4 Arteries Carry blood away from the heart Usually carries oxygenated bloodHas thick muscular wallsCan change its diameterTo selectively distribute 5 – 6 liters of blood to parts of the body that really require about 9 litersUnder relatively high pressureEventually, become Arterioles
5 Veins Carry blood to the heart Usually carries deoxygenated blood, CO2 and other waste productsLarge veins (e.g. in legs) can hold large volumes of bloodContains one way valvesTo prevent backflowUnder very small pressureEventually become Venules
6 Capillaries Where gas, nutrient and waste exchange occurs One cell thickTo facilitate the diffusion of gasses, nutrients and waste products
9 Blood Approximately 5-6 liters in the adult body Composed of: Red Blood CellsErythrocytesCarry Oxygen “on” HemoglobinWhite Blood CellsLeukocytesFight InfectionPlateletsAssist in clottingPlasmaMostly Water
13 Functions of Blood -- 2 Excretion Protection “Regulation” Transport waste to waste eliminating organsProtectionWhite Blood Cells fight infection“Regulation”
14 Regulation of Bodily Functions HormonesFrom one place in the body to anotherE.g. Adrenalin in a “flight/fright” situationChemicalsE.g. MedicationsTemperatureE.g. On a hot day, blood vessels dilate near the skins surface Allows the blood to cools and circulate cooler blood to the rest of the body
15 Important Terms! Perfusion Shock/Hypoperfusion Hemorrhage Adequate delivery of O2 and nutrients to body tissuesShock/HypoperfusionInadequate tissue perfusionHemorrhageBleeding of any kind from any place in the body
23 External Bleeding -- Treatment Other TechniquesTourniquetA last resort!Never release in the fieldMark the time applied on foreheadE.g. “TK/9:00PM”If it involves a fracture, apply a “splint”MAST/PASG
25 MAST/PASG Medical AntiShock Trousers Pneumatic AntiShock Garment Indications:Shock with Systolic BP < 50Pelvic injury with S/S of shockContraindications:Absolute ContraindicationPatient in Acute Pulmonary EdemaRelative ContraindicationsPregnancy (inflate legs only)Impaled objectOpen Chest WoundNEVER DEFLATE IN THE FIELD!
26 Internal Bleeding Not outwardly visible Severity YOU CAN’T FIX IT! BIG PROBLEM!SeverityVariesLarge blood losses in short time periodsCan occur with fractures of large bonesE.g. Pelvis, femurYOU CAN’T FIX IT!
28 Recognition of internal bleeds Often, it’s only recognized by signs & symptomsMechanism of Injury (“MOI”)Bruising/pain/swelling over affected areasBody orifice bleedingTender/rigid/distended abdomenCoffee grounds or BRB “emesis”BRB per rectumS/S of shock
32 Cardiogenic ShockCaused by the heart’s inability to pump sufficiently to meet body needsOften follows a “large” MIWithin hours or daysPoor outcomes – despite the best treatment
33 Neurogenic Shock Caused by an injured spinal cord Body loses the ability to “constrict” blood vesselsAllows BP to dropLoss of “communication” with nerves controlling skin conditionHallmark: Warm, dry skin in a patient with S/S of shock
34 Septic Shock Caused by a generalized body infection Usually, follows some “local” infectionE.g. pneumonia, UTI in elderlyBody loses the ability to “constrict” blood vesselsAllows BP to drop
35 Severity of shockIf undetected and/or untreated, can QUICKLY lead to organ failure and death!
36 Stages of Shock Compensated HR and RR are elevated Trying to maintain perfusionNormal BP is maintainedCool, pale and clammy skinBody is fighting to “compensate”
37 Stages of Shock Decompensated The hallmark: Falling BP Body can not maintain perfusionBody is losing the fight
38 Stages of Shock Irreversible Cell damage and organ death is occurring Body has lost the fightDeath almost a certainty
39 S/S of Shock Altered Mental Status (“AMS”) Agitation (an “early sign”)Lethargy UnconsciousnessCool, pale, sweaty (“diaphoretic”) skinTachycardiaAn early signBody tries to maintain cardiac output
40 More S/S of Shock Tachypnea Poor/delayed “capillary refill” Early signBody tries to maintain O2 saturationPoor/delayed “capillary refill”HypotensionA LATE SIGN!DO NOT RELY ON IT AS AN INDICATOR OF SHOCK!
41 Treatment Priorities Rapid transport! “Golden Hour” From incident to operating roomPatient needs a “date with a surgeon”!Platinum ten minutesOn scene timeAdditional stabilization and treatment during transport to the hospital
42 Shock -- Treatments ABC’s High concentration O2 Close attention to airway maintenance especially in patients losing consciousness and in facial/oral trauma patientsHigh concentration O2“Shock position” (Trendelenberg)PASG/MAST if indicated
43 Shock -- Treatments Rapid transport! Splint and further assessment and treatment enroutePrevent the loss of body heatShock patients lose control of temperatureConsider ALSCall for ALS ASAP!
44 Shock -- Treatments Reassure patient! Continuous reassessment “PFA” More than just being nice!Medical reasonsContinuous reassessmentPatients can rapidly deteriorateBe prepared to treat