1. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 18 Bleeding and Shock

2. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Topics Bleeding Shock

3. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding

4. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding Protection against infection How the body responds to blood loss External bleeding Internal bleeding

5. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding Protection against infection –Body substance isolation Gloves Protective eyewear and mask as indicated Keep open wounds covered Hand washing Decontamination

6. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding How the body responds to blood loss –Serious bleeding 1 liter in an adult 0.5 liters in a child 100–200 cc in an infant

7. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding How the body responds to blood loss –Determining severity Size of blood vessel and how fast it is bleeding Arterial versus venous bleeding Internal versus external bleeding If the bleeding is a threat to airway or breathing The patient’s physical condition Bleeding is severe when pulse or respirations increase, mental status changes, skin color becomes pale

8. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding External bleeding –Types of bleeding –First Responder care –Other methods of bleeding control –Nosebleeds

9. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding External bleeding –Types of bleeding Arterial Venous Capillary

10. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding External bleeding –Arterial Bright red Spurting Coincides with the patient’s pulse Difficult to control

11. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding External bleeding –Venous Dark red Flows steadily May be profuse, easier to control

12. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding External bleeding –Capillary Dark red Oozes slowly Usually clots spontaneously Can be profuse if large area is involved May have a high risk of infection

13. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding External bleeding –First Responder care Apply direct pressure with hand and gauze Elevate the extremity above the level of the heart Apply another dressing if the patient bleeds through the first one Use pressure points Support the patient as needed

14. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding External bleeding –Other methods of bleeding control Splints Prevents movement of fracture site to prevent further damage to blood vessels Tourniquets Last resort when other methods fail to control bleeding Can result in loss of the extremity

15. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding External bleeding –Tourniquets Use a bandage 4’’ thick and 6–8 layers deep Wrap the extremity twice as close to the wound as possible Tie off bandage, place a rod above the knot and tie again Twist until the bleeding stops and tie off the rod Document the time and report it to transporting EMS providers

16. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding

17. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding External bleeding –Nosebleeds Can result in shock or threats to airway and breathing Position the patient Pinch the nostrils Apply a cold compress Exceptions with nasal fractures or skull fractures

18. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding Internal bleeding Patient assessment First Responder care

19. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding Internal bleeding –Concealed inside the body –Results from damage to internal organs –Caused by blunt or penetrating trauma –Abnormal clotting –Ruptured blood vessels –Fractures –Can be severe

20. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding Internal bleeding –Patient assessment Signs and symptoms Discolored, tender, swollen, or hand tissue Pale, cool, clammy skin Vomiting of bright red or dark blood Mental status changes Dark tarry or bright red stools Changes in vital signs

21. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding Internal bleeding –First Responder care Maintain open airway and adequate breathing Control external bleeding Keep patient warm Treat for shock Comfort the patient

22. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock

23. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock Types Patient assessment First Responder care Anaphylactic shock

24. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock State of hypoperfusion –Results from inadequate delivery of oxygen and nutrients to the cells –Caused by Failure of the heart Abnormal dilation of the blood vessels Blood volume loss

25. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock Patient assessment –Compensated –Decompensated –Irreversible

26. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock

27. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock Compensated shock –Maintain normal function –Pale skin –Slightly rapid heart rate –Normal blood pressure –Anxiety –Delayed capillary refill in infant or child

28. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock Decompensated shock –Body can no longer compensate for hypoperfusion –Blood shunted to keep vital organs perfused Tissue in extremities produce toxic by-products Mental status changes Increase heart rate Decreased blood pressure (late sign) Cool, moist skin that is pale, gray or cyanotic, and mottled

29. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock Irreversible shock –Cells die –Blood further shunted to brain and heart –Unable to maintain blood pressure causing blood to pool Extremely low blood pressure Very rapid heart rate –Vital organ damage is permanent

30. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock First Responder care –Maintain open airway and adequate ventilations –Prevent further blood loss –Elevate lower extremities –Prevent heat loss –Provide specific care and calm the patient

31. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock Anaphylactic shock –Patient assessment Skin Respiratory system Circulatory system

32. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock Anaphylactic shock –Caused by severe allergic reaction May have respiratory or circulatory compromise, or both The faster the onset of symptoms, the greater the risk of a fatal reaction

33. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock Anaphylactic shock –First responder care Ensure ALS response Treat life-threats Maintain open airway and adequate ventilations Assist patient with epinephrine auto-injector

34. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Summary Ensure appropriate BSI precautions Determine severity of blood loss and types of bleeding Control the bleeding as appropriate Provide care as needed for both internal and external hemorrhage Assess for and appropriately treat patients with shock