Bleeding and Shock CHAPTER 25 1

Review of the Cardiovascular System Vessels Blood Heart 1

Arterial System Carotid artery Brachial artery Radial artery Femoral artery 1

The average adult has about 6 liters of blood in the body. 1

Venous System External jugular Inferior vena cava Femoral vein Great saphenous 1

Perfusion: The process of delivering blood with oxygen and nutrients to the cells, and removing wastes. The skin condition is a good indicator of perfusion. 1

The Perfusion Process Artery Vein O2 and nutrients Waste products Cell 1

Shock 1

Any alteration in the body’s ability to deliver oxygenated blood to every organ is detrimental. 1

Hypoperfusion: The state that results when cells are not perfused adequately; oxygen and nutrients are not delivered and there is an inadequate removal of metabolic waste products. Widespread hypoperfusion results in shock. 1

General Causes of Shock Pump failure Decrease in the heart’s ability to pump blood Container failure Circulatory system larger than the volume available Volume failure Decrease in available fluid volume 1

Hypovolemic shock: Hypoperfusion that results from inadequate volume. Hemorrhagic shock is hypoperfusion caused only by bleeding. 1

Causes of Hypovolemic Shock Dehydration Excessive vomiting Excessive diarrhea Blood loss Internal blood loss External blood loss 1

Assessing Shock 1

Subtle mental status changes, such as restlessness and anxiety, are the earliest signs of shock. 1

Severe blood loss leads to vasoconstriction of the blood vessels... …and blood is diverted to the vital organs. 1

Assess capillary refill under normal room temperature conditions. 10

DON’T WAIT FOR THE BP TO DROP BEFORE TREATING! Decreased blood pressure is a late sign of shock. DON’T WAIT FOR THE BP TO DROP BEFORE TREATING! 1

Infants and children can maintain a normal BP until they have lost over half their blood volume! 1

Signs and Symptoms of Shock Restlessness, anxiety, combativeness Increased heart rate Decreased CRT (infants & children only) Pale, cool, clammy skin Rapid and shallow breathing Thirst 1

Signs and Symptoms of Shock continued Nausea, vomiting Decreasing level of consciousness Cyanotic skin color Low or decreasing blood pressure Sluggish pupils 1

Emergency Care for Shock 1

Treatment of Shock Appropriate BSI precautions Maintain an open airway Gloves, eye wear, mask, and gown Maintain an open airway Provide 100% oxygen Control bleeding as much as possible Consider use of PASG (according to local protocol) 1

Treatment of Shock continued Elevate patient’s legs Cover with blanket Splint suspected extremity fractures if time permits Transport immediately 1

Raising the legs will maximize delivery of oxygenated blood to the brain. 10

The best treatment for shock is rapid transportation. 10