hemostatic Agents Apply material that absorbs the liquid portion of blood and leaves larger elements to clot Aids direct pressure but does not replace it Wound Packing Steps for packing a wound: 1. Take standard precautions 2. Expose wound and wipe away blood 3. Pack with hemostatic gauze & apply pressure Tourniquets Not just considered a last resort anymore Does not mean choosing “life or limb” Consider when other methods have failed Works well for protruding bones and crush amputations Allows you to quickly control massive bleeding and move on to treat other injuries Tourniquets Only placed on extremities Donʼt apply directly over a joint Use commercially designed tourniquet when available Note the time that the tourniquet was applied Consult medical direction before removing a tourniquet applied prior to arrival Junctional Tourniquets Allows for proximal compression of life-threatening bleeding in areas where standard tourniquet application is not possible (junction of legs and arms to the torso Groin Axilla Other Methods of Bleeding Control Splinting ○ Air splints form direct pressure Pelvic binder- used for closed unstable pelvic fracture ○ Slide under supine patient ○ Center device over trochanters ○ Secure and tighten Cold packs ○ Do not place directly on skin ○ Use in conjunction with other bleeding control techniques Pelvic Binder  Special Situations Involving Bleeding Head injury ○ Do not attempt to stop bleeding or fluid loss from ears or nose ○ Halo test- CSF will appear on gauze as a “halo” Special Situations Involving Bleeding Nosebleed (epistaxis) ○ Direct trauma ○ Hypertension ○ Sinus infection ○ Digital trauma (nose picking) Steps to control a nosebleed Step 1: Have patient lean forward & pinch nose Steps to control a nosebleed Apply pressure between upper lip and gum with a rolled bandage Steps to control a nosebleed Apply ice over the nose Shock Review Shock may develop if: 1. Cardiogenic shock- Heart fails as a pump 2. Hypovolemic- Blood volume is lost 3. Distributive- Blood vessels dilate creating a vascular container that is too big Severity of shock Compensated- changes in vital signs; pale, cool, clammy skin Decompensated- falling blood pressure; decompensated shock leads to organ failure Patient Assessment of Shock 1. AMS 2. Pale, cool, clammy skin 3. Nausea and vomiting 4. Vital sign changes 5. Drop in blood pressure 6. Changes in pulse oximetry 7. Thirst, dilated pupils and cyanosis (late signs) Patient Care for Shock 1. Maintain open airway and assess respirations 2. Control external bleeding 3. Use pelvic binding device if suspected pelvis fracture 4. Splint suspected bone or joint injuries 5. Prevent loss of body heat 6. Rapid Transport *** Golden Hour- 1 hour from time of injury to get patient to definitive care*** Try to limit on scene time to 10 minutes- Platinum 10