1. Bleeding And Shock Chapter 6/8

2. Sources of External Bleeding u Arteries u Veins u Capillaries

3. Arterial Bleeding u Most serious / arteries are usually deep in the body u Rapid and profuse blood loss u Bright red / spurts u Less likely to clot u Must use external means to stop blood flow

4. Venous Bleeding u Steady flow / bluish-red u May be profuse u More easily controlled u Veins are closer to the body surface u Can be serious

5. Capillary Bleeding u Easily controlled u Blood oozes –Road rash

6. Blood Vessel Spasm u Severed arteries –Artery draws back into the tissue –Artery constricts and slows bleeding u Partially severed arteries –Associated with greater blood loss –Example: amputations

7. Definitions u Hemorrhage: Rapid blood loss –Adult: 1 quart may lead to shock –Child: 1 pint loss of blood u Dressing –A protective covering for a wound – p.150 u Bandage –A material used to hold a dressing in place

8. Dressings u Used to control bleeding u Prevents contamination u Dressings should be: –Sterile –Larger than the wound –Thick, soft, compressible –Lint free (no cotton balls)

9. Types of Dressings u Gauze pads u Adhesive strips u Trauma dressings u Improvise u Donut shaped

10. Dressings u Application –Wash hands –Dressing should extend over edges of wound –Do not touch dressing surface that is to be next to the wound –Place medications directly onto pad –Cover with a bandage u Removal of Dressings –Soak “stuck” dressing in warm water

11. Bandages Are Used For: u Holding dressings in place u Applying pressure u Prevent or reduce swelling u Provide support or stability

12. Application of Bandages u Leave toes and fingers exposed if possible –Bandage too tight? Check for color, circulation, temperature u Wrap towards the heart –Small end of bone to large end

13. Types of Bandages u Roller gauze u Improvised u Triangular u Cravat u Adhesive / paper tape u Adhesive strips u P.150-152

14. Tourniquets –Rarely recommended –Damages nerves and vessels

15. Types of Wounds And Application of Bandages And Dressings Will Be Addressed Later

16. Someone Has Cut Their Leg: What Should You Do? (external bleeding / depends on severity) u Call for help when necessary u Protect yourself from bodily fluids u Expose the wound u Apply sterile gauze pad (dressing) u Apply constant, direct pressure for 10 minutes (don’t peak)

17. Cut Leg u If dressing becomes blood soaked – do not remove dressing, add others over it u After 10 minutes, if bleeding persists –apply pressure harder and over a wider area for 10 more minutes (seek help)

18. Additional Options u Elevate limb above heart level u Apply pressure at a pressure point u When bleeding stops: –Apply pressure bandage (roller gauze) –Wrap towards the heart

19. Problem Bleeders u Hemophiliacs u Aspirin

20. When Not To Apply Direct Pressure u Protruding bone u Skull fracture u Embedded object u May use a donut shaped pad

21. Internal Bleeding u Look for abdominal: –Pain –Tenderness –Rigidity –Bruises

22. Internal Bleeding u Look for: –Black stools –Bright red stools –Cough or vomit with blood –Fractured ribs or bruises

23. Internal Bleeding: What To Do u Monitor ABC’s u Lay on side if appropriate (expect vomiting) u Treat for shock –Raise legs 8-12 inches (if conscious) –Cover victim u Bruises: Ice, ace wrap, elevate

24. Shock u Occurs when the circulatory system fails –Resulting in inadequate blood flow to some part of the body u A MAJOR CAUSE OF DEATH !!!

25. Shock #2 u Always treat injured victims for shock u Shock: –can be prevented –cannot be reversed

26. Types of Shock u Cardiogenic –Heart fails to pump sufficient blood supply

27. Types of Shock u Neurogenic –Spinal cord damage –Drug overdose –Vessels dilate –Blood supply insufficient to fill vessels

28. Types of Shock #2 u Septic –Result of a bacterial infection –Vessels lose ability to contract

29. Types of Shock #3 u Hypovolemic (Fluid Loss) –Most common type »Blood loss »Dehydration from vomiting, diarrhea or profuse sweating

30. Shock: What To Look For u Pale, cold, clammy skin u Altered mental status –Rapid breathing and pulse u Unresponsiveness u Nausea and vomiting

31. Shock: What To Do u First, care for life threatening injuries u If the face is red, raise the head, –(injuries to upper half of body – raise the upper half of body) If the face is pale, raise the tail. (injuries to lower half of body, raise the lower half of the body)

32. Shock: What To Do #2 u If conscious and appropriate, place victim on back, raising legs 8-12 inches EXCEPT those needing ½ sitting position (listed on next slide) u Cover victim, over and under u Do not let victim eat or drink –May suck on wet cloth

33. Shock: When To Place In A Half Sitting Position u Difficulty breathing u Head injuries (when appropriate) u Strokes u Chest injuries u Penetrating eye injuries u Heart attack u Unconsciousness

34. Anaphylaxis or Anaphylactic Shock u Massive allergic reaction by the body’s immune system

35. Causes Of Anaphylactic Shock u Medications »Penicillin and related drugs, aspirin, sulfa drugs,meds and alcohol u Foods and food additives –Monosodium glutamate, peanuts u Plant pollens u Bee stings u Radiographic dyes

36. Characteristics of Anaphylaxis u Usually comes on in minutes / Peaks in 15-30 minutes u Sensation of warmth u Intense itching of soles of feet and palms of hands u Breathing difficulties u Tightness and swelling in throat u Coughing, sneezing, wheezing u Tightness in chest

37. Characteristics of Anaphylaxis #2 u Increased pulse rate u Swollen face, tongue, mouth u Nausea and vomiting u Dizziness u Blue around lips and mouth

38. Anaphylaxis: What To Do u Check ABC’s –Use ice pack on bee sting u Inject epinephrine (dilates bronchioles) –P.442 (hopefully victim will have some) –Inject in outside part of thigh, hold for 10 seconds –May need to repeat u Get help immediately (float trip) u Benedryl – too slow for major emergency, but worth a try