Chapter 27 Bleeding and Shock PDF

Dan and Joyce were attending a patient after a car accident, initially the patient was conscious and talking to them, when they check the blood pressure they found it normal but heart rate became fast. But when they were transporting him they found that the patient has become disoriented....

Dan and Joyce were attending a patient after a car accident, initially the patient was conscious and talking to them, when they check the blood pressure they found it normal but heart rate became fast. But when they were transporting him they found that the patient has become disoriented. Slide 1 Chapter 27 Bleeding and Shock Slide 3 Overview  Review of the Cardiovascular System  Shock  Assessing Shock  Emergency Care for Shock  External Bleeding  Body Substance Isolation Precautions  Assessing Blood Loss  Types of Bleeding  Emergency Care for External Bleeding  Bleeding From the Ears, Nose, and Mouth  Internal Bleeding  Assessing Blood Loss  Signs and Symptoms of Internal Bleeding  Emergency Care for Internal Bleeding Slide 4 The Circulatory System Slide 5 The Circulatory System  The heart pumps blood to the body organs through the cardiovascular system  This process is so vital to life that any interruption for more than a few minutes can mean death to the individual Slide 6 The Circulatory System  Heart  Blood vessels  Arteries  Veins  Capillaries  Blood Slide 7  Heart  Structure and function  Atrium  Ventricle  Right  Right  Receives blood from the veins  Receives blood from the of the body and the heart right atrium  Pumps oxygen-poor blood to  Pumps oxygen-poor blood the right ventricle to the lungs  Left  Left  Receives blood from the  Receives blood from the left pulmonary veins (lungs) atrium  Pumps oxygen-rich blood to  Pumps oxygen-rich blood left ventricle to the body Slide 8 Heart  Structure and function  Valves prevent backflow of blood Slide 9 Heart  Structure and function  Cardiac conductive system  Heart is more than a muscle  Specialized contractile and conductive tissue in the heart  Electrical impulses create coordinated contraction  Automaticity  The ability of cardiac muscle cells to generate their own impulses Slide 10 Blood Vessels  Arteries  Arterioles  Capillaries  Venules  Veins Slide 11 Arteries  Carry blood away from the heart to the rest of the body  Major arteries  Coronary  Vessels that supply the heart with blood  Aorta  Major artery originating from the heart, lying in front of the spine in the thoracic and abdominal cavities  Pulmonary  Artery originating at the right ventricle; carries oxygen-poor blood to the lungs  Carotid Major artery of the neck  Femoral  Major artery of the thigh  Radial  Major artery of the lower arm  Brachial  An artery of the upper arm  Posterior tibial  Dorsalis pedis Slide 12 Arteries Slide 13 Arterioles  The smallest branches of an artery leading to the capillaries Slide 14 Capillaries  Tiny blood vessels that connect arterioles to venules  Found in all parts of the body  Allow for the exchange of nutrients and waste at the cellular level Slide 15 Capillaries Slide 16 Venules  The smallest branches of a vein leading to the capillaries Slide 17 Veins  Vessels that carry blood back to the heart  Major veins  Pulmonary vein  Carries oxygen-rich blood from the lungs to the left atrium  Venae cavae  Superior  Inferior  Carries oxygen-poor blood back to the right atrium Slide 18 Veins Slide 19 Blood  Red blood cells  Give the blood its color  Carry oxygen to organs  Carry carbon dioxide away from organs  White blood cells  Part of the body’s defense against infections  Plasma  Fluid that carries the blood cells and nutrients  Platelets  Essential for the formation of blood clots Slide 20 Pulse  Left ventricle contracts, sending a wave of blood through the arteries  Can be palpated anywhere an artery simultaneously passes near the skin surface and over a bone  Peripheral  Radial  Brachial  Posterior tibial  Dorsalis pedis  Central  Carotid  Femoral Slide 21 Pulse Slide 22 Blood Pressure  A measure of the pressure exerted against the walls of the arteries during contraction and relaxation of the heart  Systolic  Pressure exerted against the walls of the artery when the left ventricle contracts  Diastolic  Pressure exerted against the walls of the artery when the left ventricle is at rest Slide 23 Perfusion  The process of delivering oxygenated blood to the organs and removing waste products and carbon dioxide  Cellular respiration Slide 24 Perfusion  Shock (hypoperfusion)  Widespread inadequate tissue perfusion Slide 25 Shock  Signs and symptoms  Pale or cyanotic skin  Cool or cold skin  Rapid weak pulse  Altered mental status  Rapid breathing  Nausea and vomiting  Low or decreasing blood pressure  A LATE SIGN! Slide 26 Shock  Shock (hypoperfusion) results in inadequate perfusion of cells with oxygen and nutrients, and inadequate removal of metabolic waste products Slide 27 Shock  Cell and organ malfunction and death can result from shock (hypoperfusion); therefore prompt recognition and treatment is vital to patient survival Slide 28 Heart Slide 29 Types of shock  Disorders of the pump – cardiogenic shock  Disorders of pipe – septic shock, anaphylactic shock, neurogenic shock.  