Trauma Emergencies• Head to Toe exam• Application of C-Collar• KED• LSB• Long bone injury• Joint injury• Traction Splint• Bleeding and shock management

Bleeding and Shock

Circulatory SystemResponsible for distribution of blood to all parts of

the body• Heart• Arteries• Capillaries• Veins• Perfusion• Hypoperfusion• Functions of the blood

Heart• Muscular organ that pumps blood, which supply

oxygen and nutrients to the cells of the body• Arteries

Carry oxygen-rich blood away from the heart• Capillaries

Oxygen-rich blood is emptied from arteries into microscopically small capillaries, which supply every cell of the body

• Veins

Carry blood that has been depleted of oxygen and loaded with CO2 and wastes from capillaries

• Perfusion

Adequate blood throughout, which fills the capillaries and supplies the cells and tissues with oxygen and nutrients

• Hypoperfusion aka shockInadequate perfusion of the body’s tissues with

oxygen and nutrientsFunctions of the blood• Transportation of gases• Nutrition• Excretion• Protection• Regulation

Bleeding

Hemorrhage

• Severe bleeding is a major cause of shock

• During S A M P L E

ask if on blood thinners i.e. coumadin, Plavix

External Bleeding

• Use standard precautions

• Classifications

Arterial bleeding

Venous bleeding

Capillary

Severity of external bleeding

• Physical size of the patient

• Natural response

constriction of vessels and clotting

restrictive clothing

Care

• ABCs

• Standard precautions

• Assess circulation

radial pulse

skin color

temperature and condition

Control ; methods• Direct pressure• Elevation• Pressure points• Splinting

*sharp ends of broken bones may cause tissue and vascular injury

*Stabilizing may prevent further injury

• Cold packs

• PASG

• Tourniquet

• Blood pressure cuff

• Provide O2

Special situations involving bleedingHead injury• Do not apply pressure to ears and nose but allow

drainage to flow freelyNosebleed• Have pt. sit and lean forward• Direct pressure• Keep calm and quiet• Do not let pt. lean back• If pt. is uncomfortable; recovery position, prepare to

suction and manage airway

Internal Bleeding• Perform a through history and examMechanism of blunt trauma that may cause

internal bleeding• Falls• MVA or motorcycle crashes• Auto-pedestrian collisions• Blast injuries

Penetrating injuries• Gunshot wounds• Stab wounds• Impaled objectsSigns• Injuries to the surface of the body

indicative of underlying injuries• Bruising, swelling, or pain over vital organs

• Painful, swollen, or deformed extremities

• Bleeding from mouth, rectum, vagina or other orifice

• Vomiting; coffee-ground, bright red

• Dark, tarry stools or bright red blood in stools

• Signs and symptoms of shock

Care

• ABCs

• O2

• Control external bleeding

• Rapid transport

Shock

Inadequate tissue perfusion

Failure of

• Pumping of the heart

• Supply of blood

• Integrity of blood vessels

ability to dilate or constrict

• Types of shock

C A N S H R I M P

Severity of shock• Compensated• Decompensated• Irreversible

Stages• Stage 1: Initial Stage of Shock• The first of the stages of shock is reversible, but

there aren't any signs to indicate shock at this stage. Cells begin to change due to issues with perfusion and oxygenation. Perfusion is the method used by veins to deliver blood to capillary beds in body tissues. Without this nutritive blood and an adequate oxygen supply, the cells switch to anaerobic metabolism, producing pyruvic and lactic acid.

• Stage 2: Compensatory Stage of Shock• During the compensatory stage of shock, the body tries

to reverse the results of the initial stage. Physiological, neural, hormonal, and biochemical reactions are employed to correct the imbalances. Hyperventilation is one such mechanism. This causes an increased rate of breathing which, in turn, may help to get more oxygen flowing to the cells and neutralize the newly acidic conditions.

• Another mechanism is the catecholamine response. Hypotension, or low blood pressure, due to the reduced volume of blood flow triggers this response. Catecholamines are hormones released by the adrenal glands. These hormones increase heart rate and attempt to increase blood pressure.

Compensated Shock

• Increased pulse rate

• Decreased pulse strength

• Cool, clammy skin

• Progressing anxiety, restlessness, combativeness

• Thirst, weakness, eventual air hunger

• Stage 3: Progressive Stage of Shock• Decompensated• If the stages of shock progress to the third stage

before the initial cause is corrected, damages become more severe and can be irreversible. Cellular function continues to deteriorate, anaerobic metabolism leads to increased metabolic acidosis, and the compensatory mechanisms can no longer maintain the balance required to protect the organs.

Decompensated shock

• Pulse becomes unpalpable

• B/P drops precipitously

• Patient becomes unconscious

• Respirations slow or cease

• Stage 4: Refractory Stage of Shock• Irreversible• The stages of shock will eventually lead to

the refractory stage if the cause of shock cannot be fixed. At this stage, the organs completely fail and lead to death. It is important to understand the stages of shock in order to recognize and prevent the progression to this final stage.

Irreversible shock

• Irreversible cell damage

• Cell death

• Tissue dysfunction

• Organ dysfunction

• Patient dies

Signs and Symptoms of shock• AMS• Pale, cool, clammy skin• Nausea and vomiting• VS changes

Pulse; IncreasedRespirations; Rapid, labored, shallowB/P; Drops {late sign}

• Thirst

• Dilated pupils

• Sometimes cyanosis

• Pediatric

compensation

Care• Airway and O2• Transportation

Clock starts at time of injuryLimit on-scene time

On Scene• ABCs with spinal precautions• Rapid trauma exam• Immobilization• Moving the Pt. to ambulance

• VSTrendingq 5 minutes

• Control any external bleeding• Splint any suspected bone or joint injuries• Maintain body heat• Rapid transport• Detailed PE

• Notify hospital ASAP

• Notify medical direction if necessary

• Request ALS

• If conscious speak calmly, reassuringly