CaseEMS GB Meeting Minutes
Tuesday, October 18, 2011
Shock and Bleeding Control Lecture by David Hess
 Paramedic, military experience, first year
 What is Shock? o Shock – inadequate perfusion of tissues o Physiology
 Basic unit of life = cell
 Cells require a constant supply of oxygen and “fuel” to stay alive
 No oxygen and no fuel = no energy o Cardiovascular System
 Transports oxygen and fuel to cells
 Removes carbon dioxide and other waste products for elimination from body
 Cardiovascular system must be able to maintain sufficient flow to meet body’s fuel demands o Flow=perfusion
 Inadequate flow = inadequate perfusion
 Leads to shock o To maintain perfusion
 Pump – heart
 Pipes – blood vessels
 Fluid – blood
 Types of shock and causes o Hypovolemic shock
 Loss of volume
 Causes
 Blood loss: trauma or disease
 Plasma loss: burns
 Water loss: vomiting, diarrhea, sweating o Shock: Signs and symptoms
 Hypovolemic shock:
 Weak, rapid pulse
 Pale, cool, clammy skin
 Anxiety, restlessness, confusion
 Low blood pressure
 Shock is NOT the same thing as a low blood pressure
 A falling blood pressure is a LATE sign of shock
 Treatment o Secure, maintain airway o Apply high concentration oxygen o Assist ventilations as needed o Control bleeding

o Stabilize fractures – could break blood vessel o Prevent loss of body heat – body temp down, mortality chance up o Place victim in Trendelenburg position – feet elevated, head down
 Four stages of shock (1,2 – okay; 3 – irreversible damage; 4 – instant death) o Can lose up to 750 ml (15%) and be okay – Stage 1 o 750 – 1500 ml (15-30%) blood loss – Stage 2
 Blood pressure down
 Anxiety
 Pulse rate over 100 beats/min
 20-30 breath/min o 1500-2000 ml (30-40%) blood loss – Stage 3
 Pulse rate over 120
 Breath rate 30-40 breath/min
 Confused o 2000+ ml of blood loss – Stage 4
 Bleeding significance o If uncontrolled, can cause shock and death o Can bleed out and die within 2 min. o Must act quickly
 Identification of external bleeding o Arterial bleed – carries blood under pressure (oxygenated)
 Bright red
 Spurting o Venous Bleed
 Dark red (deoxygenated)
 Steady flow o Capillary Bleed (venous bleeding through capallaries)
 Dark red
 Oozing
 Control of External Bleeding (act fast) o Direct pressure
 Gloved hand
 Dressing/bandage o Elevation (reduce pressure) o Arterial pressure points (push blood vessel to bone)
 Upper extremity: brachial
 Lower extremity: femoral o Tourniquets (last resort) – completely stop blood flow
 Epistaxis (nosebleed) o Management
 Sit up and lean forward
 Pinch nostrils together just underneath bridge of nose
 Remain in sitting position
 Keep quiet
 Do not swallow blood (or else will thrown up)

 Apply ice over nose or back of head
 Tourniquets o If not spurting, can stuff dressing – then no need to have tourniquet o If wound can’t stuff dressing or too big – then can use tourniquet o Never cover a tourniquet
 People need to know that tourniquet there
 Cells will accumulate waste product – carbon dioxide, blood clots o Mark the casualty’s forehead with a “T” and time put on o Never loosen or remove a tourniquet
 Internal bleeding o Can occur due to:
 Trauma
 Clotting disorders (hemophelia)
 Rupture of blood vessels
 Fractures (break bone – lose blood as well)
 Worst bone to break is pelvis
 Lots of blood loss – 2+ liters o Assessment
 Mechanism (use common sense – if fell from high and no external, probably internal)
 Signs of symptoms of hypovolemia or shock without obvious external bleeding o Signs and symptoms
 Pain, tenderness, swelling, discoloration at injury site
 Bruise – blood on the inside
 Swelling – blood pushing tissue out
 Blood from any body orifice
 Vomiting bright red blood or coffee ground material
 Dark, tarry stools (melena)
 Tender, rigid, distorted abdomen o Management
 Maintain airway, assist RR if indicated
 High concentration oxygen
 Control external bleeding
 Stabilize fractures
 Rapid transport to appropriate facility
 Monitor for shock
 Do what you can but get to hospital as fast as possible
 Can’t really do much for internal bleeding
 Summary o Blood loss can have severe, life threatening complications, even after bleeding has stopped o Aggressive but appropriate control of bleeding is essential o Not all severe bleeding is obvious

o Not all bleeding is severe o Monitor vital signs, anticipate, and look for trends
 Pictures/Videos o Hockey arterial bleed o Pig arterial bleed o Pictures of injuries o Loss of limbs pictures
General Announcements
 No shifts over fall break
 MCI – October 29 (2 weeks!) o Sign up sheets coming soon