Chapter 10

 12 pints of blood

 Veins: carry blood from the tissues, organs & systems of the body back to the heart.  Arteries: carry blood away from the heart and to the tissues, organs, & systems of the body.  Capillaries: microscopic blood vessels that connect arteries to veins. Exchange takes place between the bloodstream & body tissues

 There is blood vessel constriction and clotting that occurs

 Arterial bleeding: bright red, oxygenated blood that spurts from an artery.  Venous bleeding: Dark red in color, contains little oxygen, flows steadily.  Capillary bleeding: Bright red and flow is slow as it oozes from a bed of capillaries.

 Direct pressure (use of pressure dressing)  Elevation combined with direct pressure.  Pressure points in the upper arm and groin  Tourniquet (use only as a last resort)

 Always activate EMS for external bleeding except for minor capillary bleeding with no other injuries.

 When using dressings to control external bleeding, continue to apply dressings until the bleeding is controlled.  Do not remove the dressing until bleeding has stopped. It may take 10 – 30 minutes or longer to stop bleeding.

 Rules for bandaging:  Use sterile / clean materials  Cover the entire surface of the wound & the immediate area surrounding the wound.  Once applied, it must remain in place. Add new dressings on top of blood-soaked dressings.

 Rules for bandaging:  Do not bandage:  Too Tightly  Too loosely  Do not leave loose ends  Do not cover fingers & toes unless they are injured  Wrap bandage around the limb starting at its far (distal) end and working toward its origin or near (proximal) end.

 Wounds that have penetrated the skull  Blood or clear fluids draining from ears &/or nose  Pt. vomits or coughs up blood (coffee grounds)  Bruises on neck, chest, abdomen  Abdominal tenderness, rigidity, or distention  Bleeding from rectum or vagina  Possible fractures

 If bleeding is not controlled, the person can go into shock.  Shock is the reaction of the body to the failure of the circulatory system to provide enough blood to the vital organs.

 Oxygen & carbon dioxide are exchanged, nutrients and waste are exchanged, and fluid and salt balance must be maintained between the blood and the tissues.  When this cannot take place, hypoperfusion (lack of adequate perfusion), develops & patient goes into shock

 Hypovolemic shock: caused by blood loss or by the loss of plasma as in cases of burns  Hemorrhagic shock: caused when the body loses a significant amount of blood from the circulatory system.  Cardiogenic shock: heart shock, caused by the heart failing to pump enough blood to all parts of the body.

 Neurogenic shock: nerve shock, caused when something goes wrong with the nervous system (spinal injury) & there is a failure to control the tone of blood vessels  Anaphylactic shock: allergy shock, a life- threatening reaction of the body causes by something to which the pt. is extremely allergic.

 Psychogenic shock: fainting. Occurs when some factor, e.g. fear, causes the nervous system to react & rapidly dilate the blood vessels.  Septic shock: caused by infection. Poisons are released that cause the blood vessels to dilate.

 Restlessness or combativeness  Profuse external bleeding  Vomiting  Shaking & trembling  Altered mental status  Breathing: shallow & rapid  Pulse: rapid & weak  Skin: pale, cool, & moist  Eyes: lackluster (sluggish & dilated)

 Activate EMS, perform scene size-up, & BSI  Perform initial assessment  Control external bleeding & administer oxygen  Assist the pt. in lying down.  Provide care for shock.  Calm & reassure pt., & maintain his normal body temperature. Take care not overheat pt.  Place at least 1 blanket under & 1 over the pt.

 Properly position the pt. for open airway and be alert of vomiting.  Do not give the patient anything by mouth.  Monitor pt’s vital signs.

 Closed Wounds  Bruises or contusion  Open Wounds  Abrasion, lacerations, punctures, avulsions, & crush injuries.

 BSI,  Do NOT remove an impaled object  Expose the wound  Control bleeding & administer oxygen  Attempt to stabilize i.o. using bulky dressing  Provide care for shock  Keep pt. at rest

 BSI  Clean surface of wound  Replace avulsed skin  Control bleeding  Care for shock  Preserve amputated parts

 BSI  Do not replace organs  Cover with plastic & moist dressing  Treat pt. for shock  Give pt. nothing by mouth

 BSI  Do not clear foreign matter or dirt from wound  Control bleeding w/ dressing held w/ gentle pressure  Use roller bandage or gauze to hold dressing in place  If no signs of skull fracture or spinal injuries, you may position pt. so that head & shoulders are elevated.

 BSI  Correct Breathing Problems  Control Bleeding by direct pressure  Careful not to press too hard  Apply a dressing & bandage

 BSI  Look into mouth & probe to see if object has passed through the cheek wall.  If find penetration, pull or safely push object out of the cheek wall  Turn pt. so that blood will drain from the mouth  If object is removed, place the dressing material b/w the wound & pt’s teeth.  Dress & bandage the outside of the wound  Provide care for shock

 BSI  Chemical Burns:  Hold face under running water w/ eyes open  Flush from a medial to a lateral direction  Continue least 20 minutes  Light Burns:  Cover eyes with dark patches  Heat Burns:  Cover eyes with loose, moist dressing

 Responsive Patient  BSI  Maintain opening airway  Pt. sit up and lean slightly forward  Pt. will pinch the nostrils  Unresponsive Patient  Pt. placed on side  Pinch nose

 For cut lips: use rolled/folded dressing. Place b/t pt. lip & gums.  For avulsed lips: Apply pressure bandage to site of injury. Save avulsed part in plastic or a sterile/clean dressing.  For cuts to the internal cheek: Position dressing b/t pt. cheek & gums. Hold dressing in place w/ hand. Leave 3-4 inches outside of mouth for quick removal.

 BSI  Immediately apply direct pressure, use palm  Try to control w/ pressure dressing  Place pt. on left side  Provide care for shock & administer oxygen

 Have all dressing materials ready, take BSI, seal wound with palm of gloved hand  Apply occlusive dressings under your hand while pt. exhales and hold it in place.  Taping three sides: to allow air to escape  Taping four sides: tape last side on the exhale  Provide oxygen and care for shock

 Burns can occur due to chemicals, electricity, heat, lighting, light, and radiation  3 types of classifications  Superficial  Partial-thickness  Full-thickness

 Superficial: top layer of skin, aka: 1 st degree burn; common types is sunburn  Partial-thickness: involves top 2 layers of skin. Aka: 2nd-degree burn; intense pain, blisters, white to red skin.  Full-thickness: involves, muscle, bone, or organs. 3 rd degree burns; dry & leathery or white, dark brown, or charred. Nerve damage

 System used to estimate the amount of skin surface burned. The body is divided into 12 regions, 11 of which are estimated as 9% each and one at 1% (the genitals).  Head & neck, chest, abdomen, each arm, the front of each leg, the back of each leg, the upper back, and the lower back and buttocks:  Total of 99% for an adult

 Burns on the face, mouth, nose, throat, airway, hands, groin, buttocks, thighs, major joints, encircling body parts, or greater than 15% of the person’s body are deemed serious.

 BSI  Stop the burning process immediately  Activate EMS  Flush minor burns with cool water, several minutes. NO FLUSHING FOR SERIOUS BURNS  Remove smoldering clothing & jewelry. Do NOT remove melted clothing.  Continually monitor airway.

 Prevent further contamination. Keep burns covered with dressing.  Cover the burn with dry, clean dressing  Give special care to the eyes. Place moisten pads over eyes.  Give special care to fingers & toes. Place clean pad b/t toes & fingers before completing dressing.  Provide oxygen and care for shock.