1. Book Title Edition Chapter 1 Lecture © 2012 Pearson Education, Inc. Chapter 6 Bleeding and Shock Slide Presentation prepared by Randall Benner, M.Ed., NREMT-P

2. Learning Objectives Describe and demonstrate how to control external bleeding with direct pressure, air splints, and tourniquets. Identify common signs of internal bleeding. Describe and demonstrate procedures for controlling internal bleeding. © 2012 Pearson Education, Inc.

3. Learning Objectives Understand the basic psychopathology of shock, and factors that may influence its severity. Recognize various types of shock, and identify signs and symptoms. Describe and demonstrate the management of various types of shock. © 2012 Pearson Education, Inc.

4. Severity of Bleeding Depends on –How fast blood is flowing from vessel –Size of vessel –Whether vessel is a vein or artery –Whether bleeding is internal or external –Where bleeding originated –Victim’s age and weight –Victim’s general physical condition –Whether bleeding is a threat to airway and respiration © 2012 Pearson Education, Inc.

5. Bleeding Sources and Characteristics © 2012 Pearson Education, Inc.

6. Control of Bleeding Steps to follow –Stop the bleeding. –Determine the cause and source of bleeding, and general condition of victim. –Place the victim in a position that minimizes blood loss. –Establish and maintain an open airway. © 2012 Pearson Education, Inc.

7. Protection from Infectious Disease Precautions –Place a barrier between yourself and the victim’s blood, such as protective gear. –Don’t touch your mouth, nose, or eyes, or handle food. –When treatment concludes, wash hands thoroughly; brush under fingernails. –Wash thoroughly all items that touched the victim’s blood or body fluids. © 2012 Pearson Education, Inc.

8. Direct Pressure and Elevation Best way to control bleeding is applying direct pressure to the wound. Place a sterile cover over wound and press firmly. Elevation may be used with direct pressure, although its effectiveness has not been proved. Can also use a cold pack over the wound, along with pressure and elevation. Check dressing regularly. Never apply pressure if there is an object in the wound or a protruding bone. © 2012 Pearson Education, Inc.

9. Other Treatments If needed, pressure on dressing can be increased by using –A pressure bandage –An air splint –A blood pressure cuff A tourniquet should be used if direct pressure fails to control bleeding. © 2012 Pearson Education, Inc.

10. Using a Tourniquet © 2012 Pearson Education, Inc.

11. Internal Bleeding The result of blunt or penetrating trauma, or fractures Although not visible, it can be serious or fatal Signs and Symptoms –Injury evidence such as bruising to abdomen or chest, or deformed upper thigh –Evidence of shock (restlessness, anxiety; cool, clammy skin; weak, rapid pulse; rapid breathing) –Other signs depend on source of bleeding; see Table 6.2 in text © 2012 Pearson Education, Inc.

12. Internal Bleeding: First Aid Care Activate EMS first. Establish and maintain open airway, and monitor ABCDs (see Chapter 3). Assess for fractures; apply a splint if needed. Keep the victim quiet. Position and treat the victim for shock; keep victim warm. If the victim vomits, place in recovery/coma position. Monitor symptoms every five minutes until EMS personnel arrive. © 2012 Pearson Education, Inc.

13. Internal Bleeding © 2012 Pearson Education, Inc.

14. Nosebleed Assess for fractures; apply a splint if needed. Results from injury, disease, activity, temperature extremes, or other causes If severe or uncontrolled, it can lead to shock If a skull fracture is suspected, do NOT try to stop the flow of blood; instead, cover opening loosely with dry and sterile dressing, activate EMS, and treat for skull fracture (see Chapter 13) © 2012 Pearson Education, Inc.

15. Shock Inadequate delivery of blood (oxygen) and glucose (nutrients) to the cells Fatal if left untreated A progressive process that can be either gradual or rapid Throughout the progression of shock, the victim’s condition constantly changes The body cells most sensitive to lack of oxygen are in the heart, brain, and lungs © 2012 Pearson Education, Inc.

16. Cycle of Traumatic Shock © 2012 Pearson Education, Inc.

17. Causes of Shock Four basic causes –Fluid is lost from circulatory system (often from bleeding, burns, or dehydration) –Heart fails to pump blood effectively –Blood vessels dilate, causing blood to pool in extremities and nonvital areas –Forward movement of blood through the body is obstructed © 2012 Pearson Education, Inc.

18. Types of Shock Hypovolemic: Characterized by loss of blood (hemorrhaging) Cardiogenic: Cardiac muscle (heart) does not pump effectively Distributive: Extreme blood vessel dilation, often associated with spinal cord injury Obstructive: Blockage of blood movement, often associated with blood clots © 2012 Pearson Education, Inc.

19. Stages of Shock Compensatory: First stage; body tries to use its normal defense mechanisms Progressive: Second stage; body moves blood toward heart, brain and lungs to preserve functioning; blood pressure drops Irreversible: Final stage; multiple organs start to fail, death follows © 2012 Pearson Education, Inc.

20. Signs and Symptoms of Shock Dizziness or fainting Anxious or dull expression Nausea; possible vomiting; extreme thirst Cool, clammy, moist skin Shallow, labored, or grasping breathing In dark-skinned people, skin around the mouth may turn grayish; lips or nail beds may be blue; mucous membranes of the mouth may look pale or waxy Light-skinned people may have pale, dull skin color © 2012 Pearson Education, Inc.

21. General Signs and Symptoms of Shock © 2012 Pearson Education, Inc.

22. Symptoms of Hemorrhagic Shock © 2012 Pearson Education, Inc.

23. The Cycle of Hemorrhagic Shock © 2012 Pearson Education, Inc.

24. Preventing Shock Never wait for signs to develop or worsen; prevention is always best. Ensure that the victim’s airway is open and breathing is adequate. Control bleeding. Splint or immobilize fractures as needed. Relieve pain via proper wound dressing, bandaging, splinting, and body positioning. Keep the victim supine. Keep the victim warm (but not hot). © 2012 Pearson Education, Inc.

25. Anaphylactic Shock A severe allergic reaction caused by an immune response Often the result of insect bites or stings, foods, medicines, or other substances A dire medical emergency Generally occurs most rapidly if the allergen/antigen is injected Untreated victims can die within minutes of contacting the allergen/antigen © 2012 Pearson Education, Inc.

26. Anaphylactic Shock: Signs and Symptoms Symptoms can occur in any combination, and affect the skin, heart, blood vessels, respiratory system, gastrointestinal tract, and/or central nervous system Flushed, itching skin Sneezing, watery eyes and nose Skin rash Swollen airway “Tickle” or lump in throat that won’t go away Gastrointestinal complaints © 2012 Pearson Education, Inc.

27. Anaphylactic Shock: Signs and Symptoms © 2012 Pearson Education, Inc.

28. Anaphylactic Shock Management Activate EMS system immediately. Secure and maintain an open airway. If indicated, perform rescue breathing or CPR. If the victim has an epinephrine auto-injector (epi pen), help them to use it if allowed by local protocols. © 2012 Pearson Education, Inc.

29. Summary Severity of bleeding depends on multiple factors, including blood speed, source, and origin. Bleeding can often be effectively controlled through direct pressure in concert with other methods. Internal bleeding can lead to shock and must be medically treated immediately. Shock is a serious, progressive condition that can result in death if untreated. The best approach to shock management is prevention. © 2012 Pearson Education, Inc.