Bleeding and Shock Pipes, pump, and fluid…really, it’s that simple! 1

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Bleeding and Shock
Pipes, pump, and fluid…really,
it’s that simple!
1
The Second Rule of EMS….
…eventually the bleeding
will stop!
2
Cardiovascular System
Heart
Arteries
Veins
Capillaries
Blood
3
Cardiovascular System
• Transports O2 and fuel to the cells, tissues,
and organs.
• Removes CO2 and wastes from the cells for
elimination from the body.
• Must be able to maintain sufficient flow
through the capillary beds to meet the cell’s
O2 and fuel needs
4
Bleeding
Internal
External
5
Internal Bleeding
Trauma
Clotting disorders
Rupture of blood vessels
Fractures (injury to nearby vessels)
Can result in rapid progression to
hypovolemic shock & death!
6
Internal Bleeding S/S
Think about MOI or NOI!
Anxiety, restlessness, irritability
Pale, diaphoretic skin
Sustained tachycardia
Hypotension
Unstable vitals signs (postural changes)
7
Internal Bleeding S/S
Vomiting bright red blood or coffee ground
material
Bleeding form any body orifice
Dark, tarry stools (melena)
Tender, rigid, or distended abdomen
Pain, discoloration, swelling, tenderness at
injury site
8
Managing Internal Bleeding
ABC’s
High concentration oxygen
Assist ventilations
Control external bleeding
Stabilize fractures
RICE
Transport rapidly to appropriate facility
9
External Bleeding
• Arterial Bleed
– Bright red, spurting
• Venous Bleed
– Dark red, steady flow
• Capillary Bleed
– Dark red, oozing
10
Control of External Bleeding
Direct Pressure:
Gloved hand
Or
Dressing and bandage
11
Control of External Bleeding
Elevation:
Raise extremity
above the level of the
heart
12
Control of External Bleeding
Pressure Dressing:
Use bandage to
secure dressing in
place
13
Arterial Pressure Points
• Upper extremity:
– Brachial
– Radial
• Lower extremity:
– Femoral
– Popliteal
14
Tourniquets
Final resort when all else fails
Used for amputations
3-4” wide (blood pressure cuffs)
Write “TK” and time of application on
forehead of patient
Notify other personnel
Once applied, DO NOT REMOVE
15
Epistaxis (Nosebleed)
• Causes
– Fractured skull
– Facial injuries
– Sinusitis, other
URIs
– High BP
– Clotting disorders
– Digital insertion
(nose picking)
16
Management of Epistaxis
Sit up, lean forward
Pinch nostrils together
Keep in sitting position
Keep quiet
Apply ice over nose (15 min)
Can result in life-threatening blood loss!
17
SHOCK
Inadequate perfusion(blood flow)
leading to inadequate oxygen delivery
to tissues
18
Physiology
• Cell is the basic unit of life
• Cells get energy needed to stay alive by
reacting oxygen with fuel (usually glucose)
• No oxygen, no energy
• No energy, no life
19
Perfusion Failure
Pump Failure (heart)
Pipe Failure (vessels)
Loss of Volume
(blood)
20
Stages of Shock
Compensated Shock
Decompensated Shock
Irreversible Shock
21
Compensated Shock
• Body still compensates for blood loss
• Pulse rate increases
• Pulse strength decreases
• Pale, diaphoretic skin
• Anxiety, restlessness, combativeness
• Thirst, weakness, eventual air hunger
22
Decompensated Shock
• Body compensatory mechanisms fail
• Unpalpable pulse
• Precipitous drop in blood pressure
• Patient becomes unconscious
• Respirations slow or cease
23
Irreversible Shock
• Lack of circulation causes:
– Cellular death
– Tissue dysfunction
– Organ dysfunction
– Patient death
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Shock:
Etiology
25
• Psychogenic
• Hypovolemic
• Distributive
• Obstructive
• Cardiogenic
• Respiratory
• Neurogenic
26
Psychogenic Shock
• Simple fainting (syncope)
• Caused by stress, fright, pain
• Heart rate slows, vessels dilate
• Brain becomes hypo-perfused
