Bleeding and Shock
Temple College
ECA
Blood
Flow
Heart
Anatomy

Arteries
– Carry oxygenated blood away from the
heart
– Thick, muscular walls to withstand
pressure
– Dilate and contract

Arterioles
– Smaller arteries which connect to
capillaries
Major Arteries
Carotid
Subclavian
Axillary
Brachial
Aorta
Iliac
Radial
Ulnar
Femoral
Popliteal
Dorsal Pedal
Posterior Tibial
Anatomy

Capillaries
– Small blood vessels where gas exchange actually
take place.
– O2 & CO2

Venules
– Smaller veins that connect to the capillaries

Veins
– Carry deoxygenated blood to the heart. R.
atrium
Major Veins
Internal Jugular
External Jugular
Subclavian
Superior Vena Cava
Inferior Vena Cava
Axillary
Iliac
Femoral
Saphenous
Perfusion
Cellular
Level
External Hemorrhage


Bleeding outside of body
Causes
– Blunt Trauma
– Penetrating Trauma
What the difference?

Arterial (high pressure)
– Bright red & spurting

Venous (lower pressure)
– Darker red & flowing

Capillary
– Oozes & often clots spontaneously
Management

Protect Mucus Membranes
– Eye protection
– Gloves
– Gown
– Mask

Hand washing following each run.
Controlling External
Hemorrhage




Direct pressure
Elevate
Pressure dressing
If bandages become blood soaked,
add more.
Controlling External
Hemorrhage
Pressure points
 Brachial
arteries

– biceps

Femoral
arteries
– groin
Controlling External
Hemorrhage
Splinting aids
coagulation
 Use caution as
not to
aggravate a fx.

Controlling External
Hemorrhage

Pneumatic Anti-Shock Garment
– Stabilizes bilateral femur fx and pelvic fx
– Shock due to internal hemorrhage
Tourniquet





Use a cravat or other wide cloth device
Place ~ 2 “ above injury, but not on a joint.
Use stick/handle
Turn until bleeding has slowed or stopped
Write “TK” on pt. w/ time & place on pt.
Bleeding from Ears, Nose, Mouth
May indicate injury to Skull
and/or Brain
Internal Hemorrhage


Bleeding inside of body
Causes
– Blunt Trauma
– Penetrating Trauma
– Medical Conditions
Ulcers/GI
 Cancer
 Disease

Indications of Internal
Bleeding




Pain, tenderness, swelling at injured site
Tender, rigid and/or distended abdomen
Increased HR & RR, pale cool clammy skin,
AMS
Bruising
– Cullen’s Sign
– Turner’s Sign

Bleeding from any orifice
– Hematemsis: blood in vomit
– Melena: black, tarry stools
– Hemoptysis: coughing up blood
Management of Internal
Bleeding




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BSI
ABC’s
Oxygen via NRB @ 15 lpm
Appropriate Assessment
Spine Motion Restriction (if needed)
Rapid Transport to appropriate
hospital
Circulation vs. Perfusion



Circulation is the movement of blood
through the circulatory system
Perfusion is providing tissues with
oxygenated blood
You must have good circulation to
have adequate perfusion, but they are
not the same
Definitions of Shock


Inadequate perfusion of tissues with
oxygenated blood
Failure of the cardiovascular system to
adequately perfuse the body
If there is a problem with
any portion of the
circulatory system- pump,
pipes or fluid, then shock
may manifest.
Hemorrhage Severity




> 20 % blood loss is not tolerated by
body
Average adult male has ~ 6 L of blood
Average adult female has ~ 5 L of
blood
Significant blood loss
– Adult: 1 L
– Pediatric: 100-200 mL
Poor Perfusion




Inadequate removal of cellular waste
products
Inadequate delivery of nutrients
Death results quickly
Prompt recognition and treatment vital
to patient survival
Stages of Shock



Compensated: early stage
Decompensated
Irreversible
Compensated Shock

Mental Status
– Restlessness, Anxiety
– Altered Mental Status

Peripherial Perfusion
– Pale, cool, clammy skin
– Delayed capillary refil

Vital Signs
– Normal or slightly increased B/P
– Weak rapid thready pulse
– Increased RR (shallow, labor, irregular)

Other
– Dilated Pupils
– Marked Thirst
– Nausea/Vomiting
Decompensated Shock




Significant Change in LOC
Severe Tachycardia
Increasing RR
B/P is starting to fall
Irreversible Shock
Late stage
 Terminal
 Unconscious
 Bradycardia/pulseless
 Decreased RR/apneic
 Hypotension
B/P may be difficult to obtain at this
point.

Shock: Treatment



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Body Substance Isolation
Maintain Airway/Breathing
Control external hemorrhage
Spine Motion Restriction as needed
Consider MAST
Shock position (if no contraindications)
Cover with Blanket
Rapid transport
ALS intercept