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First Aid Lecture: Bleeding and Shock

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1 First Aid Lecture: Bleeding and Shock

2 Blood Loss Shock: (hypoperfusion) Adult has 5 – 6 qts of blood (avg)
Circulatory failure Inadequate supply of O2 blood to organs, especially brain and heart Adult has 5 – 6 qts of blood (avg) Can safely donate 1 pt > 1 pt blood loss  shock Child who loses > 1 pt is in danger

3 External Bleeding 1st priority for wound care
Hemorrhage: rapid blood loss in short period of time Types: Arterial Venous Capillary

4 Arterial Bleeding Most serious
Blood is under high pressure, moving quickly. Often will spurt heavy blood loss. Blood is bright red in color speed of blood flow  less likely to clot

5 Venous Bleeding blood flow is slow Easier to stop
(less pressure) on the way back to heart Easier to stop most veins collapse when cut. Deep veins can be as difficult to control

6 Capillary Bleeding Most common Blood oozes from capillaries
Usually clots on its own Easiest to control w/pressure

7 Clot Formation (avg time frame @10 minutes)
Blood Vessel Spasm: Arteries surrounded by muscle tissue Constricts diameter to slow bleeding

8 Clot Formation 2. Platelet Plug Formation: Temporary plug in break
Platelets stick to damaged vessel and to each other - Release chemicals a. ATP: attract other platelets b. Serotonin: enhance spasms

9 Clot Formation 3. Coagulation:
Blood transformed from liquid to gel (biochemical rxns) Enzyme Thrombin Activated in Blood Plasma Catalyzes formation of fibrin strands from protein in blood plasma Fibrin meshes platelets together into stable clot

10 What to do: Observe Universal Precautions (BSI/PPE) Four Methods:
1. Direct Pressure 2. Elevation 3. Pressure Bandage 4. Pressure Points

11 Direct Pressure Expose wound Thick dressing/cloth
Apply direct pressure: Constant strong pressure with fingers/palm Wound will be painful – continue If wounds bleed through, apply 2nd dressing. Do not remove 1st dressing. Do not disturb clot.

12 Elevation For arms/legs Uses gravity to reduce blood flow
Continue direct pressure Do not elevate w/fractures

13 Direct Pressure For injuries that cannot take direct pressure: protruding bone, skull fracture, embedded object make ring pad out of bandage

14 Pressure Bandage holds dressing in place
Frees up 1st aider for other tasks Use roller bandage to wrap around dressings Overlapping turns, wrap above and below site Move distally to proximally Tie off ends directly over dressings Check pulse below bandage to maintain circulation

15 Pressure Points When other three methods fail
Apply direct pressure to main artery supplying: arm (brachial) or leg (femoral) Press artery against bone Only apply pressure points as long as necessary to slow circulation  allows time for clotting Release pressure point as bleeding stops

16 Other Pressure Points

17 Tourniquets only to be used w/severe injuries that may cause a victim to bleed-out Use wide, flat materials (no rope/wire) Do not loosen, once applied

18 Internal Bleeding Look for: Bruises or contusions on skin
Painful, tender, rigid, bruised abdomen Vomiting, coughing blood Blood in stool or black feces

19 What to do Monitor ABC Expect vomiting. Keep victim in recovery left-side position. Treat for shock Contact EMS

20 What is Shock? (Hypoperfusion)
CS fails due to lack of adequate O2 supply to organs, especially brain and heart Brain damaged in 4-6 minutes irreparably Abdomen: 45 – 90 minutes Skin and Muscles: 3 – 6 hours

21 Shock can occur due to: Pump failure Cardiogenic shock Fluid failure
Hypovolemic shock: drop in fluid volume Hemorrhagic shock: drop in blood volume Respiratory shock: respiratory distress prevents insufficient oxygen in blood Pipe failure Neurogenic shock: nervous system damage cause vessel dilation (blood volume insufficient to fill vessels) Septic shock: bacterial infections cause vessels to lose ability to contract Psychogenic shock: emotional distress causes sudden dilation of vessels

22 Signs and Symptoms of Shock
Body attempts to divert blood to vital organs Results in: Cyanosis of skin; cool to touch Excessive perspiration: wet, clammy Rapid or weak pulse (pulse 60 – 100 /min is normal) low bp Irregular respiration, shallow breaths General weakness, restlessness, unresponsive Excessive thirst (** do not give water – can cause vomiting and aspiration) Nausea and/or vomiting Blurred vision Eyes: pupils dilated, sunken eyes, vacant expression

23 What to do Goals for treatment of shock:
Reduce/eliminate cause of shock Control bleeding Ease pain through position change Emotional support Improve circulation to brain and heart Provide adequate oxygen Maintain body temperature

24 Positioning Shock Victim
Flat on back to increase circulation Raise feet 8 – 12 inches to provide blood to heart and brain w/o affecting breathing Cover with blanket to maintain body temperature or shade from sun ** consider injuries: do not move suspected spinal injury victim

25 Special Considerations
Breathing difficulties, chest or eye injuries: Raise head/shoulders to make breathing easier Sit up against something Head injury w/difficulty breathing: position flat, with head raised slightly if no neck injury * If face is red, raise the head; if face is pale, raise the tail “U” victim/stroke: recovery position Pregnant woman: recovery Vomiting: use recovery position

26 Body Temperature 75% body heat lost by radiation and convection from body surface Place blanket between ground and victim Cover with blanket w/o overheating Overheating draws blood to surface and away from vital organs

27 Anaphylactic Shock Life-threatening allergic reaction
Fast acting: within minutes Death usually due to swollen airway, causing respiratory distress/shock Common causes Medications (ex. Penicillin) Food, drugs, food additives (ex. Peanuts, shellfish, nitrites, MSG) Insect stings Plant pollen

28 Symptoms of Anaphylaxis
Warmth Intense itching Hives, flushing, swelling on face or mucous membranes of tongue, mouth, nose Labored breathing, wheezing Victim feels faint, anxious Tightness in chest, throat, dizziness, nausea Increased pulse

29 What to do: Immediate care needed
Rescue breathing or CPR may be necessary if BLS threatened Epinephrine (Epi-pens) Increases cardiac output, constricts vessels Inject into front of thigh for 10 seconds (demo)

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