First Aid Lecture: Bleeding and Shock

1. First Aid Lecture:Bleeding and Shock

2. 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

3. External Bleeding • 1st priority for wound care • Hemorrhage: rapid blood loss in short period of time • Types: • Arterial • Venous • Capillary

4. Arterial Bleeding • 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

5. 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

6. Capillary Bleeding • Most common • Blood oozes from capillaries • Usually clots on its own • Easiest to control w/pressure

7. Clot Formation(avg time frame @10 minutes) • Blood Vessel Spasm: • Arteries surrounded by muscle tissue • Constricts diameter to slow bleeding

8. 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

9. 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

10. What to do: • Scene Safety • Observe Universal Precautions (BSI/PPE) • Four Methods: 1. Direct Pressure 2. Elevation 3. Pressure Bandage 4. Pressure Points

11. 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.

12. Elevation • For arms/legs • Uses gravity to reduce blood flow • Continue direct pressure • Do not elevate w/fractures

13. Direct Pressure • For injuries that cannot take direct pressure: protruding bone, skull fracture, embedded object • make ring pad out of bandage

14. 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

15. 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

16. Other Pressure Points

17. 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 (will be painful)

18. Internal Bleeding • Look for: • Bruises or contusions on skin • Painful, tender, rigid, bruised abdomen • Vomiting, coughing blood • Blood in stool or black feces

19. What to do • Contact CMS • Monitor CAB • Expect vomiting. Keep victim in recovery left-side position. • Treat for shock

20. 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

21. 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

22. Signs and Symptoms of Shock • Body attempts to divert blood to vital organs • Results in: • Cyanosis of skin; cool to touch • Excessive perspiration: wet, clammy • Irregular respiration, shallow breaths • General weakness, restlessness, agitated, confused, or unresponsive • Excessive thirst (** do not give water – can cause vomiting and aspiration) • Nausea and/or vomiting • Eyes: Blurred vision, dilated pupils

23. What to do Goals for treatment of shock: • Reduce/eliminate cause of shock • Control bleeding • Ease pain through position change • Emotional support • Improve circulation to brain and heart • Provide adequate oxygen • Maintain body temperature

24. 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

25. 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, pregnancy, vomiting • recovery position

26. 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

27. 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

28. 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

29. 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)