Bleeding & Shock Flashcards
Arteries
Systemic
• Carry oxygen-rich blood away from the heart
• Comprised of thick, muscular walls that enable dilation and constriction
Pulmonary
• Pulmonary artery
Veins
- Carry oxygen-depleted blood rich in carbon dioxide back to the heart
- Contain one-way valves to prevent back flow of blood
Capillaries
• Microscopic blood vessels
• Vital exchange site: oxygen, nutrients passed through
capillary walls in exchange for
carbon dioxide from cells - occurs in the alveoli - circulatory system rich in CO2 (during exchange)
Functions of Blood
- Transportation of gases
- Nutrition
- Excretion
- Protection
- Regulation
Perfusion
Adequate circulations of blood throughout body
Hypoperfusion (Shock)
Inadequate circulations of blood to tissues and organs
Pump Problem - cardiogenic
Content - hypovolemic, dehydration, bleeding
Container Problem - Sepis, Anaphylaxis, neurogenic
Two Types of Bleeding
- External
- Internal -
main area you can loose enough blood to die in thorax, abdomen, pelvis, femur fracture
how much blood do I have to loose to have a problem
20% rule (circulating blood volume)
1200ml (6000ml x 20%)
External Bleeding What does it look like:
Arteries:
Veins:
Capillaries:
Arteries: Spurting Blood, Pulsating Flow, Bright Red Color
Veins: Steady, slow flow, Dark Red Color
Capillaries: Steady Even Flow
Arterial External Bleeding is?
Oxygen Rich
Rapid and profuse
Spurting with heartbeat
Most difficult to control
Venous External Bleeding is?
Rich in carbon dioxide & waste
Steady flow
Easier to control
low pressure system
Capillary External bleeding is?
Slow and Oozing
Easily controlled
Stops Spontaneously
Think About It: Bleeding
• How severe is the bleeding? Is it exsanguinating hemorrhage? If so, how does that affect the priorities of treatment?
Patient Assessment - Primary Assessment
Standard Precautions Open Airway Monitor Respirations Ventilate if Necessary Control Bleeding Skin: Color, Temp, Condition, Check Pulses
Methods to Control External Bleeding
Direct Pressure
Elevate
Pressure Dressing
Tourniquet
Direct Pressure - How to
- Apply firm pressure to wound with gloved hand and gauze bandage
- Hold pressure until bleeding is controlled
- If necessary, add dressings when lower ones are saturated
- Never remove bandages—even when bleeding is controlled
- When controlled, check for pulse distal to wound - PMS
Elevate
- Elevate injured extremity above level of the heart while applying direct pressure
- Do not elevate if musculoskeletal injury is suspected
Pressure Dressing
• Place several gauze pads on wound
• Hold dressings in place with self-adhering roller bandage wrapped tightly over
dressings and above and below wound site
• Create enough pressure to control bleeding
Hemostatic Agents
- Commonly, dressing containing substance that absorbs and traps red blood cells
- Can be wadded up and inserted into wound
- May be a powder poured directly into the wound
- Manual pressure is always necessary
Tourniquet
- Use if bleeding is uncontrollable via direct pressure
- Use only on extremity injuries
- Once applied, do not remove or loosen
- Attach notation to patient alerting other providers tourniquet has been applied
Think About It: Bleeding
• Is the current method of bleeding control working? Do you need to move on to a more aggressive step? How would you
evaluate this?
Other Ways to Stop Bleeding
- Splinting
- Cold application
- Pneumatic anti-shock garment (PASG)
Special Bleeding Situations Head Injury
• Head injury
– From increased intracranial pressure, not direct trauma
– Stopping bleeding only increases intracranial pressure
Special Bleeding Situations Nose Bleeds (Epistaxis)
– Have patient sit and lean forward – Apply direct pressure to fleshy portion of nostrils – Keep patient calm and quiet – Do not let patient lean back – If patient becomes unconscious, place patient in recovery position and be prepared to suction
Internal Bleeding
- Damage to internal organs and large blood vessels can result in loss of a large quantity of blood in short time
- Blood loss commonly cannot be seen
- Severe blood loss can even result from injuries to extremities
Blunt Trauma is..
