1. First Aid Lecture: Bleeding and Shock

2. Blood Loss Shock: (hypoperfusion) Adult has 5 – 6 qts of blood (avg)
Circulatory failure
Inadequate supply of O2 blood to organs, especially brain and heart
Adult has 5 – 6 qts of blood (avg)
Can safely donate 1 pt
> 1 pt blood loss  shock
Child who loses > 1 pt is in danger

3. External Bleeding 1st priority for wound care
Hemorrhage: rapid blood loss in short period of time
Types:
Arterial
Venous
Capillary

4. Arterial Bleeding Most serious
Blood is under high pressure, moving quickly.
Often will spurt heavy blood loss.
Blood is bright red in color
speed of blood flow  less likely to clot

5. Venous Bleeding blood flow is slow Easier to stop
(less pressure) on the way back to heart
Easier to stop
most veins collapse when cut.
Deep veins can be as difficult to control

6. Capillary Bleeding Most common Blood oozes from capillaries
Usually clots on its own
Easiest to control w/pressure

7. Clot Formation (avg time frame @10 minutes)
Blood Vessel Spasm:
Arteries surrounded by muscle tissue
Constricts diameter to slow bleeding

8. Clot Formation 2. Platelet Plug Formation: Temporary plug in break
Platelets stick to damaged vessel and to each other
- Release chemicals
a. ATP: attract other platelets
b. Serotonin: enhance spasms

9. Clot Formation 3. Coagulation:
Blood transformed from liquid to gel (biochemical rxns)
Enzyme Thrombin Activated in Blood Plasma
Catalyzes formation of fibrin strands from protein in blood plasma
Fibrin meshes platelets together into stable clot

10. What to do: Observe Universal Precautions (BSI/PPE) Four Methods:
1. Direct Pressure
2. Elevation
3. Pressure Bandage
4. Pressure Points

11. Direct Pressure Expose wound Thick dressing/cloth
Apply direct pressure:
Constant strong pressure with fingers/palm
Wound will be painful – continue
If wounds bleed through, apply 2nd dressing. Do not remove 1st dressing.
Do not disturb clot.

12. Elevation For arms/legs Uses gravity to reduce blood flow
Continue direct pressure
Do not elevate w/fractures

13. Direct Pressure
For injuries that cannot take direct pressure: protruding bone, skull fracture, embedded object
make ring pad out of bandage

14. Pressure Bandage holds dressing in place
Frees up 1st aider for other tasks
Use roller bandage to wrap around dressings
Overlapping turns, wrap above and below site
Move distally to proximally
Tie off ends directly over dressings
Check pulse below bandage to maintain circulation

15. Pressure Points When other three methods fail
Apply direct pressure to main artery supplying:
arm (brachial) or
leg (femoral)
Press artery against bone
Only apply pressure points as long as necessary to slow circulation  allows time for clotting
Release pressure point as bleeding stops

16. Other Pressure Points

17. Tourniquets
only to be used w/severe injuries that may cause a victim to bleed-out
Use wide, flat materials (no rope/wire)
Do not loosen, once applied

18. Internal Bleeding Look for: Bruises or contusions on skin
Painful, tender, rigid, bruised abdomen
Vomiting, coughing blood
Blood in stool or black feces

19. What to do
Monitor ABC
Expect vomiting. Keep victim in recovery left-side position.
Treat for shock
Contact EMS

20. What is Shock? (Hypoperfusion)
CS fails due to lack of adequate O2 supply to organs, especially brain and heart
Brain damaged in 4-6 minutes irreparably
Abdomen: 45 – 90 minutes
Skin and Muscles: 3 – 6 hours

21. Shock can occur due to: Pump failure Cardiogenic shock Fluid failure
Hypovolemic shock: drop in fluid volume
Hemorrhagic shock: drop in blood volume
Respiratory shock: respiratory distress prevents insufficient oxygen in blood
Pipe failure
Neurogenic shock: nervous system damage cause vessel dilation (blood volume insufficient to fill vessels)
Septic shock: bacterial infections cause vessels to lose ability to contract
Psychogenic shock: emotional distress causes sudden dilation of vessels

22. Signs and Symptoms of Shock
Body attempts to divert blood to vital organs
Results in:
Cyanosis of skin; cool to touch
Excessive perspiration: wet, clammy
Rapid or weak pulse (pulse 60 – 100 /min is normal)
low bp
Irregular respiration, shallow breaths
General weakness, restlessness, unresponsive
Excessive thirst (** do not give water – can cause vomiting and aspiration)
Nausea and/or vomiting
Blurred vision
Eyes: pupils dilated, sunken eyes, vacant expression

23. What to do Goals for treatment of shock:
Reduce/eliminate cause of shock
Control bleeding
Ease pain through position change
Emotional support
Improve circulation to brain and heart
Provide adequate oxygen
Maintain body temperature

24. Positioning Shock Victim
Flat on back to increase circulation
Raise feet 8 – 12 inches to provide blood to heart and brain w/o affecting breathing
Cover with blanket to maintain body temperature or shade from sun
** consider injuries: do not move suspected spinal injury victim

25. Special Considerations
Breathing difficulties, chest or eye injuries:
Raise head/shoulders to make breathing easier
Sit up against something
Head injury w/difficulty breathing:
position flat, with head raised slightly if no neck injury
* If face is red, raise the head; if face is pale, raise the tail
“U” victim/stroke: recovery position
Pregnant woman: recovery
Vomiting: use recovery position

26. Body Temperature
75% body heat lost by radiation and convection from body surface
Place blanket between ground and victim
Cover with blanket w/o overheating
Overheating draws blood to surface and away from vital organs

27. Anaphylactic Shock Life-threatening allergic reaction
Fast acting: within minutes
Death usually due to swollen airway, causing respiratory distress/shock
Common causes
Medications (ex. Penicillin)
Food, drugs, food additives (ex. Peanuts, shellfish, nitrites, MSG)
Insect stings
Plant pollen

28. Symptoms of Anaphylaxis
Warmth
Intense itching
Hives, flushing, swelling on face or mucous membranes of tongue, mouth, nose
Labored breathing, wheezing
Victim feels faint, anxious
Tightness in chest, throat, dizziness, nausea
Increased pulse

29. What to do: Immediate care needed
Rescue breathing or CPR may be necessary if BLS threatened
Epinephrine (Epi-pens)
Increases cardiac output, constricts vessels
Inject into front of thigh for 10 seconds (demo)