First Aid Lecture:Bleeding and Shock

Blood Loss

• Shock: (hypoperfusion)Circulatory failureInadequate 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

External Bleeding

• 1st priority for wound care• Hemorrhage: rapid blood loss in short period

of time• Types:– Arterial– Venous– Capillary

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

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

Capillary Bleeding

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

Clot Formation(avg time frame @10 minutes)

1. Blood Vessel Spasm: Arteries surrounded by muscle tissue Constricts diameter to slow bleeding

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 plateletsb. Serotonin: enhance spasms

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

What to do:

• Scene Safety• Observe Universal Precautions (BSI/PPE)• Four Methods:

1. Direct Pressure2. Elevation3. Pressure Bandage4. Pressure Points

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.

Elevation• For arms/legs• Uses gravity to reduce

blood flow• Continue direct

pressure• Do not elevate

w/fractures

Direct Pressure

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

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

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

Other Pressure Points

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)

Internal Bleeding

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

What to do

• Contact CMS• Monitor CAB• Expect vomiting. Keep victim in recovery left-

side position.• Treat for shock

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

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

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

What to doGoals for treatment of shock:1. Reduce/eliminate cause of shock2. Control bleeding3. Ease pain through position change4. Emotional support5. Improve circulation to brain and heart6. Provide adequate oxygen7. Maintain body temperature

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

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

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

Anaphylactic Shock

Life-threatening allergic reaction• Fast acting: within minutes• Death usually due to swollen airway, causing respiratory

distress/shockCommon causes• Medications (ex. Penicillin)• Food, drugs, food additives (ex. Peanuts, shellfish, nitrites,

MSG)• Insect stings• Plant pollen

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

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)