LESSON 16 BLEEDING AND SHOCK

Introduction External or internal bleeding common with trauma patients Control bleeding quickly to prevent shock

Trauma Overview Frequently results in bleeding and shock, and other injuries Trauma care by EMRs includes a range of specific care skills The National Trauma Triage Protocol guides where to transport trauma patients With significant forces, increased risk for injuries to multiple organs Multi-trauma patients at greater risk for developing shock Suspect multi-system trauma in any patient subjected to significant external forces 

Anatomy and Physiology Review Arteries: carry oxygenated blood to body Veins: carry deoxygenated blood back to heart Capillaries: exchange nutrients, oxygen and carbon dioxide between blood and tissue cells Perfusion: adequate flow of blood to body tissues Pulmonary artery: carries deoxygenated blood to lungs Pulmonary veins: carry oxygenated blood back to heart

Bleeding Risk of infectious disease from contact with patient’s blood or body fluids Follow standard precautions Serious injury may prevent effective clotting Significant blood loss will cause shock and possibly death Bleeding may be external or internal  either can result in severe blood loss Difficult to estimate how much blood a patient has lost  pay close attention to signs and symptoms

Types of External Bleeding

Assessing External Bleeding Perform standard assessment Estimate severity of blood loss, based on patient’s signs and symptoms and your general impression Assess patient for shock

Skill: Controlling External Bleeding

Place sterile dressing on wound Apply direct pressure with gloved hand

After 5 minutes re-evaluate bleeding If needed, put another dressing on top of first and keep applying pressure

If needed, apply pressure bandage If appropriate, treat for shock

Tourniquet Tourniquet use carries high risk of complications Should only be used as extreme last resort by rescuers trained in its use

Internal Bleeding

Internal Bleeding Commonly occurs with blunt trauma Suspect based on mechanism of injury Internal organs may be injured Bleeding is concealed Can cause shock and be life-threatening Long bone fractures and pelvic fractures may cause serious internal bleeding Cannot control internal bleeding

Signs and Symptoms of Internal Bleeding Discolored, tender, swollen or hard skin, rigid abdomen Absence of distal pulse Increased respiratory and pulse rates Pale, cool, moist skin Nausea and vomiting Thirst Mental status changes Bleeding from body orifices

Emergency Care for Internal Bleeding Perform standard patient care Manage any external bleeding Position patient lying on back Keep patient from becoming chilled or overheated Limit movement of deformed extremity Treat for shock Administer high-flow oxygen

Shock

Shock (Hypoperfusion) Results from inadequate delivery of oxygenated blood to body tissues May result from any condition involving: Failure of heart to provide oxygenated blood (pump failure) Abnormal dilation of vessels (pipe failure) Blood volume loss (fluid failure)

Shock Progressive and may occur slowly or quickly Body attempts to compensate by increasing heart and breathing rates With continued reduced perfusion, body can no longer compensate and vital organs begin to fail Definitive treatment is critical Transport patient for treatment as soon as possible Consider possibility of shock in any serious injury or illness

Causes of Shock Severe bleeding Severe burns Heart failure Heart attack Head or spinal injuries Chest injuries Allergic Reactions Dehydration Electrocution Serious infection Extreme emotional reactions (temporary and less dangerous)

Signs and Symptoms of Shock Restlessness, anxiety Extreme thirst Rapid, weak pulse Rapid, shallow respirations Mental status changes Pale, cool, moist skin Decreased blood pressure (late sign)

Emergency Care for Shock Perform standard patient care Prevent further blood loss Put patient in shock position

Emergency Care for Shock (continued) Position patient on back and raise feet 6-12 inches (unless spinal or pelvic injury) Maintain normal body temperature

Emergency Care for Shock (continued) Do not give patient anything to eat or drink Provide care for specific injuries Administer high-flow oxygen if available Monitor patient’s breathing and vital signs every 5 minutes