1. LESSON 16
BLEEDING AND SHOCK

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

3. 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 

4. 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

5. 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

6. Types of External Bleeding

7. 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

8. Skill: Controlling External Bleeding

9. Place sterile dressing on wound
Apply direct pressure with gloved hand

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

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

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

13. Internal Bleeding

14. 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

15. 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

16. 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

17. Shock

18. 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)

20. 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

21. 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)

22. 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)

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

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

25. 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