1. Circulation and haemorrhage control
MASTER
© BASICS Education March 2019

2. Aims
To understand the place of circulatory assessment in emergency care
To list the causes of circulatory failure
To understand the methods of assessing circulation
To understand the management of circulatory problems

3. Primary Survey <C> Catastrophic haemorrhage control
Safety
<C> Catastrophic haemorrhage control
A Airway with cervical spine control
B Breathing
C Circulation
D Disability
E Exposure

4. Assessment – direct & indirect
Mechanism of injury / type of illness
External signs
e.g. blood loss, allergens
Hidden / other signs
pattern bruising
chest injury
abdomen
pelvic injury / long bone fracture

5. Assessment of circulation
Respiratory rate
Pulse rate and presence of radial pulse
Blood pressure
Skin temperature, colour and sweating
Central capillary refill time
Level of consciousness, agitation, confusion
Discuss the order in which signs may be fou
Does this all fit with the clinical picture?

6. Circulatory failure Results in SHOCK
Inadequate delivery of oxygen and nutrients to the tissues
Inadequate removal of waste products
Leads to cell damage, loss of function and eventually death

7. Causes of shock in trauma
Hypovolaemia
Tension pneumothorax
Cardiac tamponade
Spinal cord injury

8. Blood on the floor and four more
Hypovolaemic shock
External (compressible)
Internal (non-compressible)
Chest
Abdomen & retroperitoneum
Pelvis
Long bones
Blood on the floor and four more

9. Shock - indicators of cause
Tension pneumothorax
Reduced chest movement
Increased percussion note
Unilateral absent breath sounds
Deviated trachea
Cardiac tamponade
Muffled heart sounds
Distended neck veins
Spinal
Warm skin
Slow pulse
Neurological signs

10. Management of shock Oxygen Stop haemorrhage Seek out occult causes
Titrate IV 0.9% saline to maintain a radial pulse (NICE 2019)

11. Management of haemorrhage
Tourniquets (CAT etc)
Ambulance dressing & direct pressure
Consider:
Elevation
Indirect pressure
Packing wound
Haemostatic agents
Tranexamic acid
Do not delay transport

12. Pelvic fracture Aim: control bleeding
If you suspect it – don’t spring it
Mechanism
DO NOT log roll
Splintage applied at level of the greater trochanters
Scoop to Trolley or Vacuum mattress

13. Long bone splintage
Aim: control bleeding, reduce pain & maintain/restore distal perfusion

14. Principles of fluid replacement
Do not allow cannulation to extend on scene time
Cannulate all entrapped patients
Consider IO if difficulty with IV
Titrate fluid replacement to maintain a radial pulse
250ml aliquots
0.9% Saline is fluid of choice
Warm fluids if possible (37 degrees)
2 litre maximum (JRCALC)
Permissive hypotension
Availability of blood – passengers

15. Special cases Children Pregnant women Isolated head injury
Penetrating wound to heart

16. Circulation and Haemorrhage
Questions?

17. Summary Circulatory failure causes cell hypoxia
Blood loss needs to be stopped
Look for internal bleeding and get to definitive care ASAP
Cannulation / IV fluids should not delay time to definitive care
Assess and re-assess

18. Carnival UK Immediate Care Course