bleeding - copy

7/29/2019 Bleeding - Copy

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Gemma Anua

Claridtte Castillo


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Bleeding refers to the loss of blood. It can happen

inside the body (internally) or outside the body

(externally).

Stopping bleeding is essential to the care and survival

of patients in an emergency or disaster situation.

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Internal-inside the body when blood leaks from blood vessels or

organs

Clotting disorders

Rupture of blood

vessels Fractures (injury

to nearby vessels)

Trauma

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External-Outside the body when blood flows through a natural

opening

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Vaginal bleeding

GI tract bleeding

Facial

Skin cut

Amputation


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Assessment:

The patient is assessed for signs and symptoms of shock:

cool, moist, decreasing blood pressure, increasing heart rate,

delayed capillary refill, and decreasing urine volume

Goal:

The goals of emergency management are to control the

bleeding, maintain adequate circulating blood volume for

tissue oxygenation, and prevent shock.

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Initial response: Stop bleeding by chemical means

(hemostasis)

Vascular reaction involves:

Local vasoconstriction

Formation of platelet plug

Coagulation Growth of fibrous tissue into blood clot

permanently closes and seals injured vessel

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Physiological Response to Hemorrhage


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If hemorrhage is severe, mechanisms may fail,

resulting in shocka condition in which

widespread perfusion to the cells is inadequate

to deliver oxygen ad nutrients to support vital

organs and cellular function.

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Stages of Shock

Stage 1: Compensatory increased heart rate

skin is cool and clammy

bowel sounds are hypoactive

urine output decreases

normal BP

mental status changes- confusion


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Stage 2: Progressive

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hypotensive: systolic BP of less than 90 mm Hg or a decrease in

systolic BP of 40 mm Hg

Respirations are rapid and shallow

Crackles are heard over the lung fields.

The heart rate is rapid, sometimes exceeding 150 bpm

lethargy increases

lose consciousness

Urinary output decreases ( less than 30 mL/h)


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Stage 3: IrreversibleThe stage where in the organ damage is so severe that the patient

does not respond to treatment and cannot survive. Despite

treatment, BP remains low. Respiratory system failure preventsadequate oxygenation and ventilation. Multiple organ

dysfunction progressing to complete organ failure has occurred,

and death is imminent.

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Management:

> Fluid replacement which may include isotonic electrolyte

solutions (eg, lactated Ringers, normal saline

> Blood replacement, typed and cross-matched. Packed RBC are

infused when there is massive blood loss.

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Control of External Bleeding

> Identify the area of hemorrhage.

> Direct, firm pressure is applied over the bleeding area or the

involved artery at a site that is proximal to the wound

> Firm pressure dressing is applied

> The injured part is elevated

> If the injured area is an extremity, the extremity isimmobilized.

> A tourniquet is applied to an extremity only as a last resort

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Control of Internal Bleeding

> Packed RBC are administered at a rapid rate, and the patient is

prepared for more definitive treatment (surgery, pharmacologic

therapy).

> The patient is maintained in the supine position and monitored

closely until hemodynamic or circulatory parameters improve, or

until he or she is transported to the operating room or intensive

care unit.

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