c191w003 control bleeding and hypovolemic shock

8/8/2019 C191W003 Control Bleeding and Hypovolemic Shock

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Control Bleeding andControl Bleeding and

Hypovolemic ShockHypovolemic Shock


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Core Skills Control Bleeding 3

RightVentricle

Left

Ventricle

Right AtriumLeft Atrium


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FunctionFunction of Bloodof Blood

Transport OTransport O and nutrients to the cellsand nutrients to the cells

Removes CORemoves CO and other waste productsand other waste products

Detoxification and eliminationDetoxification and elimination


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PlasmaPlasma

Serum, protein and chemical substancesSerum, protein and chemical substances

Watery, salty fluidWatery, salty fluid

Constitutes over half the volume ofConstitutes over half the volume of

bloodblood

Transports substances to variousTransports substances to various

structuresstructures Transports waste productsTransports waste products

Carries red and white blood cells and plateletsCarries red and white blood cells and platelets


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Red Blood CellsRed Blood Cells

ErythrocytesErythrocytes

Primary functionPrimary functionCarry oxygen to tissuesCarry oxygen to tissues

Carry carbon dioxideCarry carbon dioxide

away from tissuesaway from tissues

Red color to bloodRed color to blood


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White Blood CellsWhite Blood Cells LeukocytesLeukocytes

DestroyDestroymicroorganismsmicroorganisms

Produce antibodiesProduce antibodies


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PlateletsPlatelets

ThrombocytesThrombocytes

MembraneMembrane--enclosedenclosedfragments of specializedfragments of specialized

cellscells

Release chemical factorsRelease chemical factors

to form blood clotsto form blood clots


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PulsesPulses

Left ventricle contractsLeft ventricle contracts

Peripheral pulsePeripheral pulse

RadialRadial

BrachialBrachial

Posterior tibialPosterior tibial

Dorsalis pedisDorsalis pedis

Central pulsesCentral pulses

CarotidCarotid

FemoralFemoral


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BloodBlood

Hemorrhage or bleedingHemorrhage or bleeding

Escape of blood from capillaries, veins,Escape of blood from capillaries, veins,

and arteriesand arteries

Adult bodyAdult body::

Contains approximately 5 to 6 liters of bloodContains approximately 5 to 6 liters of blood

1 pint of blood without harmful effects1 pint of blood without harmful effects 2 pints may cause shock2 pints may cause shock


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External BleedingExternal Bleeding IncisionIncision

LacerationLaceration

AbrasionAbrasion

Puncture woundsPuncture wounds

AmputationAmputation


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LacerationLaceration


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Puncture WoundPuncture Wound


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AbrasionAbrasion


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IncisionIncision


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Internal BleedingInternal Bleeding


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Injured Internal OrgansInjured Internal Organs


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Sources of BleedingSources of Bleeding

ArterialArterial

Rapid, profuse and pulsating; bright red inRapid, profuse and pulsating; bright red incolorcolor

VenousVenous

Steady flow; dark red or maroon in colorSteady flow; dark red or maroon in color

CapillaryCapillary

Slow and oozing; often clots spontaneouslySlow and oozing; often clots spontaneously


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Inadequate tissue perfusionInadequate tissue perfusion

CausesCauses

HemorrhageHemorrhage

Severe burnsSevere burns

Severe vomiting and/or diarrheaSevere vomiting and/or diarrhea


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Clinical Signs ofAcute HemorrhageClinical Signs ofAcute Hemorrhage

ClassClass % Blood% BloodLossLoss

Clinical SignsClinical Signs

II Up to 750 mlUp to 750 ml

(15%)(15%)

Slight increase in HR; no change in BP orSlight increase in HR; no change in BP or

respirationsrespirationsIIII 750750--1500 ml1500 ml

(15(15--30%)30%)Increased HR and respirations;Increased HR and respirations;increased diastolic BP; anxiety, fright orincreased diastolic BP; anxiety, fright orhostilityhostility

