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Bleeding and Shock

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Bleeding and Shock

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    1. 1 Bleeding and Shock Pipes, pump, and fluidreally, its that simple!

    2. 2 The Second Rule of EMS. eventually the bleeding will stop!

    3. 3 Cardiovascular System Heart Arteries Veins Capillaries Blood

    4. 4 Cardiovascular System Transports O2 and fuel to the cells, tissues, and organs. Removes CO2 and wastes from the cells for elimination from the body. Must be able to maintain sufficient flow through the capillary beds to meet the cells O2 and fuel needs

    5. 5 Bleeding Internal External

    6. 6 Internal Bleeding Trauma Clotting disorders Rupture of blood vessels Fractures (injury to nearby vessels) Can result in rapid progression to hypovolemic shock & death!

    7. 7 Internal Bleeding S/S Think about MOI or NOI! Anxiety, restlessness, irritability Pale, diaphoretic skin Sustained tachycardia Hypotension Unstable vitals signs (postural changes)

    8. 8 Internal Bleeding S/S Vomiting bright red blood or coffee ground material Bleeding form any body orifice Dark, tarry stools (melena) Tender, rigid, or distended abdomen Pain, discoloration, swelling, tenderness at injury site

    9. 9 Managing Internal Bleeding ABCs High concentration oxygen Assist ventilations Control external bleeding Stabilize fractures RICE Transport rapidly to appropriate facility

    10. 10 External Bleeding Arterial Bleed Bright red, spurting Venous Bleed Dark red, steady flow Capillary Bleed Dark red, oozing

    11. 11 Control of External Bleeding Direct Pressure: Gloved hand Or Dressing and bandage

    12. 12 Control of External Bleeding Elevation: Raise extremity above the level of the heart

    13. 13 Control of External Bleeding Pressure Dressing: Use bandage to secure dressing in place

    14. 14 Arterial Pressure Points Upper extremity: Brachial Radial Lower extremity: Femoral Popliteal

    15. 15 Tourniquets Final resort when all else fails Used for amputations 3-4 wide (blood pressure cuffs) Write TK and time of application on forehead of patient Notify other personnel Once applied, DO NOT REMOVE

    16. 16 Epistaxis (Nosebleed) Causes Fractured skull Facial injuries Sinusitis, other URIs High BP Clotting disorders Digital insertion (nose picking)

    17. 17 Management of Epistaxis Sit up, lean forward Pinch nostrils together Keep in sitting position Keep quiet Apply ice over nose (15 min) Can result in life-threatening blood loss!

    18. 18 SHOCK Inadequate perfusion(blood flow) leading to inadequate oxygen delivery to tissues

    19. 19 Physiology Cell is the basic unit of life Cells get energy needed to stay alive by reacting oxygen with fuel (usually glucose) No oxygen, no energy No energy, no life

    20. 20 Perfusion Failure Pump Failure (heart) Pipe Failure (vessels) Loss of Volume (blood)

    21. 21 Stages of Shock Compensated Shock Decompensated Shock Irreversible Shock

    22. 22 Compensated Shock Body still compensates for blood loss Pulse rate increases Pulse strength decreases Pale, diaphoretic skin Anxiety, restlessness, combativeness Thirst, weakness, eventual air hunger

    23. 23 Decompensated Shock Body compensatory mechanisms fail Unpalpable pulse Precipitous drop in blood pressure Patient becomes unconscious Respirations slow or cease

    24. 24 Irreversible Shock Lack of circulation causes: Cellular death Tissue dysfunction Organ dysfunction Patient death

    25. 25 Shock: Etiology

    26. 26 Psychogenic Hypovolemic Distributive Obstructive Cardiogenic Respiratory Neurogenic

    27. 27 Psychogenic Shock Simple fainting (syncope) Caused by stress, fright, pain Heart rate slows, vessels dilate Brain becomes hypo-perfused Loss of consciousness occurs Patient usually recovers by self

    28. 28 Psychogenic Shock S/S Anxiety, restlessness, irritability Rapid pulse Normal or low blood pressure Hyperventialtion

    29. 29 Hypovolemic Shock Loss of volume Causes: Blood loss from trauma Plasma loss from burns Fluid/electrolyte loss from vomiting, diarrhea, sweating, increased urine output, increase respiratory loss Third space fluid shifts

    30. 30 Hypovolemic Shock S/S Anxiety, restlessness, irritability Rapid, weak pulse Change in mental status Signs of inadequate perfussion (diaphoresis, cyanosis, pale/clammy skin) Increased respiratory rate

    31. 31 Distributive Shock: Septic Results from bodys response to bacteria in bloodstream Vessels dilate, become leaky

    32. 32 Distributive Shock: Septic S/S Anxiety, restlessness, irritability Febrile, warm skin Hypotension Tachycardia Increased respiratory rate Change in mental status

    33. 33 Distributive Shock: Anaphylactic Results from severe allergic reactions Body responds to allergen by releasing histamine Histamine release causes vessels to dilates and become leaky

    34. 34 Distributive Shock: Anaphylactic S/S Sudden onset Mild itching, rash, uticaria, hives Burning sensation (skin) Hypotension Generalized edema Angiodema, airway compromise Respiratory distress Coma, rapid death

    35. 35 Obstructive Shock Interference with blood flow through the cardiovascular system Tension pneumothorax Cardiac tamponade Pulmonary embolism

    36. 36 Obstructive Shock S/S Anxiety, irritability, restlessness Weak, irregular pulse Chest pain, shortness of breath Hypotension Pale, cool, clammy skin JVD, discoloration above nipple line

    37. 37 Cardiogenic Shock Pump failure Hearts output depends on How often it beats (heart rate) How hard it beats (contractility) Rate or contractility problems cause pump failure

    38. 38 Cardiogenic Shock S/S Causes Acute myocardial infarction Very low heart rates (bradycardias) Very high heart rates (tachycardias)

    39. 39 Cardiogenic Shock S/S Chest pain Weak, irregular pulse Hypotension (HTN with CHF) Cyanosis, signs of inadequate perfusion Cool, clammy skin Anxiety

    40. 40 Respiratory Shock Failure of respiratory system to supply oxygen to or remove CO2 from the alveoli Airway obstruction Flail chest, SCW Pneumothorax Respiratory muscle paralysis

    41. 41 Respiratory Shock S/S Anxiety, restlessness, irritability Rapid, weak pulse Hypotension Change in mental status Signs of inadequate perfussion Increased respiratory rate Bronchoconstrcition (wheezes)

    42. 42 Neurogenic Shock Spinal cord injuries that result in the interruption of communication pathways between CNS and rest of body Vessels below the injury site dilate leading to decreased vascular resistance

    43. 43 Neurogenic Shock S/S Anxiety, restlessness, irritability Bradycardia Hypotension Skin above injury site: pale, cool, clammy Skin below injury site: warm, pink, dry Signs of spinal injury

    44. 44 Treatment ABCs Apply O2, assist ventilations as needed Keep patient in position of comfort Control bleeding, stabilize fractures Prevent loss of body heat Assist with medications Nothing by mouth Calm and reassure

    45. 45 Treatment Elevate lower extremities 8 to 12 inches in hypovolemic shock Do NOT elevate the lower extremities in cardiogenic shock

    46. 46 Shock is NOT the same as low pressure A falling blood pressure is a LATE sign of shock!

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