First Aid Lecture:
Bleeding and Shock
Blood Loss
• Shock: (hypoperfusion)
Circulatory failure
Inadequate supply of O2 blood to organs,
especially brain and heart
• Adult has 5 – 6 qts of blood (avg)
 Can safely donate 1 pt
 > 1 pt blood loss  shock
• Child who loses > 1 pt is in danger
External Bleeding
• 1st priority for wound care
• Hemorrhage: rapid blood loss in short period
of time
• Types:
– Arterial
– Venous
– Capillary
Arterial Bleeding
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Most serious
Blood is under high pressure, moving quickly.
Often will spurt heavy blood loss.
Blood is bright red in color
speed of blood flow  less likely to clot
Venous Bleeding
• blood flow is slow
– (less pressure) on the way back to heart
• Easier to stop
– most veins collapse when cut.
• Deep veins can be as difficult to control
Capillary Bleeding
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Most common
Blood oozes from capillaries
Usually clots on its own
Easiest to control w/pressure
Clot Formation
(avg time frame @10 minutes)
1. Blood Vessel Spasm:
 Arteries surrounded by muscle tissue
 Constricts diameter to slow bleeding
Clot Formation
2. Platelet Plug Formation:
 Temporary plug in break
 Platelets stick to damaged vessel and to each
other
- Release chemicals
a. ATP: attract other platelets
b. Serotonin: enhance spasms
Clot Formation
3. Coagulation:
 Blood transformed from liquid to gel
(biochemical rxns)
 Enzyme Thrombin Activated in Blood Plasma
 Catalyzes formation of fibrin strands from protein in
blood plasma
 Fibrin meshes platelets together into stable clot
What to do:
• Observe Universal Precautions (BSI/PPE)
• Four Methods:
1. Direct Pressure
2. Elevation
3. Pressure Bandage
4. Pressure Points
Direct Pressure
- Expose wound
- Thick dressing/cloth
- Apply direct pressure:
- Constant strong pressure
with fingers/palm
- Wound will be painful –
continue
- If wounds bleed through,
apply 2nd dressing. Do not
remove 1st dressing.
- Do not disturb clot.
Elevation
• For arms/legs
• Uses gravity to reduce
blood flow
• Continue direct
pressure
• Do not elevate
w/fractures
Direct Pressure
• For injuries that cannot take
direct pressure: protruding
bone, skull fracture, embedded
object
– make ring pad out of bandage
Pressure Bandage
• holds dressing in place
• Frees up 1st aider for other tasks
• Use roller bandage to wrap around dressings
– Overlapping turns, wrap above and below site
– Move distally to proximally
– Tie off ends directly over dressings
– Check pulse below bandage to maintain
circulation
Pressure Points
- When other three methods fail
- Apply direct pressure to main
artery supplying:
- arm (brachial) or
- leg (femoral)
- Press artery against bone
- Only apply pressure points as
long as necessary to slow
circulation  allows time for
clotting
- Release pressure point as
bleeding stops
Other Pressure Points
Tourniquets
• only to be used w/severe injuries that may
cause a victim to bleed-out
– Use wide, flat materials (no rope/wire)
– Do not loosen, once applied
Internal Bleeding
• Look for:
– Bruises or contusions on skin
– Painful, tender, rigid, bruised abdomen
– Vomiting, coughing blood
– Blood in stool or black feces
What to do
• Monitor ABC
• Expect vomiting. Keep victim in recovery leftside position.
• Treat for shock
• Contact EMS
What is Shock?
(Hypoperfusion)
• CS fails due to lack of adequate O2 supply to
organs, especially brain and heart
– Brain damaged in 4-6 minutes irreparably
– Abdomen: 45 – 90 minutes
– Skin and Muscles: 3 – 6 hours
Shock can occur due to:
• Pump failure
– Cardiogenic shock
• Fluid failure
– Hypovolemic shock: drop in fluid volume
– Hemorrhagic shock: drop in blood volume
– Respiratory shock: respiratory distress prevents insufficient
oxygen in blood
• Pipe failure
– Neurogenic shock: nervous system damage cause vessel
dilation (blood volume insufficient to fill vessels)
– Septic shock: bacterial infections cause vessels to lose
ability to contract
– Psychogenic shock: emotional distress causes sudden
dilation of vessels
Signs and Symptoms of Shock
• Body attempts to divert blood to vital organs
• Results in:
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Cyanosis of skin; cool to touch
Excessive perspiration: wet, clammy
Rapid or weak pulse (pulse 60 – 100 /min is normal)
low bp
Irregular respiration, shallow breaths
General weakness, restlessness, unresponsive
Excessive thirst (** do not give water – can cause vomiting
and aspiration)
– Nausea and/or vomiting
– Blurred vision
– Eyes: pupils dilated, sunken eyes, vacant expression
What to do
Goals for treatment of shock:
1. Reduce/eliminate cause of shock
2. Control bleeding
3. Ease pain through position change
4. Emotional support
5. Improve circulation to brain and heart
6. Provide adequate oxygen
7. Maintain body temperature
Positioning Shock Victim
• Flat on back to increase circulation
• Raise feet 8 – 12 inches to provide blood to
heart and brain w/o affecting breathing
• Cover with blanket to maintain body
temperature or shade from sun
** consider injuries: do not move suspected
spinal injury victim
Special Considerations
• Breathing difficulties, chest or eye injuries:
– Raise head/shoulders to make breathing easier
– Sit up against something
• Head injury w/difficulty breathing:
– position flat, with head raised slightly if no neck injury
* If face is red, raise the head; if face is pale, raise the
tail
• “U” victim/stroke: recovery position
• Pregnant woman: recovery
• Vomiting: use recovery position
Body Temperature
• 75% body heat lost by radiation and
convection from body surface
• Place blanket between ground and victim
• Cover with blanket w/o overheating
– Overheating draws blood to surface and away
from vital organs
Anaphylactic Shock
Life-threatening allergic reaction
• Fast acting: within minutes
• Death usually due to swollen airway, causing
respiratory distress/shock
Common causes
• Medications (ex. Penicillin)
• Food, drugs, food additives (ex. Peanuts, shellfish,
nitrites, MSG)
• Insect stings
• Plant pollen
Symptoms of Anaphylaxis
• Warmth
• Intense itching
• Hives, flushing, swelling on face or mucous
membranes of tongue, mouth, nose
• Labored breathing, wheezing
• Victim feels faint, anxious
• Tightness in chest, throat, dizziness, nausea
• Increased pulse
What to do:
• Immediate care needed
• Rescue breathing or CPR may be necessary if
BLS threatened
• Epinephrine (Epi-pens)
– Increases cardiac output, constricts vessels
• Inject into front of thigh for 10 seconds
(demo)