Presentation on theme: "Bleeding and Shock Home. Blood and its function zTransports gases-brings oxygen to the cells and takes carbon dioxide back to the lungs zTransports nutrients."— Presentation transcript:
Bleeding and Shock Home
Blood and its function zTransports gases-brings oxygen to the cells and takes carbon dioxide back to the lungs zTransports nutrients and waste products zProtection-carries antibodies and WBCs zRegulation-transports regulatory hormones, chemicals, etc
Home Blood Vessels zArteries yThick muscular walls yMaintains high pressures yCarries oxygen from lungs zCapillaries yThin walls yLocation of oxygen exchange between blood and cells zVeins yLower pressure than arteries yBring carbon dioxide back to the lungs yHave one way valves
Home Blood Volumes zBlood volumes yAverage of Liters yAverage adult male-7% total body weight yAverage adult female-6.5% total body weight zSerious blood loss yAdult-rapid loss of 1 Liter can be serious yChild-500 cc yInfant-150 cc
Home Types of Shock zHypovolemic - decreased circulating volume caused by bleeding, dehydration, burns, etc zCardiogenic - inadequate pumping due to mechanical problems (MI, valve disease, contusion), electrical problems (irregular heartbeat, dysrhythmia) or congestive heart failure zAnaphylactic -massive histamine response from exposure to antigen causing arterioles and capillaries to dilate and intravascular fluid to leak out
Home Types of Shock (cont..) zSeptic -toxins from severe bacterial infection alters permeability of the vessels causing third spacing zNeurogenic -uncontrolled dilation of the vessels caused by a spinal cord injury zRemember : 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).
Home The Stages of Shock zCompensated yThe body is able to compensate for the decrease in perfusion zUncompensated yCompensation mechanisms are starting to fail zIrreversible yCell, tissue, and organ death begin due to lack of perfusion
Home Compensated Shock zCardiac output and systolic blood pressure are maintained zSigns and Symptoms yMental Status-anxiety, restlessness, combativeness yVital Signs- slightly increased respirations and pulse, slightly delayed cap refill, cool skin
Home Uncompensated Shock zBlood pressure begins to decrease and patient condition worsens zSigns and Symptoms yMental Status-lethargy, confusion, unconsciousness yVital 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
Home Irreversible Shock zCell ischemia and death occur leading to organ death zMay begin from one day up to three weeks after the initial event zIf patient reaches this stage, they will most likely die zSigns and Symptoms yMental Status-unconscious, coma yVital Signs-bradycardia, profound and severe hypotension, dysrhythmias
Home Internal Bleeding zInternal Bleeding xGastrointestinal-could have many causes coffee ground or bright red emesis dark, tarry or bright red stool xTrauma-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 wont cause hypovolemia
Home External Bleeding zArterial- profuse amounts of bright red blood often spurting with the pulse ycan cause hypovolemia if not treated immediately zVenous- steady flow of dark red or maroon colored blood, can be profuse ycan cause hypovolemia if left untreated zCapillary- slow, small amount of reddish blood that oozes from the wound yusually stops on own with minimal blood loss
Home Controlling Bleeding to the Extremity 1. Direct pressure. 2. Elevation. 3. Pressure bandage.
Home If that doesnt work Pressure point. Home
Special Considerations zNosebleed yHave patient sit upright and leaning forward slightly yPinch as much of the nose as possible and hold for 5-10 minutes zVaginal bleeding yDo not hold direct pressure or pack yUse OB pad or towel externally zMouth injuries yDo not hold pressure ySuction as needed zHead injuries yHead wounds tend to bleed profusely yDo not press hard if crepitus is present or area is mushy yIf bleeding from nose or ears related to HI, loosely place gauze externally to absorb blood
Home Treating Hypovolemic Shock zApply high flow oxygen yRed blood cells account for 45% of the the blood and carry 99% of the oxygen zControl external bleeding zApply MAST if indicated yTEMS 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
Home Treating Hypovolemic Shock (cont..) zElevate the lower extremities 8-12 inches yDo not elevate in presence of head, spine, chest, abdominal or lower extremity injuries zMaintain body temperature zProvide rapid transport zAnd of course, IV therapy
Home IV Therapy and Shock zTwo large bore y16-18 gauge yLactated Ringers and/or Normal Saline zBleeding is controlled-external bleeding y250 cc bolus and reassess (BP and lung sounds) yMaintain BP>90 mmHg and/or pulse <120 zSuspected uncontrolled bleeding-internal yIV fluids to maintain systolic BP at mmHg zHead injury yMaintain Systolic BP of 110 if GCS <8 zBurns yCarefully monitor and document IV fluids
Home Minimum Systolic Blood Pressures z<10 kg (22 lbs) = 50 mmHg z10-20 kg (25-44 lbs) = 70 mmHg z20+ kg (44+ lbs) = 90 mmHg
Home In Closing... zPatients with signs and symptoms of shock must be rapidly transported to the hospital for definitive care. zDo not delay transport for IV access!
Home References zMosbys Paramedic Textbook by M. J. Sanders, 1994 yMosby-Year Book Inc., St Louis zBrady Emergency Care 8th edition by M. F. O Keefe et al, 1998 yBrady/Prentice Hall, New Jersey zTidewater EMS Council Inc, Regional Medical Protocols, 2001