January 2013 Silver Cross EMS EMD CE Shock & Bleeding January 2013 Silver Cross EMS EMD CE

The Problem Damage to internal soft tissues and organs can cause life-threatening problems. Internal bleeding results in shock. Shock is a state of collapse of the cardio-vascular system that results in inadequate delivery of blood and oxygen to the organs. Poor tissue perfusion and oxygen/carbon dioxide exchange. More trauma patients die from shock than from any other condition.

The Components The Heart (pump) The Blood (fluid) The Vessels (pipes) Problems with any one of these can cause shock

Parts and Function of the Circulatory System The pump The heart functions as the body’s pump. The heart consists of four separate chambers. The two upper chambers on the top of the heart are the atrias. The two lower chambers on the bottom of the heart are the ventricles.

Parts and Function of the Circulatory System

Blood Flow Through the Heart Memory Aid Abbreviation V RA RV PA PV LA LV A Veins carry blood to the Vena Cava, then goes through the Rt. Atrium. The Rt. Ventricle carries the blood to the lungs through the Pulmonary Artery. The Pulmonary Vein carries blood to the Lt. Atrium. The Lt. Ventricle pumps the blood to the body via the Aorta.

Parts and Function of the Circulatory System The pipes The arteries carry blood away from the heart after it’s been oxygenated in the lungs. The capillaries form a network that distributes blood to all parts of the body and exchanges the oxygen and carbon dioxide. The veins return the blood from the capillaries to the heart to be re-oxygenated.

Parts and Function of the Circulatory System The fluid The liquid part of the blood is plasma. Red blood cells carry oxygen and CO2. White blood cells consume bacteria and viruses to combat infections in the body. Platelets form clots that help stop bleeding.

Pump Failure Cardiogenic shock occurs if the heart cannot pump enough blood to supply the needs of the body. Pump failure can result from a heart attack. Inadequate pumping of the heart can cause blood to back up in the vessels of the lungs, resulting in congestive heart failure (CHF).

Pipe Failure Pipe failure is caused by the expansion of the capillaries to as much as three or four times their normal size. Blood pools in the capillaries. The rest of the body is deprived of blood. Blood pressure falls and shock results. Shock induced by fainting (psychogenic shock) Fainting is a short-term condition that corrects itself once the patient is placed in a horizontal position.

Pipe Failure Anaphylactic shock Caused by an extreme allergic reaction to a foreign substance The patient appears flushed, breathing may become difficult, and blood pressure drops rapidly. Death will result if prompt action is not taken. I collected all of the parts of “anaphylactic shock” on this slide and moved all of “spinal shock” to the next slide. 11

Pipe Failure Spinal shock May occur in patients who have sustained a spinal cord injury The injury allows the capillaries to expand, and blood pools below the level of the injury. The brain, heart, lungs, and other vital organs are deprived of blood, resulting in shock. I collected all of the parts of “spinal shock” on this slide. 12

Fluid Loss Fluid loss caused by excessive bleeding (hemorrhage) is the most common cause of shock. Blood escapes from a wound and the system’s total fluid level drops. The heart begins to pump faster to maintain pressure in the pipes. The pump eventually stops pumping, resulting in cardiac arrest.

Fluid Loss External bleeding is easy to detect. With internal bleeding, the bleeding cannot be seen, but you may see these signs: Bruising Swelling Rigidity in the affected area Severe pain in the immediate area

Fluid Loss Whether the bleeding is external or internal, if it remains unchecked, the result will be shock, pump failure, and death. Fluid loss could be from illness also. An average adult has about 12 pints (6 L) of blood circulating in the system. The loss of 2 or more pints can lead to shock.

Signs and Symptoms of Shock Shock deprives the body of sufficient blood to function normally. As shock progresses, the body alters its functions in an attempt to maintain sufficient blood supply. Signs and symptoms of shock Confusion, restlessness, or anxiety Cold, clammy, sweaty, pale skin

Signs and Symptoms of Shock Signs and symptoms of shock (cont’d) Rapid breathing Rapid, weak pulse Increased capillary refill time Nausea and vomiting Weakness or fainting Thirst

General Treatment for Shock Maintain the patient’s ABCs. Treat the cause of shock, if possible. Maintain the patient’s body temperature. Keep the patient calm. Do not allow the patient to eat or drink. Eating or drinking may cause vomiting. Patients in shock may need surgery and should not have anything in their stomachs.

General Treatment for Shock Position the patient correctly. If the patient has no head injury, extreme discomfort, or difficulty breathing, lay the patient flat on his or her back on a horizontal surface. Elevate the legs 6" to 12" off the floor.

Treatment for Anaphylactic Shock Transport as soon as possible. Some patients may carry an epinephrine auto-injector. The patient should follow their doctor’s instructions for administration of any medications. Place patient in a position of comfort and monitor ABC’s.

Treatment for Shock Caused by Fluid Loss Shock caused by internal blood loss Bleeding from stomach ulcers, ruptured blood vessels, or tumors can cause internal bleeding and shock. Patients with internal bleeding may exhibit: Coughing or vomiting of blood Abdominal tenderness, rigidity, bruising, distention Rectal bleeding Vaginal bleeding in women

Controlling External Blood Loss Capillary bleeding Most common type of external blood loss The blood oozes out. Apply direct pressure to the site. Venous bleeding Second most common type This bleeding has a steady flow. Apply direct pressure for at least 5 minutes.

Controlling External Blood Loss Arterial bleeding Most serious type of bleeding Arterial blood spurts or surges with each heartbeat. Exert direct pressure and maintain pressure until EMS arrives.

Controlling External Blood Loss Direct pressure Place a dry, sterile dressing directly on the wound and press with a gloved hand. Do not remove a dressing after you apply it. Elevation If direct pressure does not stop external bleeding from an extremity, elevate the injured arm or leg as you maintain direct pressure. Do not do this is there’s a suspected fracture.

Controlling External Blood Loss Tourniquets Indicated only in situations where life threatening extremity bleeding cannot be controlled by direct pressure or elevation. If the caller has already applied a tourniquet do not have it removed but never advise the caller to apply one. I moved all of the “pressure points” bullets to the next slide. 25

SUMMARY If shock is not treated, the patient will quickly deteriorate and die. Whatever the cause of shock, the general treatments are the same. Maintain the patient’s ABC’s to keep them from declining until they can get more advanced care.

Sources AAOS Emergency Medical Responder, 5th Edition Will County 9-1-1 EMDPRS, 2012 Edition