Bleeding, Shock and Soft Tissue
Injuries
Respond
Bleeding, Shock and
Soft Tissue Injuries
At the end of this module, a student will be
able to manage the patient with external
bleeding and shock as well as soft tissue
injuries in accordance with appropriate CPGs.
Knowledge Objectives
1. Differentiate between arterial, venous and
capillary bleeding
2. Explain the pre‐hospital emergency care
management for the patient with external
bleeding
3. List the signs and symptoms of hypovolaemic
shock
Knowledge Objectives
4. Explain the pre‐hospital emergency care
management for the patient with signs and
symptoms of hypovolaemic shock
5. Explain the pre‐hospital emergency care
management for the patient with a soft
tissue injury
6. Explain the burn surface area calculation
using Wallace’s rule of nines
Knowledge Objectives
7. List the common causes of burns and scalds
8. Explain the pre‐hospital emergency care
management for the patient with burns
9. List the functions of dressing and bandaging
Attitudinal Objectives
At the completion of this section, the student
will be able to:
Demonstrate a caring attitude towards
patients with a traumatic injury who request
pre‐hospital
Skills Objectives
1. Demonstrate direct pressure as a method of
pre‐hospital emergency care management
for external bleeding
2. Demonstrate the pre‐hospital emergency
care management for the patient with
hypovolaemic shock
3. Demonstrate the pre‐hospital emergency
care management for the patient with closed
soft tissue injuries
Skills Objectives
4. Demonstrate the pre‐hospital emergency
care management for the patient with open
soft tissue injuries
5. Demonstrate the pre‐hospital emergency
care management for the patient with burns
Differentiate between arterial, venous
and capillary bleeding
Explain care management for the
patient with external bleeding
• Standard Infection Control Precautions
• Do not be distracted by bleeding.
• In some cases, significant bleeding may need
to be controlled even before applying oxygen.
• General impression
– Use AVPU
– Note any bleeding
Explain care management for the
patient with external bleeding
• Direct pressure is the most
common and effective way to
control bleeding
• Apply pressure with gloved
finger or hand
• Elevating a bleeding
extremity often stops venous
bleeding
• Use both direct pressure and
elevation whenever possible
• Apply a pressure dressing
Hypovolaemic Shock
• Too little fluid circulating in the system
• Occurs when the circulating blood volume
does not deliver adequate oxygen to the body
• The most common cause is external bleeding
List the signs and symptoms of
hypovolaemic shock
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Increase & feeble pulse rate
Sweating and coldness of the skin
Pallor of the skin
Shallow, Rapid respiration
Nausea or vomiting
Thirst
Pupils slow to react
Faintness - Giddiness
Soft Tissue Injuries
Types of Wounds
• Incision
– Made by a sharp edged
object
• Bleeds freely – heals
quickly
• Laceration
– Snagging or tearing of
tissue
• Bleeds less freely –
healing can be prolonged
Soft Tissue Injuries
• Puncture
– Caused by a pointed object
• A small wound – but may
have extensive internal
damage. Difficult to assess
• Contusion
– Caused by a blunt
instrument
• May have underlying
fractures or damaged
tissue
• Gunshot
– Caused by bullet, shot or
bomb shrapnel
• Exit wound may be larger
Soft Tissue Injuries
Complications
– Bleeding – External / Internal
– Damage – Bones / Organs / Blood vessels
– Infection
– Foreign bodies
The care management for the patient
with a soft tissue injury
List the common causes of
burns and scalds
• Burns are caused by
Dry Heat
– Flame or Radiation
(Thermal)
– Electricity
– Friction
– Chemicals
• Scalds are caused by
Wet Heat
– Water
– Steam
– Fat
– Hot liquid Chemicals
Thermal Burns
Dangers
• Shock – due to loss of body fluids i.e. Plasma
• Infection – of the exposed tissue
• Damage – to the Respiratory tract
Electrical Burns
Dangers
• Ensure your own safety before dealing with
the patient
• Isolate any electrical current before touching
the patient
Friction Burns
Dangers
• In addition to the burn – surface tissue may
have been chaffed or scraped away
• Additional flesh wounds may also require
treatment
Chemical Burns
Dangers
• The destruction of tissues by the chemical
reaction
• The chemicals may be hot
• Some chemicals can melt into the skin and
tissue and then solidify
Types of Burns
• Superficial (first-degree)
– Skin is reddened and painful.
• Partial-thickness (second-degree)
– Blisters are present.
• Full-thickness (third-degree)
– Destroys underlying muscle and other tissues
Extent of Burns
Rule of Nines
• Method for determining
what percentage of the
body has been burned
Care management for the patient
with burns
List the functions of
dressing and bandaging
A dressing and bandage should be:
• Applied to provide sufficient pressure to control
bleeding
• Prevent further contamination of the wound
• Large enough to completely cover the injury
• Sterile
• Soft absorbent material which will not adhere to the
wound
• Immobilise the injured area
• Prevent movement of impaled objects
• A bandage should hold a dressing in place
Questions / Discussion
Summary
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Differentiate between arterial, venous and capillary bleeding
The care management for the patient with external bleeding
List the signs and symptoms of hypovolaemic shock
The care management for the
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patient with signs and symptoms of hypovolaemic shock
patient with a soft tissue injury
Explain the burn surface area calculation using Wallace’s rule
of nines
List the common causes of burns and scalds
The care management for the patient with burns
List the functions of dressing and bandaging