Presentation on theme: "1 Bleeding and Shock Pipes, pump, and fluid…really, it’s that simple!"— Presentation transcript:
1 Bleeding and Shock Pipes, pump, and fluid…really, it’s that simple!
2 The Second Rule of EMS…. …eventually the bleeding will stop!
3 Cardiovascular System Heart Arteries Veins Capillaries Blood
4 Cardiovascular System Transports O2 and fuel to the cells, tissues, and organs. Removes CO2 and wastes from the cells for elimination from the body. Must be able to maintain sufficient flow through the capillary beds to meet the cell’s O2 and fuel needs
5 Bleeding Internal External
6 Internal Bleeding Trauma Clotting disorders Rupture of blood vessels Fractures (injury to nearby vessels) Can result in rapid progression to hypovolemic shock & death!
7 Internal Bleeding S/S Think about MOI or NOI! Anxiety, restlessness, irritability Pale, diaphoretic skin Sustained tachycardia Hypotension Unstable vitals signs (postural changes)
8 Internal Bleeding S/S Vomiting bright red blood or coffee ground material Bleeding form any body orifice Dark, tarry stools (melena) Tender, rigid, or distended abdomen Pain, discoloration, swelling, tenderness at injury site
9 Managing Internal Bleeding ABC’s High concentration oxygen Assist ventilations Control external bleeding Stabilize fractures RICE Transport rapidly to appropriate facility
15 Tourniquets Final resort when all else fails Used for amputations 3-4” wide (blood pressure cuffs) Write “TK” and time of application on forehead of patient Notify other personnel Once applied, DO NOT REMOVE
16 Epistaxis (Nosebleed) Causes –Fractured skull –Facial injuries –Sinusitis, other URIs –High BP –Clotting disorders –Digital insertion (nose picking)
17 Management of Epistaxis Sit up, lean forward Pinch nostrils together Keep in sitting position Keep quiet Apply ice over nose (15 min) Can result in life-threatening blood loss!
18 SHOCK Inadequate perfusion(blood flow) leading to inadequate oxygen delivery to tissues
19 Physiology Cell is the basic unit of life Cells get energy needed to stay alive by reacting oxygen with fuel (usually glucose) No oxygen, no energy No energy, no life
20 Perfusion Failure Pump Failure (heart) Pipe Failure (vessels) Loss of Volume (blood)
27 Psychogenic Shock Simple fainting (syncope) Caused by stress, fright, pain Heart rate slows, vessels dilate Brain becomes hypo-perfused Loss of consciousness occurs Patient usually recovers by self
28 Psychogenic Shock S/S Anxiety, restlessness, irritability Rapid pulse Normal or low blood pressure Hyperventialtion
29 Hypovolemic Shock Loss of volume Causes: –Blood loss from trauma –Plasma loss from burns –Fluid/electrolyte loss from vomiting, diarrhea, sweating, increased urine output, increase respiratory loss –“Third space” fluid shifts
30 Hypovolemic Shock S/S Anxiety, restlessness, irritability Rapid, weak pulse Change in mental status Signs of inadequate perfussion (diaphoresis, cyanosis, pale/clammy skin) Increased respiratory rate
31 Distributive Shock: Septic Results from body’s response to bacteria in bloodstream Vessels dilate, become “leaky”
37 Cardiogenic Shock Pump failure Heart’s output depends on –How often it beats (heart rate) –How hard it beats (contractility) Rate or contractility problems cause pump failure
38 Cardiogenic Shock S/S Causes –Acute myocardial infarction –Very low heart rates (bradycardias) –Very high heart rates (tachycardias) Why would a high heart rate caused decreased output? Hint: Think about when the heart fills.
40 Respiratory Shock Failure of respiratory system to supply oxygen to or remove CO2 from the alveoli Airway obstruction Flail chest, SCW Pneumothorax Respiratory muscle paralysis
41 Respiratory Shock S/S Anxiety, restlessness, irritability Rapid, weak pulse Hypotension Change in mental status Signs of inadequate perfussion Increased respiratory rate Bronchoconstrcition (wheezes)
42 Neurogenic Shock Spinal cord injuries that result in the interruption of communication pathways between CNS and rest of body Vessels below the injury site dilate leading to decreased vascular resistance
44 Treatment ABC’s Apply O2, assist ventilations as needed Keep patient in position of comfort Control bleeding, stabilize fractures Prevent loss of body heat Assist with medications Nothing by mouth Calm and reassure
45 Treatment Elevate lower extremities 8 to 12 inches in hypovolemic shock Do NOT elevate the lower extremities in cardiogenic shock Why the difference in management?
46 Shock is NOT the same as low pressure A falling blood pressure is a LATE sign of shock!