1. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 26 Bleeding and Shock

2. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Review of Circulatory System

3. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Review of Circulatory System Heart Blood Blood Vessels Arteries Capillaries Veins

4. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Circulatory System

5. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Perfusion K ey Term Circulation of blood through an organ

6. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Hypoperfusion K ey Term Inadequate circulation of blood through an organ

7. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ External Bleeding

8. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Take BSI precautions when controlling bleeding.

9. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ 3 Types of External Bleeding Arterial Capillary Venous

10. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Severity of Blood Loss Determined by: General impression of blood loss Signs or symptoms of hypoperfusion

11. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Sudden loss of... One liter of blood in an adult Half a liter of blood in a child 100-200cc of blood in an infant...is serious!

12. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Uncontrolled bleeding or significant blood loss leads to shock (hypoperfusion) and possibly death! Do not wait for signs and symptoms to appear before beginning treatment! Blood Loss

13. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Direct Pressure

14. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Elevation

15. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Pressure Bandage

16. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Pressure Point – Brachial

17. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Pressure Point – Femoral

18. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Supplemental Methods of Bleeding Control

19. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Splinting

20. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Air Splinting

21. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ A tourniquet is a last resort.

22. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bleeding from the Nose, Ears, and Mouth

23. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Managing a Simple Nosebleed

24. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Skull Fracture May cause loss of blood or clear fluid (cerebrospinal fluid) from the nose and ears. Do not stop the flow of fluid.

25. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Internal Bleeding

26. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Severity of Internal Bleeding Should Be Based on: Mechanism of injury Clinical signs and symptoms

27. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Consider mechanism of injury.

28. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Mechanism of Injury May Include: Falls Auto, motorcycle, or pedestrian accidents Penetrating trauma Blast Injuries

29. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Signs & Symptoms of Internal Bleeding Significant MOI Pain, tenderness, deformity, swelling, discoloration Bleeding from the mouth, rectum, or vagina Tender, rigid, or distended abdomen

30. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Signs & Symptoms of Internal Bleeding Vomiting blood Bright red Coffee-ground color and consistency Blood in stool Bright red Dark, tarry

31. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Signs & Symptoms of Internal Bleeding Capillary refill time > 2 seconds Infants and children only: Nausea and vomiting Decreasing blood pressure (late sign) Dilated pupils (late sign)

32. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Emergency Care of Internal Bleeding BSI Maintain airway; administer oxygen. Control any external bleeding.

33. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Emergency Care of Internal Bleeding Splint if injured area is on an extremity. Transport immediately.

34. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Signs of shock (hypoperfusion) appear LATE! Waiting for signs of shock to appear before recognizing and treating may result in the DEATH of your patient.

35. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Shock

36. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Inadequate perfusion of cells with oxygen and nutrients AND Inadequate removal of metabolic waste products Shock (Hypoperfusion)

37. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Inability of heart to pump Decreased supply of blood Lack of integrity in blood vessels Failure of vessels to dilate & constrict Causes of Shock

38. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ To compensate for shock, the body shunts blood away from areas of lesser need to areas of greater need. Early Shock

39. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Reduced perfusion results in malfunction of cells and organs. When this is not recognized and treated, death may result. Late Shock

40. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Signs & Symptoms of Shock Restlessness, changes in mental status Pale, cool, and clammy skin Increased pulse rate Increased respiratory rate Continued…

41. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Signs & Symptoms of Shock Decreasing blood pressure is a LATE sign. Continued…

42. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Signs & Symptoms of Shock Pulse oximetry may be unreliable Nausea and vomiting Dilated pupils Thirst Cyanosis Continued…

43. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Signs & Symptoms of Shock (Infants & Children) Capillary refill time > 2 seconds May maintain blood pressure until blood volume is half gone By the time an infant’s or child’s blood pressure drops, they are NEAR DEATH!

44. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Emergency Care of Shock Rapid transport is goal. Golden Hour Platinum Ten Minutes

45. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Take BSI precautions.

46. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Maintain airway; administer oxygen.

47. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Control external bleeding.

48. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Emergency Care of Shock Splint suspected bone or joint injuries. Do not delay transportation. Backboard can be used to splint the entire body.

49. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Apply PASG if indicated.

50. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Elevate lower extremities 8-12 inches.

51. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Prevent loss of body heat.

52. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Transport immediately.

53. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ 1. Describe the following types of bleeding: Arterial Capillary Venous 2. Describe the emergency care for external bleeding. Review Questions

54. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ 3. List the signs and symptoms of internal bleeding. 4. Describe the emergency care for internal bleeding. Review Questions

55. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ 5. Define shock (hypoperfusion). 6. List the signs and symptoms of shock in the order in which they are likely to appear. 7. Describe the emergency care for shock (hypoperfusion). Review Questions

56. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ What is the priority for this patient? Does an initial assessment still need to be done? What assessment information do you want to receive from Squad 31? S TREET S CENES

57. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Is the mechanism of injury important information for this patient? What is the treatment priority for this patient? S TREET S CENES

58. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ How often should you get a new set of vital signs? S TREET S CENES

59. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Sample Documentation