Control Bleeding and
Hypovolemic Shock
Introduction



Review methods of controlling bleeding
Hemorrhage control save lives
ABC Measures
–
–
–
–

Clear the airway/restoring breathing
Stop the bleeding
Protect the wound
Treat/prevent shock
A-B-C measures apply to all injuries
Core Skills
Control Bleeding
2
Left Atrium
Right Atrium
Left
Ventricle
Right
Ventricle
Core Skills
Control Bleeding
3
Function of Blood

Transport O² and nutrients to the cells

Removes CO² and other waste products

Detoxification and elimination
Core Skills
Control Bleeding
4
Plasma

Serum, protein and chemical substances

Watery, salty fluid

Constitutes over half the volume of
blood

Transports substances to various
structures

Transports waste products

Carries red and white blood cells and platelets
Core Skills
Control Bleeding
5
Red Blood Cells

Erythrocytes

Primary function
– Carry oxygen to tissues
– Carry carbon dioxide
away from tissues

Red color to blood
Core Skills
Control Bleeding
6
White Blood Cells

Leukocytes

Destroy
microorganisms

Produce antibodies
Core Skills
Control Bleeding
7
Platelets

Thrombocytes

Membrane-enclosed
fragments of specialized
cells

Release chemical factors
to form blood clots
Core Skills
Control Bleeding
8
Pulses


Left ventricle contracts
Peripheral pulse
–
–
–
–

Radial
Brachial
Posterior tibial
Dorsalis pedis
Central pulses
– Carotid
– Femoral
Core Skills
Control Bleeding
9
Blood Pressure

Exerts pressure against blood vessels walls

Systolic
– Pressure created in the
arteries
– Reported first

Diastolic
– Left ventricle relaxed and
refilling
– Reported second
Core Skills
Control Bleeding
10
Blood
Hemorrhage or bleeding
 Escape of blood from capillaries, veins,
and arteries
 Adult body:

– Contains approximately 5 to 6 liters of blood
– 1 pint of blood without harmful effects
– 2 pints may cause shock
Core Skills
Control Bleeding
11
External Bleeding

Incision

Laceration

Abrasion

Puncture wounds

Amputation
Core Skills
Control Bleeding
12
Laceration
Core Skills
Control Bleeding
13
Puncture Wound
Core Skills
Control Bleeding
14
Amputation
Core Skills
Control Bleeding
15
Abrasion
Core Skills
Control Bleeding
16
Incision
Core Skills
Control Bleeding
17
Internal Bleeding

Not always obvious

Suspicion based on mechanism of injury
– Falls
– Blast injuries
– Penetrating trauma
Core Skills
Control Bleeding
18
Internal Bleeding
Core Skills
Control Bleeding
19
Injured Internal Organs
Core Skills
Control Bleeding
20
Sources of Bleeding



Arterial
Rapid, profuse and pulsating; bright red in
color
Venous
Steady flow; dark red or maroon in color
Capillary
Slow and oozing; often clots spontaneously
Core Skills
Control Bleeding
21
Hypovolemic Shock
Inadequate tissue perfusion
 Causes
Hemorrhage
Severe burns
Severe vomiting and/or diarrhea

Core Skills
Control Bleeding
22
Clinical Signs of Acute Hemorrhage
Class
% Blood
Loss
I
Up to 750 ml Slight increase in HR; no change in BP or
(15%)
respirations
II
750-1500 ml Increased HR and respirations; increased
(15-30%)
diastolic BP; anxiety, fright or hostility
III
1500-2000
Increased HR and respirations; fall in
ml (30-40%) systolic BP; significant AMS
IV
>2000
(>40%)
Core Skills
Clinical Signs
Severe tachycardia; severe lowering of
BP; cold, pale skin; severe AMS
Control Bleeding
23
Other Common Signs of
Hypovolemic Shock
Cold, clammy skin
 Cyanosis- nail beds, lips and ear lobes
 Weak, thready, rapid pulse
 Shallow respirations
 Oliguria
 Listlessness, stupor, LOC
 Excessive thirst

Core Skills
Control Bleeding
24
Internal Signs of Hemorrhage
 Soft
tissue bruising
 Abdominal tenderness
 Hemoptysis
 Hematemesis
 Melena
Core Skills
Control Bleeding
25
Treatment-Direct Pressure
First, expose the wound!!!
 Place a sterile dressing
over the wound and
apply pressure
 Use a bandage or
cravat to tie a knot over the dressing
covering the wound

Core Skills
Control Bleeding
26
Treatment-Elevation
Raise injured extremity above the heart
 Used together with direct pressure
 Use an object to maintain elevation
 Utilize bystanders

