1. Bleeding and Shock
CHAPTER 25 1

2. Review of the Cardiovascular System
Vessels
Blood Heart 1

3. Arterial System Carotid artery Brachial artery Radial artery
Femoral artery 1

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

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

6. 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

7. The Perfusion Process Artery Vein O2 and nutrients Waste products Cell1

8. Shock 1

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

10. 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

11. 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

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

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

14. Assessing Shock 1

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

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

17. Assess capillary refill under normal room temperature conditions.10

18. 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

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

20. 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

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

22. Emergency Care for Shock1

23. 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

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

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

26. The best treatment for shock is rapid transportation.10