Shock and Bleeding

1. Shock and Bleeding Hamburg High School EMT Program

5. Circulatory System • Anatomy • Heart • Muscular organ, size of your fist, located in the center of the thoracic cavity • Arteries • Carry blood rich in oxygen – all arteries carry blood away from the heart • Capillary • Place where exchange of oxygen and carbon dioxide take place • Veins • Carry blood high in carbon dioxide – all veins carry blood back to the heart

6. Function of the Blood • Transportation of Gases • Carries oxygen from lungs to body cells, carries carbon dioxide back to lungs to be exhaled • Nutrition • Circulates nutrients from tissue to other body cells • Excretion • Carries waste products from cells to organs, such as the kidneys

7. Function of the Blood • Protection • Carries antibodies and WBC’s, which help fight disease and infection • Regulation • Blood carries substances that control the functions of the body, such as hormones, water, salt, enzymes, and chemicals • Blood also helps regulate body temperature by carrying body heat to the lungs and skin

8. The average amount of blood found in a: • Male: 5 – 6 Liters • Female: 4 – 5 Liters

9. Composition of Blood • Plasma • Water, salty fluid that makes up over half the volume of the blood. (56% of the bloods volume) • Red & white blood cells and platelets are carried in plasma • Red Blood Cells • RBC’s, erythrocytes, or red corpuscles. • Carry oxygen to tissues and carbon dioxide away. • Gives blood its red color

10. Composition of Blood • White Blood Cells • WBC’s or leukocytes • Involved in destroying micro-organisms (germs) and produce antibodies that help the body resist infection • Platelets • Helps the blood to clot; when fragments are activated they release chemical factors • Solid part of blood

11. Perfusion • Circulation of blood through an organ • Perfusion supplies oxygen and other nutrients to the cells of all organ systems and the removal of waste products

12. Hypoperfusion (SHOCK) • Inadequate circulation of blood through an organ

13. Types of Bleeding • Arterial Bleed • Bright red • Spurting • Venous Bleed • Dark red/maroon • Steady flow • Easier to control • Capillary Bleed • Dark red • Oozing • Often clots spontaneously

14. Severity of Bleeding • Considered severe when loss equals: • One liter (1000 cc) in an adult • ½ liter (500 cc) in a child • 100-200 cc in an infant • Uncontrolled bleeding or significant blood loss leads to shock (hypoperfusion) and possibly death

15. Severity of Blood LossDetermined by: • General impression of the amount of blood loss • Signs or symptoms of hypoperfusion • If the patient exhibits signs and symptoms of shock (hypoperfusion), the bleeding is to be considered serious

16. Control of External Bleeding • PPE for BSI • Maintain Airway • Administer Oxygen 1. Direct Pressure • gloved hand • dressing/bandage 2. Elevation 3. Tourniquet • CONSIDER: • Arterial pressure points • Upper extremity: Brachial • Lower extremity: Femoral

17. Other Methods to Control Bleeding • Splints • Air splints

18. Tourniquet • Application can cause permanent damage to nerves, muscle, and blood vessels resulting in loss of the extremity • Used for amputations • 3-4” wide & 6-8 layers deep • Wrap around extremity twice at a point above bleeding as close to the wound as possible • Tie one knot in the bandage and place a stick or rod on top of the knot and tie it • Twist the stick until the bleeding stops • Once the bleeding has stopped secure in place

19. Tourniquet • Blood pressure cuff may be used as a tourniquet until bleeding stops • Write “TK” and time of application on forehead of patient • Notify other personnel • Do not loosen or remove until definitive care is available • Do not use wire, rope, or any material that may cut into the skin • Do not cover with sheets, blankets, etc. • Do not apply over a joint, but as close to the injury as possible

20. Bleeding from the Nose, Ears, and Mouth • Possible causes • Skull fracture • Simple nose bleed – epistaxis • Facial trauma

21. Skull Fracture • May cause loss of blood or clear fluid (cerebrospinal fluid) from the nose and ears. • Check for Halo Effect • Do not stop the flow of fluid – collect in a loose dressing

22. Epistaxis • Causes • Fractured skull • Facial injuries • Sinusitis, other URIs • High BP • Clotting disorders • Digital trauma (nose picking)

23. Epistaxis • Nosebleed • Management • Sit up, lean forward • Pinch the fleshy portion of the nostrils together • Keep in sitting position • Keep patient calm and quiet • Apply ice over nose • 15 min adequate

24. Epistaxis Epistaxis can result in life-threatening blood loss

25. Internal Bleeding 1. Can result in severe blood loss which can lead to shock and subsequent death 2. Injured or damaged internal organs are a common cause of extensive bleeding that is concealed 3.Painful, swollen, deformed extremities (fractures) may lead to serious internal blood loss 4. Suspicion and severity of internal bleeding should be based on mechanism of injury and clinical signs and symptoms

