Bleeding & Shock Flashcards
Bleeding control is performed during which assessment?
Primary Assessment
Variables for severity of bleed
- Amount of blood loss
- Rate of loss
- Other injuries/pre-existing conditions
- Age
Percentage of 200ml of Blood loss in an adult vs. infant
Adult = 4% Infant = 25%
Types of bleeding
- Arterial bleeding
- Venous bleeding
- Capillary bleeding
Arterial bleeding
- Bright red squirting blood from wound
- Squirting coincides with the contraction of the heart
- More difficult to control because of the higher pressure
- As BP decreases so will the squirting
Venous Bleeding
- Dark red blood with a steady flow
- May be profuse, but it is easier to control
- Lower pressures
Capillary Bleeding
- Dark slow oozing flow
- Easiest to control
- May spontaneously clot on it’s own
- Large enough area can be prone for infection (Road Rash)
Bleeding Control techniques
- Direct pressure
- Tourniquets
- Elevation
- Splinting
- Hemostatic Agents
Direct pressure
- 1st method for bleeding control
- Will handle most of the wounds an EMT sees
- Gauze applied on wound
- Pressure dressing (Kerlix/Coban)
- Helps allow the clotting process to take hold
Tourniquets
- If bleeding is not controlled with direct pressure/bandage
- Follow manufacturer’s instructions
- Place High and tight
- Must tighten until bleeding stops, no pulse past tourniquet
- Label time and location of TK
- 2 TK can be used
Why splinting is important?
Broken bones if left un-splinted the potential of laceration Increases
Splinting should only be done on scene if pt is?
Stable
Hemostatic Agents
- Designed to improve clotting
- Extremity Use only
Types of Hemostatic Agents
- Fibrinogen
- Thrombin
- Chitosan
Isolated nose bleed aka?
Epistaxis
Nose bleed Rx
Have pt lean slightly forward & place direct pressure with ice pack on the bridge of the nose
Impaled Objects
- Leave in place! Unless object is compromising the airway or breathing
- Pad and stabilize around the object
Internal bleeding considerations
- MOI
- NOI
- Vitals
- BP
- Skin signs
Pneumatic antishock garment (PASG) aka MAST indications
- Pelvic Fracture with BP greater than 90mmHg
- Internal ABDM bleed
- Retroperitoneal bleed with hypotension
PASG contraindications
- Penetrating thoracic trauma
- Splinting of Lower extremity fracture
- Eviscerated ABDM Organs
- Impaled object in ABDM
- Pregnant
- Cardiopulmonary Arrest
- CHF
- Pulmonary Edema
Soft Tissue Injuries
- Contusion
- Hematoma
- Crush Injury
- Abrasions
- Lacerations
- Avulsions
- Amputations
- Penetration/Puncture
- Bites
- Clamping Injury
Contusion
- A Bruise
- Blood Vessels in the dermis are damaged
- Localized Swelling/Pain
- Discoloration
Hematoma
- Similar to contusion
- Larger blood vessels involved
- Large lump with bluish discoloration from blood pooling
Crush injury
- Can cause severe under lying internal injuries
- Organs can pop
- Can be opened or closed
Abrasions
- Scraping away the epidermis
- Oozing capillary bleed
- Can be serious with greater surface area
- “Road Rash”
Lacerations
- A break in the skin of varying depth
- Extent of Bleeding depends on vessels hit
- “linear” clean razor cut
- “Stellate” irregular jagged cut from blunt objects
Avulsions
- Loose flap of skin & underlying soft tissue
- Still attached would be a “partial”
- Torn free would be a “total” or “Complete”
- Bleeding will be dependent on depth and internal structures hit
Amputations
- Disruption in the continuity of an extremity or other body part
- Bleeding can be massive
- Incomplete amputations tend to bleed more than complete amputations.
Penetrations/Punctures
- Sharp object being driven into the skin
- Entry wound may seem small with little bleeding, but injuries below could be massive
- Severity depends on location, depth, size, & force of object
Bites
- Are a combination of penetration/puncture and crush injuries
- Severity depends on location, force, & size of animal.
Clamping Injury
-Body part is caught by or strangled by a piece of machinery
Penetrating chest trauma
- Treat all wounds from the neck to the naval as sucking chest wounds
- Anticipate pneumothorax
Rx for penetrating chest wound
Occlusive dressing or chest seal to stop bleeding
4 categories of shock
- Hypovolemic Shock
- Distributive Shock
- Cariogenic Shock
- Obstructive Shock
Hypovolemic Shock
- Inadequate volume due to blood or other fluid loss
- Shock Caused by low blood volume
Medical problems associated with fluid loss
- Long bouts of Vomiting
- Diarrhea
- Fluid Loss associated with burns
Distributive Shock
- Decrease in intravascular volume caused by massive systemic vasodilation
- No actual fluid loss in some cases
- Volume becomes Inadequate to fill Increased size
Distributive Shock S/Sx
-Increased capillary permeability
-Fluid leaks out of the capillary beds leading to fluid loss
-Loss in peripheral vascular resistance (PVR)
Leads to Lower Systolic pressures
-Preload is reduced , which reduces cardiac output
Cardiogenic Shock
- Heart is ineffective as a pump
- When the heart has lost 40% or more of the left ventricle through MI the heart will have reduced output (most likely cause)
- The left ventricle does not have the ability to create the force to eject all the blood from the chamber.
What kind of patients are prone to cardiogenic shock?
Pt’s with CHF, Infection, & abnormal heart rhythms
Obstructive Shock
Condition that Obstructs blood flow
What does large clots like Pulmonary Embolism do?
Reduces preload and lead to decreased cardiac output
What does tension pneumothorax and pericardial tamponade do?
- Compress the heart to prevent adequate ventricular filling
- Reduces cardiac output
- Lowers systolic blood pressure
Body response to shock
- Increased heart rate
- Increased Force of ventricular contraction
- Vasoconstriction
- Release of epinephrine and norepinephrine (Fight or flight)
Stages of shock
- Compensatory shock
- Decompensatory shock
- Irreversible shock
Compensatory Shock
- The body is able to maintain normal BP to vital organs.
- Increasing cardiac output sustains BP for a time
Decompensatory Shock or Progressive Shock
- Body’s compensatory systems are failing
- Cells & Tissues are becoming ischemic from lack of profusion
- Blood is beginning to pool
Irreversible Shock
- the body dies, cell/tissue death and organ shut down
- regardless of Rx Pts outcome will be death
S/Sx of compensated shock
- Anxiety
- Normal BP
- Tachycardia (100+)
- Pulse can begin to weaken
- Slight Increase in RR
- Skins May be poor
S/Sx of Decompensated shock
- ALOC to unresponsive
- Hypotension, this shows transition to decompensated
- Marked Tachycardia (130+)
- Pulse quality weak to absent
- Skins white and waxy
Anaphylactic Shock
- Distributive Shock
- Capillaries becomes permeable
- Epinephrine is the Rx
Septic Shock
- Massive Infection releases toxins in the blood
- Distributive Shock
- Vessels dilate
- Capillaries leak
- Possible Fever
Neurogenic Shock
- Distributive Shock
- AKA Vasogenic Shock
- Caused by spinal cord injury
- Loss of sympathetic tone cause vessels to dilate
- No blood loss
- Preload is decreased dropping BP