Disorders of fluid – hypovolemic shock, hemorrhagic shock. Shock  Trauma patients develop shock (hypoperfusion) from the loss of blood from both internal and external sites. This type of shock (hypoperfusion) is referred to as hypovolemic or hemorrhagic shock Slide 31 Shock  Signs and symptoms of shock (hypoperfusion)  Restlessness  Anxiety  Altered mental status Slide 32  Shock  Signs and symptoms  Peripheral perfusion  Delayed capillary refill greater than 2 seconds in normal ambient air temperature—infant and child patients only  Weak, thready, or absent peripheral pulses, no tachycardia- beta blocker.  Pale, cool, clammy skin Slide 33 Shock  Signs and symptoms  Vital signs  Decreased blood pressure (late sign)  Increased pulse rate (early sign)—weak and thready  Increased breathing rate  Shallow  Labored  Irregular Slide 34 Shock  Other signs and symptoms  Dilated pupils  Marked thirst  Nausea and vomiting  Pallor with cyanosis to the lips Slide 35 Shock  Infants and children can maintain their blood pressure until their blood volume is more than half gone  By the time their blood pressure drops, they are close to death  The infant or child in shock has less reserve Slide 36 Emergency Care for Shock  Body substance isolation  Maintain airway/artificial ventilation  Administer oxygen if indicated  Control any external bleeding Slide 37 Shock management Emergency Care for Shock  If signs of shock (hypoperfusion) are present and the lower abdomen is tender and pelvic injury is suspected, with no evidence of chest injury, apply and inflate the pneumatic antishock garment if approved by medical direction Slide 39 PASG Emergency Care for Shock  Unless prevented by injury, elevate the lower extremities approximately 8 to 12  Splint any suspected bone or joint injuries  Prevent loss of body heat by covering the patient with a blanket when appropriate  Immediate transport Slide 41 External Bleeding  External bleeding  Assessing blood loss  The sudden loss of 1 liter (1000 cc) of blood in the adult patient, 1/2 liter (500 cc) of blood in the child, and 100-200 cc of the blood volume in an infant is considered serious  The severity of blood loss must be based on the patient’s signs and symptoms and the general impression of the amount of blood loss  If the patient exhibits signs and symptoms of shock (hypoperfusion), the bleeding is to be considered serious Slide 42 External Bleeding  Assessing blood loss  The natural response to bleeding is blood vessel contractions and clotting; however, a serious injury may prevent effective clotting from occurring  Uncontrolled bleeding or significant blood loss leads to shock (hypoperfusion) and possibly death Slide 43  External Bleeding  Types of bleeding  Arterial bleeding  The blood spurts from the wound  Bright, red, oxygen-rich blood  Arterial bleeding is the most difficult to control because of the pressure at which arteries bleed  As the patient’s blood pressure drops, the amount of spurting may also drop Slide 44 External Bleeding  Venous bleeding  The blood flows as a steady stream  Dark, oxygen-poor blood  Bleeding from a vein can be profuse; however, in most cases it is easier to control due to the lower venous pressure Slide 45 External Bleeding  Capillary bleeding  The blood oozes from a capillary and is dark red in color  The bleeding often clots spontaneously Slide 46 Emergency Care for External Bleeding  Body substance isolation  Maintain airway/artificial ventilation Slide 47 Emergency Care for External Bleeding  Bleeding control  Concentrated direct pressure  Apply fingertip pressure directly on the point of bleeding  Large, gaping wounds may require packing with sterile gauze and direct hand pressure if direct fingertip pressure fails to control bleeding Slide 48 Emergency Care for External Bleeding  Bleeding control  Diffuse direct pressure  If bleeding does not stop, remove dressing and assess for bleeding point to apply direct pressure. If diffuse bleeding is discovered, apply additional pressure Slide 49 Emergency Care for External Bleeding  Extremity elevation  Elevation of a bleeding extremity may be used secondary to and in conjunction with direct pressure Slide 50 Emergency Care for External Bleeding  Pressure points  May be used in upper and lower extremities  Pressure decreases blood flow to the extremity  Technique works best when combined with other methods of bleeding control Slide 51  Emergency Care for External Bleeding  