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BLEEDING AND SHOCKLESSON 16

© 2011 National Safety Council 16-2

Introduction

• External or internal bleeding common with trauma patients

• Control bleeding quickly to prevent shock

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Trauma Overview

• Frequently results in bleeding and shock, and other injuries

• Trauma care by EMRs includes a range of specific care skills

• The National Trauma Triage Protocol guides where to transport trauma patients

• With significant forces, increased risk for injuries to multiple organs

• Multi-trauma patients at greater risk for developing shock

• Suspect multi-system trauma in any patient subjected to significant external forces

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Anatomy and Physiology Review

• Arteries: carry oxygenated blood to body

• Veins: carry deoxygenated blood back to heart

• Capillaries: exchange nutrients, oxygen and carbon dioxide between blood and tissue cells

• Perfusion: adequate flow of blood to body tissues

• Pulmonary artery: carries deoxygenated blood to lungs

• Pulmonary veins: carry oxygenated blood back to heart

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Bleeding

• Risk of infectious disease from contact with patient’s blood or body fluids

• Follow standard precautions

• Serious injury may prevent effective clotting

• Significant blood loss will cause shock and possibly death

• Bleeding may be external or internal either can result in severe blood loss

• Difficult to estimate how much blood a patient has lost pay close attention to signs and symptoms

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Types of External Bleeding

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Assessing External Bleeding

• Perform standard assessment

• Estimate severity of blood loss, based on patient’s signs and symptoms and your general impression

• Assess patient for shock

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Skill: Controlling External Bleeding

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1. Place sterile dressing on wound

2. Apply direct pressure with gloved hand

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3. After 5 minutes re-evaluate bleeding

4. If needed, put another dressing on top of first and keep applying pressure

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5. If needed, apply pressure bandage

6. If appropriate, treat for shock

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Tourniquet

• Tourniquet use carries high risk of complications

• Should only be used as extreme last resort by rescuers trained in its use

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Internal Bleeding

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Internal Bleeding

• Commonly occurs with blunt trauma

• Suspect based on mechanism of injury

• Internal organs may be injured

• Bleeding is concealed

• Can cause shock and be life-threatening

• Long bone fractures and pelvic fractures may cause serious internal bleeding

• Cannot control internal bleeding

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Signs and Symptoms of Internal Bleeding

• Discolored, tender, swollen or hard skin, rigid abdomen

• Absence of distal pulse

• Increased respiratory and pulse rates

• Pale, cool, moist skin

• Nausea and vomiting

• Thirst

• Mental status changes

• Bleeding from body orifices

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Emergency Care for Internal Bleeding

• Perform standard patient care

• Manage any external bleeding

• Position patient lying on back

• Keep patient from becoming chilled or overheated

• Limit movement of deformed extremity

• Treat for shock

• Administer high-flow oxygen

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Shock

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Shock (Hypoperfusion)

• Results from inadequate delivery of oxygenated blood to body tissues

• May result from any condition involving:

- Failure of heart to provide oxygenated blood (pump failure)

- Abnormal dilation of vessels (pipe failure)

- Blood volume loss (fluid failure)

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Shock

• Progressive and may occur slowly or quickly

• Body attempts to compensate by increasing heart and breathing rates

• With continued reduced perfusion, body can no longer compensate and vital organs begin to fail

• Definitive treatment is critical

• Transport patient for treatment as soon as possible

• Consider possibility of shock in any serious injury or illness

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Causes of Shock

• Severe bleeding

• Severe burns

• Heart failure

• Heart attack

• Head or spinal injuries

• Chest injuries

• Allergic Reactions

• Dehydration

• Electrocution

• Serious infection

• Extreme emotional reactions (temporary and less dangerous)

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Signs and Symptoms of Shock

• Restlessness, anxiety

• Extreme thirst

• Rapid, weak pulse

• Rapid, shallow respirations

• Mental status changes

• Pale, cool, moist skin

• Decreased blood pressure (late sign)

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Emergency Care for Shock

• Perform standard patient care

• Prevent further blood loss

• Put patient in shock position

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1. Position patient on back and raise feet 6-12 inches (unless spinal or pelvic injury)

2. Maintain normal body temperature

Emergency Care for Shock (continued)

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Emergency Care for Shock (continued)

3. Do not give patient anything to eat or drink

4. Provide care for specific injuries

5. Administer high-flow oxygen if available

6. Monitor patient’s breathing and vital signs every 5 minutes