IIIIII 15001500--20002000ml (30ml (30--40%)40%)Increased HR and respirations; fall inIncreased HR and respirations; fall insystolic BP; significantsystolic BP; significantAMSAMS

IVIV >2000>2000(>40%)(>40%)

Severe tachycardia; severe lowering ofSevere tachycardia; severe lowering ofBP; cold, pale skin; severe AMSBP; cold, pale skin; severe AMS


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Other Common Signs ofOther Common Signs of


Cold, clammy skinCold, clammy skin

CyanosisCyanosis-- nail beds, lips and ear lobesnail beds, lips and ear lobes

Weak, thready, rapid pulseWeak, thready, rapid pulse

Shallow respirationsShallow respirations

OliguriaOliguria Listlessness, stupor, LOCListlessness, stupor, LOC

Excessive thirstExcessive thirst


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TreatmentTreatment--DirectPressureDirectPressure

First, expose the wound!!!First, expose the wound!!!

Place a sterile dressingPlace a sterile dressingover the wound andover the wound andapply pressureapply pressure

Use a bandage orUse a bandage or

cravat to tie a knot over the dressingcravat to tie a knot over the dressingcovering the woundcovering the wound


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TreatmentTreatment--ElevationElevation

Raise injured extremity above the heartRaise injured extremity above the heart

Used together with direct pressureUsed together with direct pressure

Use an object to maintain elevationUse an object to maintain elevation

Utilize bystandersUtilize bystanders


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TreatmentTreatment--Pressure DressingPressure Dressing

Use a pressure dressing ifbleeding isUse a pressure dressing ifbleeding isNOT controlled with direct pressureNOT controlled with direct pressure

Place Kerlex, ace wrap or cravat overPlace Kerlex, ace wrap or cravat overprevious dressingprevious dressing

Wrap this dressing overWrap this dressing over

the wound and previousthe wound and previousdressingdressing


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Pressure

Points

Pressure

Points

Severe bleedingSevere bleeding

Bleeding not controlled by direct pressureBleeding not controlled by direct pressure

and elevationand elevation

Apply pressure to appropriate pressureApply pressure to appropriate pressure

pointpoint

(


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Pressure PointsPressure Points

emporalTemporal

CarotidCarotid

BrachialBrachial

RadialRadial

FemoralFemoral

Posterior/Posterior/AnteriorAnteriortibialastibialas

(


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BrachialPressure

PointBrachial

Pressure

Point

Lower part of the upper armLower part of the upper arm

Above the elbow in the groove betweenAbove the elbow in the groove between

musclesmuscles

Using fingers or thumbUsing fingers or thumb

Apply pressure to the inside of the armApply pressure to the inside of the arm

over the boneover the bone


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Brachial Pressure PointBrachial Pressure Point


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Femoral Pressure PointFemoral Pressure Point

Control severeControl severebleeding of thigh andbleeding of thigh andlower leglower leg

Front, center part ofFront, center part ofcreasecrease in the grointhe groin


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Application of

Pressure

Points

Application of

Pressure

Points

Position the casualty on his or her backPosition the casualty on his or her back

Kneel on opposite side from woundKneel on opposite side from wound

Place heel of hand directly on pressure pointPlace heel of hand directly on pressure point

Lean forward to apply pressureLean forward to apply pressure

If bleeding is not controlledIf bleeding is not controlled

Press directly over arteryPress directly over artery Press heel of other handPress heel of other hand on fingertipson fingertips


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SplintingSplinting Immobilization is one of the best ways toImmobilization is one of the best ways to

stop bleedingstop bleeding

Broken bone fragments may grate onBroken bone fragments may grate on

blood vesselsblood vessels

Muscular activity can increase rate ofMuscular activity can increase rate of

blood flowblood flow

Air splints used to apply direct pressureAir splints used to apply direct pressure


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Air Splints


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TourniquetTourniquet

Direct pressure, elevation, pressureDirect pressure, elevation, pressure

dressings or pressure points will not stopdressings or pressure points will not stop

some bleedingsome bleeding

In these cases, aIn these cases, a

tourniquet may betourniquet may be

lifesavinglifesaving


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TourniquetTourniquet

Forceful, arterial bleeding (amputation)Forceful, arterial bleeding (amputation)may require early use of a tourniquet.may require early use of a tourniquet.