Core Skills
Control Bleeding
27
Treatment-Pressure Dressing
Use a pressure dressing if bleeding is
NOT controlled with direct pressure
 Place Kerlex, ace wrap or cravat over
previous dressing
 Wrap this dressing over
the wound and previous
dressing

Core Skills
Control Bleeding
28
Pressure Points
Severe bleeding
 Bleeding not controlled by direct pressure
and elevation
 Apply pressure to appropriate pressure
point

(
Core Skills
Control Bleeding
29
Pressure Points
Core Skills
Control Bleeding
30
Pressure Points
(

Temporal

Carotid

Brachial

Radial

Femoral

Posterior/
Anterior
tibialas
Core Skills
Control Bleeding
31
Brachial Pressure Point
Lower part of the upper arm
 Above the elbow in the groove between
muscles
 Using fingers or thumb
 Apply pressure to the inside of the arm
over the bone

Core Skills
Control Bleeding
32
Brachial Pressure Point
Core Skills
Control Bleeding
33
Femoral Pressure Point
Control severe
bleeding of thigh and
lower leg
 Front, center part of
crease in the groin

Core Skills
Control Bleeding
34
Application of Pressure Points

Position the casualty on his or her back

Kneel on opposite side from wound

Place heel of hand directly on pressure point

Lean forward to apply pressure

If bleeding is not controlled
– Press directly over artery
– Press heel of other hand on fingertips
Core Skills
Control Bleeding
35
Splinting
Immobilization is one of the best ways to
stop bleeding
 Broken bone fragments may grate on
blood vessels
 Muscular activity can increase rate of
blood flow
 Air splints used to apply direct pressure

Core Skills
Control Bleeding
36
Air Splints
Core Skills
Control Bleeding
37
Tourniquet
Direct pressure, elevation, pressure
dressings or pressure points will not stop
some bleeding
 In these cases, a
tourniquet may be
lifesaving

Core Skills
Control Bleeding
38
Tourniquet
Forceful, arterial bleeding (amputation)
may require early use of a tourniquet.
 DO NOT WASTE TIME attempting a
pressure dressing in these cases

Core Skills
Control Bleeding
39
Tourniquet

Use a cravat, if available. If not, use:
a belt
a rope
a BP cuff
rope
strap from LBE
or any other material available
Core Skills
Control Bleeding
40
Apply a Tourniquet








Place tourniquet between heart and wound
Place pad over artery to be compressed
Wrap tourniquet around extremity
Tie half-knot on upper surface
Place short stick on half-knot
Tie a square knot
Twist stick to tighten
UNTIL BLEEDING STOPS
Core Skills
Control Bleeding
41
Apply a Tourniquet
Never cover a tourniquet
 'T" on casualty's forehead
 Never loosen or remove a
tourniquet

Core Skills
Control Bleeding
42
Amputation
Apply dressing to cover end of the stump
 Control Bleeding

– Blood vessels collapse, retract
or curl closed to limit bleeding
– Direct pressure, pressure
dressing or tourniquet
Core Skills
Control Bleeding
43
Preservation of Amputation Parts







Rinse amputated part free of debris
Wrap loosely in saline-moistened sterile gauze
Seal amputated part in a plastic bag or cravat
Place in a cool container, do not freeze
Never place amputated part in water
Never place amputated part directly on ice
Never use dry ice to cool an amputated part
Core Skills
Control Bleeding
44
Hemostatic Agents
Quickclot hemostatic powder
Chitosan hemostatic dressing
Core Skills
Control Bleeding
45
Treatment Goals

Directed at adequate oxygenation and
ventilation
 STOP THE BLEEDING
 Maintain circulation with fluid
replacement
Core Skills
Control Bleeding
46
Treatment
ABCs
 Circulation and hemorrhage control

-IV access

-Control external bleeding
 Baseline vitals
 Brief neuro exam
 Position casualty and expose hemorrhage
sites

Core Skills
Control Bleeding
47
Treatment
Maintain body temperature
 IV fluid administration- 2 large bore IVs
 Perform serial neurological exams every
5 minutes
 Perform vital signs every 5 minutes
 Transport to medical facility ASAP

Core Skills
Control Bleeding
48
Hextend
 Superficial (> 50% of injured
 Significant extremity or truncal
 Significant blood loss
• Incoherent
• Loss of radial pulse
Core Skills
Control Bleeding
49
Summary
A&P of Circulatory System
 Identify Hemorrhage and Hypovolemic
Shock
 Provide Treatment for Hemorrhage
 Provide Treatment for Hypovolemic
Shock

Core Skills
Control Bleeding
50
QUESTIONS ??
Core Skills
Control Bleeding
51