Chapter 11 Bleeding Shock

Bleeding & Shock Some Facts Trauma is the leading cause of death for persons aged 1 to 44. A vital part of trauma care is recognizing and treating signs and symptoms of bleeding and shock Profuse bleeding and shock are life-threatening problems requiring immediate attention

Bleeding External / Internal External Bleeding Use Body Substance Isolation (BSI) precautions Always wash hands following contact Waterless cleans

Signs & Symptoms Arterial Rapid, spurting, profuse, bright red (under pressure) Clot formation is difficult Difficult to control As blood pressure drops, spurting will also drop

Signs & Symptoms Venous Usually steady flow (under lower pressure), can be heavy Dark red Debris and air can be sucked into wound Clotting rate is dependent on size of area or vessels involved

Signs & Symptoms Capillary Slow (oozing) Red but not as bright as arterial bleeding Good chance of infection Clots easily

Blood Volumes & Serious Losses

Blood Loss Severe or uncontrolled blood loss will lead to Shock (Hypoperfusion) Most Bleeding will stop by itself within 6-10 minutes (dependent on area of involvement and vessels involved)

Care (Control) of External Bleeding External bleeding usually easy to control Complete the initial assessment including the ABC’s before focusing on bleeding Follow BSI precautions Cover wound with a clean dressing to reduce risk of infection Follow basic steps for controlling bleeding If bleeding or CSF from ears do not stop flow

Care (Control) of External Bleeding Direct pressure Controls most bleeding Elevate injured area (if no fractures are present) Pressure Bandage Arterial pressure points (Femoral/Brachial) Summon EMS if bleeding cannot be controlled or if pressure points must be used

External Bleeding Nosebleeds (Epistaxis) Care for a Nosebleed Sitting position leaning slightly forward Apply direct pressure (may take 15 min.) Pinching nose or rolled gauze under nose Cold compresses Do not Pack nose Blow nose or Tilt head back

Internal Bleeding May not be obvious, may take time for signs & symptoms to appear Leading causes Blunt trauma Penetrating injuries Suspect internal bleeding in any serious injury

Signs & Symptoms Bruising (Contusion) contusions over abdomen or chest the size of your fist - assume a 10% blood volume loss Painful, swollen, deformed extremities Swollen, painful, tender or rigid abdomen rebound tenderness Bleeding from mouth, ears, nose

Signs Symptoms Vomiting coffee grounds vomitus or bright red blood Dark tarry stools or passing bright red blood in stools Abnormal rectal or vaginal bleeding Anxiety & restlessness Increased respiratory rate

Signs & Symptoms Cool, moist skin Pale or ashen skin leading to cyanosis Excessive thirst Decreasing level of consciousness Any additional signs or symptoms of shock

Care of Internal Bleeding Care depends on the severity and site of the injury For minor internal bleeding (bruising) Apply cold compresses If internal bleeding appears to be serious Activate EMS Complete initial assessment including the ABC’s Treat for shock

Shock (Hypoperfusion) Life-threatening potential Inevitable result of any serious injury (illness) Results from the body’s inability to maintain adequate perfusion Signs & symptoms may be present immediately, become evident during the physical exam or an ongoing assessment

Shock Conditions required for normal flow of oxygenated blood to the tissues Heart functioning properly Adequate blood volume Intact functional vessels

Classifications Cardiogenic Shock - pump failure Hypovolemic - Hemorrhagic Non-hemorrhagic Metabolic Septic Neurogenic Psychogenic Anaphylaxic

Signs (In order of appearance) Altered Mental Status Anxiety, restlessness, combativeness Pale, Cool, Clammy Skin Develops into cyanosis (lips & nailbeds) Infants & children may begin to exhibit capillary refill times greater than 2 seconds Nausea & Vomiting

Signs (In order of appearance) Vital Sign Changes Pulse Increases, becomes weak & thready Respirations Increase becoming more shallow & labored Blood Pressure One of last signs to change Dilated pupils

Care for Shock Perform initial assessment If no immediate life-threatening problems perform a physical exam and SAMPLE history Activate EMS when necessary Control any external bleeding

Care for Shock Position patient Supine with legs elevated unless Respiratory difficulty - upright Chest pain - upright or semi-recumbent Maintain body temperature Nothing by Mouth (food or drink) Administer oxygen if available