Bleeding And ShockChapter 6/8

Sources of External Bleeding

ArteriesVeinsCapillaries

Arterial Bleeding Most serious / arteries are usually

deep in the body Rapid and profuse blood loss Bright red / spurts Less likely to clot Must use external means to stop

blood flow

Venous Bleeding Steady flow / bluish-red May be profuse More easily controlled Veins are closer to the body

surface Can be serious

Capillary Bleeding Easily controlled Blood oozes

–Road rash

Blood Vessel Spasm

Severed arteries– Artery draws back into the tissue

– Artery constricts and slows bleeding Partially severed arteries

– Associated with greater blood loss

– Example: amputations

Definitions Hemorrhage: Rapid blood loss

– Adult: 1 quart may lead to shock– Child: 1 pint loss of blood

Dressing– A protective covering for a wound –

p.150 Bandage

– A material used to hold a dressing in place

Dressings Used to control bleeding Prevents contamination Dressings should be:

–Sterile–Larger than the wound–Thick, soft, compressible–Lint free (no cotton balls)

Types of Dressings

Gauze pads Adhesive strips Trauma

dressings Improvise Donut shaped

Dressings 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

Removal of Dressings

– Soak “stuck” dressing in warm water

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

Application of Bandages

Leave toes and fingers exposed if possible– Bandage too tight? Check for

color, circulation, temperature Wrap towards the heart

– Small end of bone to large end

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

Tourniquets–Rarely recommended

–Damages nerves and vessels

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

Someone Has Cut Their Leg: What Should You Do? (external bleeding / depends on severity)

Call for help when necessary Protect yourself from bodily fluids Expose the wound Apply sterile gauze pad (dressing) Apply constant, direct pressure

for 10 minutes (don’t peak)

Cut Leg

If dressing becomes blood soaked

– do not remove dressing, add others over it

After 10 minutes, if bleeding persists– apply pressure harder and over a wider

area for 10 more minutes (seek help)

Additional Options Elevate limb above heart level Apply pressure at a pressure point When bleeding stops:

– Apply pressure bandage (roller gauze)

– Wrap towards the heart

Problem Bleeders Hemophiliacs Aspirin

When Not To Apply Direct Pressure

Protruding bone Skull fracture Embedded object May use a donut shaped pad

Internal Bleeding

Look for abdominal:–Pain

–Tenderness

–Rigidity–Bruises

Internal Bleeding

Look for:–Black stools

–Bright red stools

–Cough or vomit with blood

–Fractured ribs or bruises

Internal Bleeding: What To Do

Monitor ABC’s Lay on side if appropriate (expect

vomiting) Treat for shock

– Raise legs 8-12 inches (if conscious)– Cover victim

Bruises: Ice, ace wrap, elevate

Shock Occurs when the circulatory

system fails– Resulting in inadequate blood flow

to some part of the body

A MAJOR CAUSE OF DEATH !!!

Shock #2 Always treat injured victims

for shockShock:

–can be prevented–cannot be reversed

Types of ShockCardiogenic

–Heart fails to pump sufficient blood supply

Types of ShockNeurogenic

– Spinal cord damage

– Drug overdose

– Vessels dilate

– Blood supply insufficient to fill vessels

Types of Shock #2Septic

–Result of a bacterial infection

–Vessels lose ability to contract

Types of Shock #3

Hypovolemic (Fluid Loss)

–Most common type»Blood loss

»Dehydration from vomiting, diarrhea or profuse sweating

Shock: What To Look For

Pale, cold, clammy skin Altered mental status

– Rapid breathing and pulse Unresponsiveness Nausea and vomiting

Shock: What To Do First, care for life threatening injuries 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)

Shock: What To Do #2 If conscious and appropriate, place

victim on back, raising legs 8-12 inches EXCEPT those needing ½ sitting position (listed on next slide)

Cover victim, over and under Do not let victim eat or drink

– May suck on wet cloth

Shock: When To Place In A Half Sitting Position

Difficulty breathing Head injuries (when appropriate) Strokes Chest injuries Penetrating eye injuries Heart attack Unconsciousness

Anaphylaxis or Anaphylactic Shock

Massive allergic reaction by the body’s immune system

Causes Of Anaphylactic Shock

Medications» Penicillin and related drugs, aspirin, sulfa

drugs,meds and alcohol

Foods and food additives– Monosodium glutamate, peanuts

Plant pollens Bee stings Radiographic dyes

Characteristics of Anaphylaxis Usually comes on in minutes / Peaks in

15-30 minutes Sensation of warmth Intense itching of soles of feet and palms

of hands Breathing difficulties Tightness and swelling in throat Coughing, sneezing, wheezing Tightness in chest

Characteristics of Anaphylaxis #2

Increased pulse rate

Swollen face, tongue, mouth Nausea and vomiting Dizziness Blue around lips and mouth

Anaphylaxis: What To Do

Check ABC’s– Use ice pack on bee sting

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

Get help immediately (float trip) Benedryl – too slow for major

emergency, but worth a try