Chapter 11 - Bleeding and Shock
Hemorrhage – a large amount of bleeding in a short period of time.
Blood and blood vessels:
Plasma –
liquid part of the blood
makes up approx. half of blood volume
contains nutrients and carries away waste products
White blood cells – disease fighters
produce antibodies that help body resist infection
Red blood cells – largest segment of blood
solids
produced in marrow of large bones
transport oxygen to cells from lungs and carbon dioxide back to
lungs
out-number white blood cells approx. 1,000 – 1.
Platelets – assist with blood clotting
Major Functions of Blood:
protects against disease
maintains constant body temperature
transports oxygen, nutrients, and wastes.
Signals of External Bleeding:
Arterial – often rapid, profuse, spurts from wound, difficult to control
Venous – flows from wound at a steady rate
Capillary – oozes from wound
When Bleeding Occurs:
brain, heart, and lungs immediately attempt to compensate for blood loss to
maintain flow of oxygen-rich blood to body, especially vital organs
platelets collect at the wound to stop blood loss
white blood cells try to prevent infection by attacking microorganisms that
enter through skin break
body manufactures extra red blood cells
normally excess fluid from bloodstream is absorbed by kidneys, lungs,
intestines – in severe bleeding, this fluid is reabsorbed by blood vessels
severe reduction of blood volume is life threatening.
External bleeding
most stops by itself within 10 min.
look for sever bleeding during initial assessment
Symptoms of severe bleeding:
blood spurting from a wound
blood that fails to clot even after you have taken all measures to control it.
Controlling external bleeding:
follow BSI (Body substance isolation)
direct pressure
elevation
pressure bandage
pressure point – brachial and femoral arteries
continue to monitor airway and breathing
if bleeding severe, administer supplemental oxygen of available and you are
trained.
Preventing Disease Transmission:
avoid contacting the victim’s blood directly or indirectly (use gloves, protective
eyewear)
avoid eating and drinking and touching your mouth, nose, or eyes while providing
care or before washing your hands
always wash you hands thoroughly after providing care, even if you wore gloves
Internal Bleeding: Suspect it in any serious injury. Severe internal bleeding will
eventually produce signs of shock. These signs and symptoms may take time to appear.
They include:
discoloration of the skin
soft tissues (like in the abdomen) that are tender, swollen, or firm
anxiety or restlessness
rapid, weak pulse
rapid breathing
skin that feels cool or moist or looks pale, ashen, or bluish
nausea and vomiting
excessive thirst
declining level of consciousness (LOC)
drop in blood pressure
Controlling Internal Bleeding:
if minor, apply ice
if severe, need more advanced care
while waiting:
 do no further harm
 monitor ABCs and vital signs
 help the victim rest in the most comfortable position
 keep the victim from getting chilled or over-heated
 reassure the victim
 provide care for other conditions
 administer oxygen if it is available and you are trained to do so
Shock (hypoperfusion)
►a condition in which the circulatory system fails to adequately circulate oxygenrich blood to all parts of body.
►is inevitable in any serious injury or illness
►when vital organs do not receive oxygen-rich blood, they fail to function properly.
►Improper functioning triggers shock.
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To maintain adequate blood flow:
the heart must be working well.
An adequate amount of blood must be circulating in the body.
The blood vessels must be intact and able to adjust blood flow.
Injury or sudden illness ca interrupt normal body functions. If minor, this interruption is
brief. If more severe, the body is unable to adjust.
How shock develops – see page 234
Signs & Symptoms of Shock
Restlessness and irritability – best symptom
Rapid and weak pulse
Rapid breathing
Pale, ashen, or bluish, cool, moist skin
Excessive thirst
Nausea and vomiting
Drowsiness or loss of consciousness
Drop in blood pressure.
Care for Shock:
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Do an initial assessment and provide care for life-threatening
conditions.
If there are no life-threatening conditions, perform a physical exam
and SAMPLE history. Then:
 Do not harm
 Monitor ABCs and provide care
 Help the victim rest comfortably
 Keep the victim from getting chilled or over-heated
 Reassure the victim
 Provide care for specific conditions
You can also:
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Control any external bleeding ASAP
Elevate the legs about 12” unless contra-indicated
Administer oxygen if available and you are trained
Do not give them anything to eat or drink
Call for advanced medical personnel