chapter 11 bleeding shock. bleeding & shock some facts –trauma is the leading cause of death...
TRANSCRIPT
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Chapter 11
Bleeding
Shock
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Bleeding & Shock
Some Facts– Trauma is the leading cause of death for
persons aged 1 to 44.– A vital part of trauma care is recognizing
and treating signs and symptoms of bleeding and shock
– Profuse bleeding and shock are life-threatening problems requiring immediate attention
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Bleeding
External / Internal
External Bleeding– Use Body Substance Isolation (BSI)
precautions– Always wash hands following contact
Waterless cleans
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Signs & Symptoms
Arterial– Rapid, spurting, profuse, bright red (under
pressure)– Clot formation is difficult– Difficult to control– As blood pressure drops, spurting will also
drop
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Signs & Symptoms
Venous– Usually steady flow (under lower pressure),
can be heavy– Dark red– Debris and air can be sucked into
wound– Clotting rate is dependent on size of area
or vessels involved
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Signs & Symptoms
Capillary– Slow (oozing)– Red but not as bright as arterial bleeding– Good chance of infection– Clots easily
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Blood Volumes & Serious Losses
Age Group
Average Blood Volume
Serious Volume Loss
Adult 5 - 6 liters 1 liter
Adolescent 2 – 3 ½ liters ¾ liter
Child 1 ½ - 2 liters ½ liter
Infant 500-600 ml 50-100 cc
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Blood Loss
Severe or uncontrolled blood loss will lead to Shock (Hypoperfusion)
Most Bleeding will stop by itself within 6-10 minutes (dependent on area of involvement and vessels involved)
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Care (Control) of External Bleeding
External bleeding usually easy to control Complete the initial assessment including
the ABC’s before focusing on bleeding Follow BSI precautions Cover wound with a clean dressing to
reduce risk of infection Follow basic steps for controlling bleeding
– If bleeding or CSF from ears do not stop flow
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Care (Control) of External Bleeding
Direct pressure– Controls most bleeding
Elevate injured area (if no fractures are present)
Pressure Bandage Arterial pressure points (Femoral/Brachial)
– Summon EMS if bleeding cannot be controlled or if pressure points must be used
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External BleedingNosebleeds (Epistaxis)
Care for a Nosebleed– Sitting position leaning slightly forward– Apply direct pressure (may take 15 min.)
Pinching nose or rolled gauze under noseCold compresses
– Do notPack noseBlow nose orTilt head back
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Internal Bleeding
May not be obvious, may take time for signs & symptoms to appear
Leading causes– Blunt trauma– Penetrating injuries
Suspect internal bleeding in any serious injury
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Signs & Symptoms
Bruising (Contusion)– contusions over abdomen or chest the size
of your fist - assume a 10% blood volume loss
Painful, swollen, deformed extremities Swollen, painful, tender or rigid abdomen
– rebound tenderness Bleeding from mouth, ears, nose
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Signs Symptoms
Vomiting coffee grounds vomitus or bright red blood
Dark tarry stools or passing bright red blood in stools
Abnormal rectal or vaginal bleeding Anxiety & restlessness Increased respiratory rate
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Signs & Symptoms
Cool, moist skin Pale or ashen skin leading to cyanosis Excessive thirst Decreasing level of consciousness Any additional signs or symptoms of
shock
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Care of Internal Bleeding
Care depends on the severity and site of the injury
For minor internal bleeding (bruising)– Apply cold compresses
If internal bleeding appears to be serious– Activate EMS– Complete initial assessment including the
ABC’s– Treat for shock
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Shock (Hypoperfusion)
Shock– Life-threatening potential– Inevitable result of any serious injury
(illness)– Results from the body’s inability to
maintain adequate perfusion– Signs & symptoms may be present
immediately, become evident during the physical exam or an ongoing assessment
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Shock
Conditions required for normal flow of oxygenated blood to the tissues– Heart functioning properly– Adequate blood volume– Intact functional vessels
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Classifications
Cardiogenic Shock - pump failure Hypovolemic -
– Hemorrhagic– Non-hemorrhagic
MetabolicSeptic
Neurogenic Psychogenic Anaphylaxic
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Signs (In order of appearance)
Altered Mental Status– Anxiety, restlessness, combativeness
Pale, Cool, Clammy Skin– Develops into cyanosis (lips & nailbeds)– Infants & children may begin to exhibit
capillary refill times greater than 2 seconds Nausea & Vomiting
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Signs(In order of appearance)
Vital Sign Changes– Pulse
Increases, becomes weak & thready
– RespirationsIncrease becoming more shallow & labored
– Blood PressureOne of last signs to change
– Dilated pupils
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Care for Shock
Perform initial assessment– If no immediate life-threatening problems
perform a physical exam and SAMPLE history
Activate EMS when necessary Control any external bleeding
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Care for Shock
Position patient– Supine with legs elevated unless– Respiratory difficulty - upright– Chest pain - upright or semi-recumbent
Maintain body temperature Nothing by Mouth (food or drink) Administer oxygen if available