26. Internal Bleeding • Mechanism of Injury • Blunt trauma • Falls • Motorcycle Crashes • Pedestrian Impacts • Automobile Collision • Blast Injuries • Look for evidence of contusions, abrasions, deformities, impact marks and swelling

27. Internal Bleeding • Mechanism of Injury • Penetrating Trauma • Pain, tenderness, swelling or discoloration at site of injury • Bleeding from mouth, rectum, vagina or other orifice • Vomiting of bright red blood or dark coffee-ground-colored emesis • Dark, tarry stools or stools with bright red blood • Tender, rigid abdomen • S/S of shock

28. Internal Bleeding • Management • BSI • Open airway • High concentration oxygen • Assist ventilations • Control external bleeding with direct pressure • Stabilize fractures • Transport rapidly to appropriate facility

29. Abdominal Evisceration Penetrating Trauma

30. SHOCK Inadequate perfusion (blood flow) of cells leading to inadequate oxygen delivery to tissues

31. Cardiovascular System • Transports oxygen, fuel to cells • Removes carbon dioxide, waste products for elimination from body Cardiovascular system must be able to maintain sufficient flow through capillary beds to meet cell’s oxygen and fuel needs

32. How can perfusion fail, thus causing shock? • Heart fails as a pump • Blood vessels dilate • Loss of Volume

33. 3 Types of Shock and Their Causes Hypovolemic Shock Cardiogenic Shock Distributive Shock

35. 1. Hypovolemic Shock • A type of shock that is the result of low blood volume

36. A. Hemorrhagic Shock • Shock most often seen by EMT’s • The natural response to bleeding is blood vessel constriction and clotting. Uncontrolled or significant bleeding can lead to shock and possibly death • Loss of volume

37. A. Hemorrhagic Shock • Signs and Symptoms • AMS, restlessness, anxiety • Increased respiratory rate • Weak, rapid pulse • Pale, moist/clammy, cool skin • Nausea, vomiting • Thirst • Falling blood pressure (LATE SIGN) • Infants and children maintain their blood pressure until their blood volume is more than half gone, so by the time their blood pressure drops they are close to death

38. B. Metabolic Shock • Form of Hypovolemic shock that is the result of electrolyte or plasma loss and does not involve the loss of whole blood. It can occur due to dehydration or from burns

39. B. Metabolic Shock • Signs and Symptoms • Sunken eyes • Poor skin turgor or tenting of the skin • Recent episodes of vomiting and diarrhea • Presence of burns

40. 2. Cardiogenic Shock • Result of a massive myocardial infarction • Heart is unable to pump effectively and as a result blood begins to back up in the system • Heart’s output depends on • How often it beats (heart rate) • How hard it beats (contractibility)

41. 2. Cardiogenic Shock • Signs and Symptoms • Those symptoms commonly seen during a heart attack • Emergency care • CPR with AED

42. 3. Distributive Shock • Blood vessels suddenly dilate causing the blood pressure to fall

43. A. Anaphylactic Shock • Form of shock caused by a violent systemic reaction to an allergen/toxin • Signs and Symptoms • Those seen with a severe allergic reaction

44. B. Neurogenic Shock • Spinal cord severed • Uncontrolled dilation of the blood vessels and drop in blood pressure • Compensatory mechanisms are not activated because nerve impulses cannot be conducted through the spinal cord

45. C. Septic Shock • Caused by a severe bacterial infection • Toxins (poisons) released into the bloodstream • Vessels dilate and there is a drop in blood pressure • Increase in fluid seeping into the tissues from the capillaries • Urinary tract infection is a common cause • Seldom seen in the field

46. Psychogenic Shock • Simple fainting (syncope) • Caused by stress, pain, fright • Heart rate slows, vessels dilate • Brain becomes hypoperfused • Loss of consciousness occurs

47. Shock:Signs and Symptoms • Anxiety, restlessness, combativeness, or altered mental status • Weakness, faintness or dizziness • Thirst • Shallow rapid breathing • Rapid, weak pulse • Pale, cool, clammy skin

48. Shock:Signs and Symptoms • Capillary refill >2 seconds (infants and children ONLY) • Dropping blood pressure (late sign) • Dilated pupils that are sluggish to respond • Nausea & vomiting

49. Shock: Signs and Symptoms Shock is NOT the same thing as a low blood pressure! A falling blood pressure is a LATE sign of shock!

50. Severity of Shock • Compensated shock (Early) • Body senses a decrease in perfusion and attempts to compensate • Increased heart rate & respirations to increase flow of blood and oxygen • Decompensated shock (Late) • Body can no longer compensate for low blood volume (late sign is falling B/P)