2Blood and it’s function Transports gases-brings oxygen to the cells and takes carbon dioxide back to the lungsTransports nutrients and waste productsProtection-carries antibodies and WBC’sRegulation-transports regulatory hormones, chemicals, etc
3Blood Vessels Arteries Capillaries Veins Thick muscular walls Maintains high pressuresCarries oxygen from lungsCapillariesThin wallsLocation of oxygen exchange between blood and cellsVeinsLower pressure than arteriesBring carbon dioxide back to the lungsHave one way valves
4Blood Volumes Blood volumes Serious blood loss Average of 4.5-5 Liters Average adult male-7% total body weightAverage adult female-6.5% total body weightSerious blood lossAdult-rapid loss of 1 Liter can be seriousChild-500 ccInfant-150 cc
5Types of ShockHypovolemic-decreased circulating volume caused by bleeding, dehydration, burns, etcCardiogenic-inadequate pumping due to mechanical problems (MI, valve disease, contusion), electrical problems (irregular heartbeat, dysrhythmia) or congestive heart failureAnaphylactic-massive histamine response from exposure to antigen causing arterioles and capillaries to dilate and intravascular fluid to leak out
6Types of Shock (cont..)Septic-toxins from severe bacterial infection alters permeability of the vessels causing third spacingNeurogenic-uncontrolled dilation of the vessels caused by a spinal cord injuryRemember: 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).
7The Stages of Shock Compensated Uncompensated Irreversible The body is able to “compensate” for the decrease in perfusionUncompensatedCompensation mechanisms are starting to failIrreversibleCell, tissue, and organ death begin due to lack of perfusion
8Compensated ShockCardiac output and systolic blood pressure are maintainedSigns and SymptomsMental Status-anxiety, restlessness, combativenessVital Signs- slightly increased respirations and pulse, slightly delayed cap refill, cool skin
9Uncompensated ShockBlood pressure begins to decrease and patient condition worsensSigns and SymptomsMental Status-lethargy, confusion, unconsciousnessVital 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
10Irreversible ShockCell ischemia and death occur leading to organ deathMay begin from one day up to three weeks after the initial eventIf patient reaches this stage, they will most likely dieSigns and SymptomsMental Status-unconscious, comaVital Signs-bradycardia, profound and severe hypotension, dysrhythmias
11Internal Bleeding Internal Bleeding Gastrointestinal-could have many causescoffee ground or bright red emesisdark, tarry or bright red stoolTrauma-blunt or penetratingbruising over the abdomen or chestswollen and painful extremities2 units of blood can be contained in the lower leg4 units of blood can be contained in the femur areaclosed head injuries won’t cause hypovolemia
12External BleedingArterial-profuse amounts of bright red blood often spurting with the pulsecan cause hypovolemia if not treated immediatelyVenous-steady flow of dark red or maroon colored blood, can be profusecan cause hypovolemia if left untreatedCapillary-slow, small amount of reddish blood that oozes from the woundusually stops on own with minimal blood loss
13Controlling Bleeding to the Extremity 1. Direct pressure.2. Elevation.3. Pressure bandage.
15Special Considerations NosebleedHave patient sit upright and leaning forward slightlyPinch as much of the nose as possible and hold for 5-10 minutesVaginal bleedingDo not hold direct pressure or packUse OB pad or towel externallyMouth injuriesDo not hold pressureSuction as neededHead injuriesHead wounds tend to bleed profuselyDo not press hard if crepitus is present or area is mushyIf bleeding from nose or ears related to HI, loosely place gauze externally to absorb blood
16Treating Hypovolemic Shock Apply high flow oxygenRed blood cells account for 45% of the the blood and carry 99% of the oxygenControl external bleedingApply MAST if indicatedTEMS 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
17Treating Hypovolemic Shock (cont..) Elevate the lower extremities 8-12 inchesDo not elevate in presence of head, spine, chest, abdominal or lower extremity injuriesMaintain body temperatureProvide rapid transportAnd of course, IV therapy
18IV Therapy and Shock Two large bore 16-18 gaugeLactated Ringers and/or Normal SalineBleeding is controlled-external bleeding250 cc bolus and reassess (BP and lung sounds)Maintain BP>90 mmHg and/or pulse <120Suspected uncontrolled bleeding-internalIV fluids to maintain systolic BP at mmHgHead injuryMaintain Systolic BP of 110 if GCS <8BurnsCarefully monitor and document IV fluids
19Minimum Systolic Blood Pressures <10 kg (22 lbs) = 50 mmHg10-20 kg (25-44 lbs) = 70 mmHg20+ kg (44+ lbs) = 90 mmHg
20In 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!
21References Mosby’s Paramedic Textbook by M. J. Sanders, 1994 Mosby-Year Book Inc., St LouisBrady Emergency Care 8th edition by M. F. O’ Keefe et al, 1998Brady/Prentice Hall, New JerseyTidewater EMS Council Inc, Regional Medical Protocols, 2001