• Leading cause of internal bleeding – Falls – Motor vehicle crashes – Automobile–pedestrian collisions – Blast injuries
Penetrating Trauma
• Common penetrating injuries
– Gunshot wounds
– Stab wounds
– Impaled objects
Signs of Internal Bleeding
- Injuries to surface of body
- Bruising, swelling, or pain over vital organs
- Painful, swollen, or deformed extremities
- Bleeding from mouth, rectum, or vagina
- Tender, rigid, or distended abdomen
- Vomiting coffee-ground or bright-red material
Pediatric Considerations Bleeding
• Infants and children—efficient
compensating mechanisms maintain blood pressure until half of volume is depleted
• Potential for shock must be recognized and treated before tell-tale signs appear
Cultural Considerations: Bleeding
• Places on body to look to assess circulation via skin color
– Fingernails and lips
– Conjunctiva in eyes
– Palms of hands; soles of feet
Treatment of Internal Bleeding
Administer Oxygen
Maintain ABC’c
Control External Bleeding
Rapid Transport to Appropriate Medical Facility
Shock
Inability to supply cells with oxygen
Inadquate removal of waster products from cells
Causes of Shock
• Failure of any component of circulatory
system
– Heart: loses ability to pump
– Blood vessels: dilate, making too large a “container” to fill
– Blood: loses volume from bleeding
Pump
Content
Container
Severity of Shock Compensated
Compensated - Body shunts blood where needed
Severity of Shock Decompensated
Decompensated - Blood pressure falls as body can’t handle loss of blood
Severity of Shock Irreversible
Cell damage occurring, causing rapid death
During Shock
- Pulse increases to maintain cardiac output
- Blood vessels constrict, causing pale, clammy skin
- Respiration rate increases
- Blood is shunted away from the GI organs causing nausea
- Decreasing blood pressure is a late sign of shock
Types of Shock
- Hypovolemic
- Cardiogenic
- Neurogenic
Hypovolemic Shock
- Results from a decreased volume of circulating blood and plasma
- Called hemorrhagic shock if caused by uncontrolled bleeding (internal or external)
- Can be caused by burns or crush injuries
Cardiogenic Shock
- Seen in patients suffering myocardial infarction
- Results from inadequate perfusion to heart, decreasing strength of contractions
- Heart’s electrical system may malfunction causing heartbeat that is too slow, too fast, or irregular
Neurogenic Shock
- Results from inability to control dilation of blood vessels because of nerve paralysis
- No blood loss, but vessels dilated so much that blood volume can’t fill them
- Rarely seen in the field
Signs and Symptoms of Shock
- Altered mental status
- Pale, cool, clammy skin
- Nausea and vomiting
- Vital sign changes
Care for Shock
- Aggressive airway maintenance
- Administer high-concentration oxygen
- Attempt to stop cause of shock
- Apply and inflate PASG if approved
- Splint any suspected bone or joint injuries
- Prevent loss of body heat
- Deliver patient to appropriate medical facility within “golden hour”
- Speak calmly and reassure throughout assessment and care
Bleeding & Shock Chapter Review
• Almost all external bleeding can be controlled by direct pressure and elevation. If these don’t work, apply tourniquet if bleeding is on an extremity.
• Emergency care for internal bleeding is based on prevention and treatment of shock.
• Early signs of shock: restlessness, anxiety, pale skin, rapid pulse and respirations.
• If shock is uncontrolled, patient’s blood pressure falls (late sign of shock).
• Signs and symptoms may not be evident early; treatment based on MOI may be lifesaving.
• Treat shock by airway maintenance; administration of high-concentration oxygen; controlling bleeding; and keeping
the patient warm. One of most important treatments is early recognition of shock and immediate transport.
Remember: Bleeding & Shock
• The circulatory system is designed to ensure adequate perfusion of body
tissues.
• The classification of hemorrhage is directly related to the type of vessel ruptured and
the pressure within that vessel.
• Treatment of external hemorrhage includes progression through the following steps: direct pressure, elevation, tourniquet application, use of hemostatic agents.
• Internal bleeding is impossible to evaluate. The most appropriate treatment must be
rapid transport to an appropriate facility.
Remember: Bleeding & Shock
- Shock develops if the heart fails, blood volume is lost, or blood vessels dilate, resulting in inadequate perfusion.
- Signs of shock reflect the body’s attempts at compensating for inadequate perfusion.
- The most significant treatment for the shock patient is early recognition and prompt transport to a hospital where the patient will receive definitive care.
Questions to Consider: Bleeding & Shock
- What can I use for a tourniquet that will control bleeding but not damage tissue?
- When treating a patient with shock, what should I do at the scene and what should I do en route to the hospital?
Questions to Consider: Bleeding & Shock
• Is a patient with pale, cool skin,
tachycardia, and rapid, shallow respirations in shock or just under stress?
How will continuing assessment help in making that decision?
Critical Thinking
• A patient has been involved in a motor vehicle collision. There is considerable damage to the vehicle. The steering column and wheel are badly deformed.
The patient complains of a “sore chest.” You note no external bleeding.
• The patient’s vital signs are pulse 116, respirations 20, blood pressure 106/70. How would you proceed to assess and care for this patient?
Be Able to trace a drop of blood through the body including the valves of the heart
.
an adult patient with a blood volume of 7 will start to see symptoms of shock after how much blood loss
.
test questions on what does blood loss look like
bright red
Dark red color
steady even flow
which type of blood loss is characterized by……
.
Always check the pulse distal to the injury, PMS
.
can use an BP cuff as a tourniquet
look this up in the book - pg 627
Nosebleed
lean the patient back
swallow blood they are going to vomit
blood they get in the mouth spit it out
recovery position
place pt on left side
can loose a two liters of blood with bilateral femur fracture.
.
blunt trauma pt in cardiac arrest don’t survive
penetrating trauma a little bit better
lost circulating blood volume
.
internal
look of for mechanism
bruising
over liver is it rigid or hurt
kids compensate much better than adults - they maintain for a longer period of time - and then drop off a cliff
.
Three phases of shock
compensated - increases HR, Blood vessels get smaller -
HR 130, cool clammy skin, BP 120/80
decompensated - blood pressure starts to fall - not a good sign prehospital - HR, Skin, abdomen
irreversible
know symptoms of shock in kids
633
.
know compensated, decompensated, irreversible
last vital sign to fail in shock in BP
.
hypovolemic - content - blood vomiting, diarrhea, shot dehydration
cardiogenic - pump
nuerogenic - container
septic
anaypy
psychogenic
.
care for shock
.