DO NOTWASTETIME attempting aDO NOTWASTETIME attempting apressure dressing in these casespressure dressing in these cases


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Apply a Tourniquet

Apply a Tourniquet

Place tourniquet between heart and woundPlace tourniquet between heart and wound

Place pad over artery to be compressedPlace pad over artery to be compressed

Wrap tourniquet around extremityWrap tourniquet around extremity

Tie halfTie half--knot on upper surfaceknot on upper surface

Place short stick on halfPlace short stick on half--knotknot

Tie a square knotTie a square knot

Twist stick to tightenTwist stick to tighten

UNTIL BLEEDING STOPSUNTIL BLEEDING STOPS


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Apply a Tourniquet

Apply a Tourniquet

Never cover a tourniquetNever cover a tourniquet

'T" on casualty's forehead'T" on casualty's forehead

Never loosen or remove aNever loosen or remove a

tourniquettourniquet


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Apply dressing to cover end of the stumpApply dressing to cover end of the stump

Control BleedingControl Bleeding

Blood vessels collapse, retractBlood vessels collapse, retractor curl closed to limit bleedingor curl closed to limit bleeding

Direct pressure, pressureDirect pressure, pressure

dressing or tourniquetdressing or tourniquet


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Preservation ofAmputation PartsPreservation ofAmputation Parts Rinse amputated part free of debrisRinse amputated part free of debris

Wrap loosely in salineWrap loosely in saline--moistened sterile gauzemoistened sterile gauze

Seal amputated part in a plastic bag or cravatSeal amputated part in a plastic bag or cravat Place in a cool container, do not freezePlace in a cool container, do not freeze

NeverNeverplace amputated part in waterplace amputated part in water

NeverNeverplace amputated part directly on iceplace amputated part directly on ice

NeverNeveruse dry ice to cool an amputated partuse dry ice to cool an amputated part


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Hemostatic AgentsHemostatic Agents

QuickclotQuickclot hemostatic powderhemostatic powder

ChitosanChitosan

hemostatic dressinghemostatic dressing


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TreatmentTreatment ABCsABCs

Circulation and hemorrhage controlCirculation and hemorrhage control

--IV accessIV access --Control external bleedingControl external bleeding

Baseline vitalsBaseline vitals

Brief neuro examBrief neuro exam

Position casualty and expose hemorrhagePosition casualty and expose hemorrhagesitessites


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TreatmentTreatment

Maintain body temperatureMaintain body temperature

IV fluid administrationIV fluid administration-- 2 large bore IVs2 large bore IVs

Perform serial neurological exams everyPerform serial neurological exams every5 minutes5 minutes

Perform vital signs every 5 minutesPerform vital signs every 5 minutes

Transport to medical facility ASAPTransport to medical facility ASAP


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HextendHextend

Superficial (> 50% of injuredSuperficial (> 50% of injured

Significant extremity or truncalSignificant extremity or truncal

Significant blood lossSignificant blood loss

IncoherentIncoherent

Loss of radial pulseLoss of radial pulse


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SummarySummary A&P of Circulatory SystemA&P of Circulatory System

Identify Hemorrhage and HypovolemicIdentify Hemorrhage and Hypovolemic

ShockShock

Provide Treatment for HemorrhageProvide Treatment for Hemorrhage

Provide Treatment for HypovolemicProvide Treatment for Hypovolemic

ShockShock


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c191w003 control bleeding and hypovolemic shock

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