• Loss of consciousness occurs
• Patient usually recovers by self
27
Psychogenic Shock S/S
• Anxiety, restlessness, irritability
• Rapid pulse
• Normal or low blood pressure
• Hyperventialtion
28
Hypovolemic Shock
• Loss of volume
• Causes:
– Blood loss from trauma
– Plasma loss from burns
– Fluid/electrolyte loss from vomiting,
diarrhea, sweating, increased urine
output, increase respiratory loss
– “Third space” fluid shifts
29
Hypovolemic Shock S/S
• Anxiety, restlessness, irritability
• Rapid, weak pulse
• Change in mental status
• Signs of inadequate perfussion (diaphoresis,
cyanosis, pale/clammy skin)
• Increased respiratory rate
30
Distributive Shock: Septic
• Results from body’s response to bacteria in
bloodstream
• Vessels dilate, become “leaky”
31
Distributive Shock: Septic S/S
• Anxiety, restlessness, irritability
• Febrile, warm skin
• Hypotension
• Tachycardia
• Increased respiratory rate
• Change in mental status
32
Distributive Shock:
Anaphylactic
• Results from severe allergic reactions
• Body responds to allergen by releasing
histamine
• Histamine release causes vessels to dilates
and become “leaky
33
Distributive Shock:
Anaphylactic S/S
• Sudden onset
• Mild itching, rash, uticaria, hives
• Burning sensation (skin)
• Hypotension
• Generalized edema
• Angiodema, airway compromise
• Respiratory distress
• Coma, rapid death
34
Obstructive Shock
• Interference with blood flow through the
cardiovascular system
• Tension pneumothorax
• Cardiac tamponade
• Pulmonary embolism
35
Obstructive Shock S/S
• Anxiety, irritability, restlessness
• Weak, irregular pulse
• Chest pain, shortness of breath
• Hypotension
• Pale, cool, clammy skin
• JVD, discoloration above nipple line
36
Cardiogenic Shock
• Pump failure
• Heart’s output depends on
– How often it beats (heart rate)
– How hard it beats (contractility)
• Rate or contractility problems cause pump
failure
37
Cardiogenic Shock S/S
• Causes
– Acute myocardial infarction
– Very low heart rates (bradycardias)
– Very high heart rates (tachycardias)
Why would a high heart rate caused decreased output?
Hint: Think about when the heart fills.
38
Cardiogenic Shock S/S
• Chest pain
• Weak, irregular pulse
• Hypotension (HTN with CHF)
• Cyanosis, signs of inadequate perfusion
• Cool, clammy skin
• Anxiety
39
Respiratory Shock
• Failure of respiratory system to supply
oxygen to or remove CO2 from the alveoli
• Airway obstruction
• Flail chest, SCW
• Pneumothorax
• Respiratory muscle paralysis
40
Respiratory Shock S/S
• Anxiety, restlessness, irritability
• Rapid, weak pulse
• Hypotension
• Change in mental status
• Signs of inadequate perfussion
• Increased respiratory rate
• Bronchoconstrcition (wheezes)
41
Neurogenic Shock
• Spinal cord injuries that result in the
interruption of communication
pathways between CNS and rest of
body
• Vessels below the injury site dilate
leading to decreased vascular
resistance
42
Neurogenic Shock S/S
• Anxiety, restlessness, irritability
• Bradycardia
• Hypotension
• Skin above injury site: pale, cool, clammy
• Skin below injury site: warm, pink, dry
• Signs of spinal injury
43
Treatment
• ABC’s
• Apply O2, assist ventilations as needed
• Keep patient in position of comfort
• Control bleeding, stabilize fractures
• Prevent loss of body heat
• Assist with medications
• Nothing by mouth
• Calm and reassure
44
Treatment
• Elevate lower extremities 8 to 12 inches in
hypovolemic shock
• Do NOT elevate the lower extremities in
cardiogenic shock
Why the difference in
management?
45
Shock is NOT the same as low
pressure
A falling blood pressure is a
LATE sign of shock!
46
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