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Bleeding and Shock Home.

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Presentation on theme: "Bleeding and Shock Home."— Presentation transcript:

1 Bleeding and Shock Home

2 Blood and it’s function
Transports gases-brings oxygen to the cells and takes carbon dioxide back to the lungs Transports nutrients and waste products Protection-carries antibodies and WBC’s Regulation-transports regulatory hormones, chemicals, etc

3 Blood Vessels Arteries Capillaries Veins Thick muscular walls
Maintains high pressures Carries oxygen from lungs Capillaries Thin walls Location of oxygen exchange between blood and cells Veins Lower pressure than arteries Bring carbon dioxide back to the lungs Have one way valves

4 Blood Volumes Blood volumes Serious blood loss Average of 4.5-5 Liters
Average adult male-7% total body weight Average adult female-6.5% total body weight Serious blood loss Adult-rapid loss of 1 Liter can be serious Child-500 cc Infant-150 cc

5 Types of Shock Hypovolemic-decreased circulating volume caused by bleeding, dehydration, burns, etc Cardiogenic-inadequate pumping due to mechanical problems (MI, valve disease, contusion), electrical problems (irregular heartbeat, dysrhythmia) or congestive heart failure Anaphylactic-massive histamine response from exposure to antigen causing arterioles and capillaries to dilate and intravascular fluid to leak out

6 Types of Shock (cont..) Septic-toxins from severe bacterial infection alters permeability of the vessels causing third spacing Neurogenic-uncontrolled dilation of the vessels caused by a spinal cord injury Remember: Shock can be related to a leaky tank (hypovolemic), a bad pump (cardiogenic), a change in the piping (neurogenic), or additives that can affect many things (septic or anaphylaxis).

7 The Stages of Shock Compensated Uncompensated Irreversible
The body is able to “compensate” for the decrease in perfusion Uncompensated Compensation mechanisms are starting to fail Irreversible Cell, tissue, and organ death begin due to lack of perfusion

8 Compensated Shock Cardiac output and systolic blood pressure are maintained Signs and Symptoms Mental Status-anxiety, restlessness, combativeness Vital Signs- slightly increased respirations and pulse, slightly delayed cap refill, cool skin

9 Uncompensated Shock Blood pressure begins to decrease and patient condition worsens Signs and Symptoms Mental Status-lethargy, confusion, unconsciousness Vital Signs-decreased blood pressure, increased heart rate and respirations, delayed cap refill, pale, cold and clammy skin, narrowing pulse pressures, cyanosis, weak and thready pulse

10 Irreversible Shock Cell ischemia and death occur leading to organ death May begin from one day up to three weeks after the initial event If patient reaches this stage, they will most likely die Signs and Symptoms Mental Status-unconscious, coma Vital Signs-bradycardia, profound and severe hypotension, dysrhythmias

11 Internal Bleeding Internal Bleeding
Gastrointestinal-could have many causes coffee ground or bright red emesis dark, tarry or bright red stool Trauma-blunt or penetrating bruising over the abdomen or chest swollen and painful extremities 2 units of blood can be contained in the lower leg 4 units of blood can be contained in the femur area closed head injuries won’t cause hypovolemia

12 External Bleeding Arterial-profuse amounts of bright red blood often spurting with the pulse can cause hypovolemia if not treated immediately Venous-steady flow of dark red or maroon colored blood, can be profuse can cause hypovolemia if left untreated Capillary-slow, small amount of reddish blood that oozes from the wound usually stops on own with minimal blood loss

13 Controlling Bleeding to the Extremity
1. Direct pressure. 2. Elevation. 3. Pressure bandage.

14 If that doesn’t work... 4. Pressure point. Home

15 Special Considerations
Nosebleed Have patient sit upright and leaning forward slightly Pinch as much of the nose as possible and hold for 5-10 minutes Vaginal bleeding Do not hold direct pressure or pack Use OB pad or towel externally Mouth injuries Do not hold pressure Suction as needed Head injuries Head wounds tend to bleed profusely Do not press hard if crepitus is present or area is mushy If bleeding from nose or ears related to HI, loosely place gauze externally to absorb blood

16 Treating Hypovolemic Shock
Apply high flow oxygen Red blood cells account for 45% of the the blood and carry 99% of the oxygen Control external bleeding Apply MAST if indicated TEMS protocol-MAST can be inflated in the presence of a pelvic fracture and/or bilateral femur fractures with signs of shock (including a systolic BP less than 80 mmHg) at all levels

17 Treating Hypovolemic Shock (cont..)
Elevate the lower extremities 8-12 inches Do not elevate in presence of head, spine, chest, abdominal or lower extremity injuries Maintain body temperature Provide rapid transport And of course, IV therapy

18 IV Therapy and Shock Two large bore
16-18 gauge Lactated Ringers and/or Normal Saline Bleeding is controlled-external bleeding 250 cc bolus and reassess (BP and lung sounds) Maintain BP>90 mmHg and/or pulse <120 Suspected uncontrolled bleeding-internal IV fluids to maintain systolic BP at mmHg Head injury Maintain Systolic BP of 110 if GCS <8 Burns Carefully monitor and document IV fluids

19 Minimum Systolic Blood Pressures
<10 kg (22 lbs) = 50 mmHg 10-20 kg (25-44 lbs) = 70 mmHg 20+ kg (44+ lbs) = 90 mmHg

20 In Closing... Patients with signs and symptoms of shock must be rapidly transported to the hospital for definitive care. Do not delay transport for IV access!

21 References Mosby’s Paramedic Textbook by M. J. Sanders, 1994
Mosby-Year Book Inc., St Louis Brady Emergency Care 8th edition by M. F. O’ Keefe et al, 1998 Brady/Prentice Hall, New Jersey Tidewater EMS Council Inc, Regional Medical Protocols, 2001

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