Bleeding And Shock
Chapter 6/8
Sources of External Bleeding
Arteries
Veins
Capillaries
Arterial Bleeding
Most
serious / arteries are usually
deep in the body
Rapid and profuse blood loss
Bright red / spurts
Less likely to clot
Must use external means to stop
blood flow
Venous Bleeding
Steady
flow / bluish-red
May be profuse
More easily controlled
Veins are closer to the body
surface
Can be serious
Capillary Bleeding
Easily
controlled
Blood oozes
–Road rash
Blood Vessel Spasm
Severed
arteries
– Artery draws back into the tissue
– Artery constricts and slows bleeding
Partially
severed arteries
– Associated with greater blood loss
– Example: amputations
Definitions
Hemorrhage:
Rapid blood loss
– Adult: 1 quart may lead to shock
– Child: 1 pint loss of blood
Dressing
– A protective covering for a wound –
p.150
Bandage
– A material used to hold a dressing in
place
Dressings
Used
to control bleeding
Prevents contamination
Dressings should be:
–Sterile
–Larger than the wound
–Thick, soft, compressible
–Lint free (no cotton balls)
Types of Dressings
Gauze
pads
Adhesive strips
Trauma
dressings
Improvise
Donut shaped
Dressings
 Application
– Wash hands
– Dressing should extend over edges of wound
– Do not touch dressing surface that is to be next
to the wound
– Place medications directly onto pad
– Cover with a bandage
 Removal
of Dressings
– Soak “stuck” dressing in warm water
Bandages Are Used For:
Holding
dressings in place
Applying pressure
Prevent or reduce swelling
Provide support or stability
Application of Bandages
Leave
toes and fingers exposed if
possible
– Bandage too tight? Check for
color, circulation, temperature
Wrap
towards the heart
– Small end of bone to large end
Types of Bandages
 Roller
gauze
 Improvised
 Triangular
 Cravat
 Adhesive / paper tape
 Adhesive strips
 P.150-152
Tourniquets
–Rarely recommended
–Damages nerves and
vessels
Types of Wounds And
Application of Bandages And
Dressings Will Be Addressed
Later
Someone Has Cut Their Leg:
What Should You Do?
(external bleeding / depends on severity)
Call
for help when necessary
Protect yourself from bodily fluids
Expose the wound
Apply sterile gauze pad (dressing)
 Apply constant, direct pressure
for 10 minutes (don’t peak)
Cut Leg
If
dressing becomes blood soaked
– do not remove dressing, add
others over it
After
10 minutes, if bleeding persists
– apply pressure harder and over a wider
area for 10 more minutes (seek help)
Additional Options
Elevate
limb above heart level
Apply pressure at a pressure point
When bleeding stops:
– Apply pressure bandage (roller
gauze)
– Wrap towards the heart
Problem Bleeders
Hemophiliacs
Aspirin
When Not To Apply Direct
Pressure
Protruding
bone
Skull fracture
Embedded object
May use a donut shaped pad
Internal Bleeding
Look
for abdominal:
–Pain
–Tenderness
–Rigidity
–Bruises
Internal Bleeding
Look
for:
–Black stools
–Bright red stools
–Cough or vomit with blood
–Fractured ribs or bruises
Internal Bleeding: What To Do
Monitor ABC’s
Lay
on side if appropriate (expect
vomiting)
Treat for shock
– Raise legs 8-12 inches (if conscious)
– Cover victim

Bruises: Ice, ace wrap, elevate
Shock
Occurs
when the circulatory
system fails
– Resulting in inadequate blood flow
to some part of the body
A MAJOR
CAUSE OF
DEATH !!!
Shock #2
Always
treat injured victims
for shock
Shock:
–can be prevented
–cannot be reversed
Types of Shock
Cardiogenic
–Heart fails to pump
sufficient blood supply
Types of Shock
Neurogenic
– Spinal cord damage
– Drug overdose
– Vessels dilate
– Blood supply insufficient to fill
vessels
Types of Shock #2
Septic
–Result of a bacterial
infection
–Vessels lose ability to
contract
Types of Shock #3
Hypovolemic
(Fluid Loss)
–Most common type
»Blood loss
»Dehydration from vomiting,
diarrhea or profuse sweating
Shock: What To Look For
Pale,
cold, clammy skin
Altered
mental status
– Rapid breathing and pulse
Unresponsiveness
Nausea
and vomiting
Shock: What To Do
First,
care for life threatening injuries
If the face is red, raise the head,
– (injuries to upper half of body – raise the
upper half of body)
If the face is pale, raise the tail.
(injuries to lower half of body, raise the
lower half of the body)
Shock: What To Do #2
conscious and appropriate, place
victim on back, raising legs 8-12 inches
 If
EXCEPT those needing ½ sitting position
(listed on next slide)
Cover
 Do
victim, over and under
not let victim eat or drink
– May suck on wet cloth
Shock: When To Place In A Half
Sitting Position
 Difficulty
breathing
 Head injuries (when appropriate)
 Strokes
 Chest injuries
 Penetrating eye injuries
 Heart attack
 Unconsciousness
Anaphylaxis or
Anaphylactic Shock
Massive
allergic reaction by
the body’s immune system
Causes Of Anaphylactic Shock
 Medications
» Penicillin and related drugs, aspirin, sulfa
drugs,meds and alcohol
 Foods
and food additives
– Monosodium glutamate, peanuts
 Plant
pollens
Bee
stings
 Radiographic
dyes
Characteristics of Anaphylaxis
Usually
comes on in minutes /
Peaks in 15-30 minutes
Sensation
of warmth
Intense itching of soles of feet and
palms of hands
Breathing
difficulties
Tightness and swelling in throat
Coughing, sneezing, wheezing
Tightness in chest
Characteristics of Anaphylaxis #2
Increased
pulse rate
Swollen
Nausea
face, tongue, mouth
and vomiting
Dizziness
Blue around lips and mouth
Anaphylaxis: What To Do

Check ABC’s
– Use ice pack on bee sting
Inject epinephrine (dilates
bronchioles)
– P.442 (hopefully victim will have some)
– Inject in outside part of thigh, hold for
10 seconds
– May need to repeat
Get help immediately (float trip)
 Benedryl – too slow for major
emergency, but worth a try