Splints  Reduction of motion of bone ends will reduce the amount and aggravation of tissue damage and bleeding associated with a fracture  Splinting may allow prompt control of bleeding associated with a fracture Slide 52 Emergency Care for External Bleeding  Pressure splints  The use of air pressure splints can help control severe bleeding associated with lacerations of soft tissue or when bleeding is associated with fractures  Pneumatic counterpressure devices (pneumatic antishock garment) can be used as effective pressure splints to help control severe bleeding Slide 53 Emergency Care for External Bleeding  Tourniquet  Use as a last resort to control bleeding of an amputated extremity  Can cause permanent damage to nerves, muscles, and blood vessels, resulting in the loss of an extremity Slide 54 Emergency Care for External Bleeding  Tourniquet  Use a bandage 4 wide and 6 to 8 layers deep  Wrap it around the extremity twice at a point proximal to the bleeding but as distal on the extremity as possible  Tie one knot in the bandage and place a stick or rod on top of the knot and tie the ends of the bandage over the stick in a square knot  Twist the stick until the bleeding stops  Once the bleeding has stopped, secure the stick or rod in position Slide 55 Emergency Care for External Bleeding  Tourniquet  Notify other emergency personnel who may care for the patient that a tourniquet has been applied  Document the use of a tourniquet and the time applied in the prehospital patient report  A continuously inflated blood pressure cuff may be used as a tourniquet until bleeding stops Slide 56 Emergency Care for External Bleeding  Tourniquet  Precautions with the use of a tourniquet  Use a wide bandage and secure tightly  Never use wire, rope, a belt, or any other material that may cut into the skin and underlying tissue  Do not remove or loosen the tourniquet once it is applied unless directed to do so by medical direction  Leave the tourniquet in open view  Do not apply a tourniquet directly over any joint, but as close to the injury as possible Slide 57 Bleeding from the Ears, Nose, and Mouth  Potential causes  Injured skull  Facial trauma  Digital trauma (nose picking)  Sinusitis and other upper respiratory tract infections  Hypertension (high blood pressure)  Coagulation disorders Slide 58 Bleeding from the Ears, Nose, and Mouth  Bleeding from the ears or nose may occur because of a skull fracture. If the bleeding is the result of trauma, do not attempt to stop the blood flow. Collect the blood with a loose dressing, which may also limit exposure to sources of infection Slide 59 Emergency Medical Care for Nosebleed  Place the patient in a sitting position leaning forward  Apply direct pressure by pinching the fleshy portion of the nostrils together  Keep the patient calm and quiet Slide 60 Internal Bleeding  Assessing blood loss  Internal bleeding can result in severe blood loss with resultant shock (hypoperfusion) and subsequent death  Suspicion and severity of internal bleeding should be based on the mechanism of injury and clinical signs and symptoms Slide 61 Internal Bleeding  Relationship to mechanism of injury  Blunt trauma  Falls  Motorcycle crashes  Pedestrian impacts  Automobile collisions  Blast injuries  Look for evidence of contusions, abrasions, deformity, impact marks, and swelling  Penetrating trauma Slide 62 Internal Bleeding  Injured or damaged internal organs commonly lead to extensive bleeding that is concealed  Painful, swollen, deformed extremities may also lead to serious internal blood loss Slide 63  Internal Bleeding  Amount of blood loss associated with various injuries Slide 64 Internal Bleeding  Signs and symptoms  Pain, tenderness, swelling, or discoloration of suspected site of injury  Bleeding from the mouth, rectum, or vagina, or other orifice  Vomiting bright red blood or dark, coffee ground– colored blood  Dark, tarry stools or stools with bright red blood  Tender, rigid, and/or distended abdomen  Late signs and symptoms of hypovolemic shock (hypoperfusion) Slide 65 Emergency Care for Internal Bleeding  Body substance isolation  Maintain airway/artificial ventilation  Administer oxygen if not already done during the initial assessment  If bleeding is suspected in an extremity, control bleeding by direct pressure and application of a splint  Immediate transport is critical for patient with signs and symptoms of shock (hypoperfusion) Slide 66 Summary  Review of the Cardiovascular System  Shock  Assessing Shock  Emergency Care for Shock  External Bleeding  Body Substance Isolation Precautions  Assessing Blood Loss  Types of Bleeding  Emergency Care for External Bleeding  Bleeding From the Ears, Nose, and Mouth  Internal Bleeding  Assessing Blood Loss  Signs and Symptoms of Internal Bleeding  Emergency Care for Internal Bleeding Slide 67