1. Chapter 11
Bleeding
Shock

2. Bleeding & Shock Some Facts
Trauma is the leading cause of death for persons aged 1 to 44.
A vital part of trauma care is recognizing and treating signs and symptoms of bleeding and shock
Profuse bleeding and shock are life-threatening problems requiring immediate attention

3. Bleeding External / Internal External Bleeding
Use Body Substance Isolation (BSI) precautions
Always wash hands following contact
Waterless cleans

4. Signs & Symptoms Arterial
Rapid, spurting, profuse, bright red (under pressure)
Clot formation is difficult
Difficult to control
As blood pressure drops, spurting will also drop

5. Signs & Symptoms Venous
Usually steady flow (under lower pressure), can be heavy
Dark red
Debris and air can be sucked into wound
Clotting rate is dependent on size of area or vessels involved

6. Signs & Symptoms Capillary Slow (oozing)
Red but not as bright as arterial bleeding
Good chance of infection
Clots easily

7. Blood Volumes & Serious Losses

8. Blood Loss
Severe or uncontrolled blood loss will lead to Shock (Hypoperfusion)
Most Bleeding will stop by itself within 6-10 minutes (dependent on area of involvement and vessels involved)

9. Care (Control) of External Bleeding
External bleeding usually easy to control
Complete the initial assessment including the ABC’s before focusing on bleeding
Follow BSI precautions
Cover wound with a clean dressing to reduce risk of infection
Follow basic steps for controlling bleeding
If bleeding or CSF from ears do not stop flow

10. Care (Control) of External Bleeding
Direct pressure
Controls most bleeding
Elevate injured area (if no fractures are present)
Pressure Bandage
Arterial pressure points (Femoral/Brachial)
Summon EMS if bleeding cannot be controlled or if pressure points must be used

11. External Bleeding Nosebleeds (Epistaxis)
Care for a Nosebleed
Sitting position leaning slightly forward
Apply direct pressure (may take 15 min.)
Pinching nose or rolled gauze under nose
Cold compresses
Do not
Pack nose
Blow nose or
Tilt head back

12. Internal Bleeding
May not be obvious, may take time for signs & symptoms to appear
Leading causes
Blunt trauma
Penetrating injuries
Suspect internal bleeding in any serious injury

13. Signs & Symptoms Bruising (Contusion)
contusions over abdomen or chest the size of your fist - assume a 10% blood volume loss
Painful, swollen, deformed extremities
Swollen, painful, tender or rigid abdomen
rebound tenderness
Bleeding from mouth, ears, nose

14. Signs Symptoms Vomiting coffee grounds vomitus or bright red blood
Dark tarry stools or passing bright red blood in stools
Abnormal rectal or vaginal bleeding
Anxiety & restlessness
Increased respiratory rate

15. Signs & Symptoms Cool, moist skin
Pale or ashen skin leading to cyanosis
Excessive thirst
Decreasing level of consciousness
Any additional signs or symptoms of shock

16. Care of Internal Bleeding
Care depends on the severity and site of the injury
For minor internal bleeding (bruising)
Apply cold compresses
If internal bleeding appears to be serious
Activate EMS
Complete initial assessment including the ABC’s
Treat for shock

17. Shock (Hypoperfusion)
Life-threatening potential
Inevitable result of any serious injury (illness)
Results from the body’s inability to maintain adequate perfusion
Signs & symptoms may be present immediately, become evident during the physical exam or an ongoing assessment

18. Shock
Conditions required for normal flow of oxygenated blood to the tissues
Heart functioning properly
Adequate blood volume
Intact functional vessels

19. Classifications Cardiogenic Shock - pump failure Hypovolemic -
Hemorrhagic
Non-hemorrhagic
Metabolic
Septic
Neurogenic
Psychogenic
Anaphylaxic

20. Signs (In order of appearance)
Altered Mental Status
Anxiety, restlessness, combativeness
Pale, Cool, Clammy Skin
Develops into cyanosis (lips & nailbeds)
Infants & children may begin to exhibit capillary refill times greater than 2 seconds
Nausea & Vomiting

21. Signs (In order of appearance)
Vital Sign Changes
Pulse
Increases, becomes weak & thready
Respirations
Increase becoming more shallow & labored
Blood Pressure
One of last signs to change
Dilated pupils

22. Care for Shock Perform initial assessment
If no immediate life-threatening problems perform a physical exam and SAMPLE history
Activate EMS when necessary
Control any external bleeding

23. Care for Shock Position patient Supine with legs elevated unless
Respiratory difficulty - upright
Chest pain - upright or semi-recumbent
Maintain body temperature
Nothing by Mouth (food or drink)
Administer oxygen if available