Control Bleeding and Hypovolemic Shock. Core SkillsControl Bleeding2 Introduction n Review methods...
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Transcript of Control Bleeding and Hypovolemic Shock. Core SkillsControl Bleeding2 Introduction n Review methods...
Core Skills Control Bleeding 2
IntroductionIntroduction
Review methods of controlling bleedingReview methods of controlling bleeding Hemorrhage control save livesHemorrhage control save lives ABC Measures ABC Measures
– Clear the airway/restoring breathingClear the airway/restoring breathing– Stop the bleedingStop the bleeding– Protect the woundProtect the wound– Treat/prevent shockTreat/prevent shock
A-B-C measures apply to A-B-C measures apply to allall injuries injuries
Core Skills Control Bleeding 4
FunctionFunction of Bloodof Blood
Transport OTransport O² ² and nutrients to the cells and nutrients to the cells
Removes CORemoves CO² ² and other waste products and other waste products
Detoxification and eliminationDetoxification and elimination
Core Skills Control Bleeding 5
PlasmaPlasma
Serum, protein and chemical substancesSerum, protein and chemical substances Watery, salty fluid Watery, salty fluid Constitutes over half the volume of Constitutes over half the volume of
bloodblood Transports substances to various Transports substances to various
structures structures Transports waste productsTransports waste products Carries red and white blood cells and plateletsCarries red and white blood cells and platelets
Core Skills Control Bleeding 6
Red Blood CellsRed Blood Cells
ErythrocytesErythrocytes
Primary functionPrimary function
– Carry oxygen to tissues Carry oxygen to tissues
– Carry carbon dioxide Carry carbon dioxide
away from tissuesaway from tissues
Red color to bloodRed color to blood
Core Skills Control Bleeding 7
White Blood CellsWhite Blood Cells
LeukocytesLeukocytes
Destroy Destroy
microorganismsmicroorganisms
Produce antibodies Produce antibodies
Core Skills Control Bleeding 8
PlateletsPlatelets
ThrombocytesThrombocytes
Membrane-enclosed Membrane-enclosed
fragments of specialized fragments of specialized
cellscells
Release chemical factors Release chemical factors
to form blood clotsto form blood clots
Core Skills Control Bleeding 9
PulsesPulses
Left ventricle contractsLeft ventricle contracts Peripheral pulsePeripheral pulse
– RadialRadial
– Brachial Brachial
– Posterior tibialPosterior tibial
– Dorsalis pedisDorsalis pedis Central pulsesCentral pulses
– CarotidCarotid
– FemoralFemoral
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Blood PressureBlood Pressure Exerts pressure against blood vessels walls Exerts pressure against blood vessels walls SystolicSystolic
– Pressure created in the Pressure created in the
arteriesarteries
– Reported firstReported first DiastolicDiastolic
– Left ventricle relaxed and Left ventricle relaxed and
refillingrefilling
– Reported secondReported second
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BloodBlood
Hemorrhage or bleeding Hemorrhage 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
Core Skills Control Bleeding 12
External BleedingExternal Bleeding
IncisionIncision
Laceration Laceration
Abrasion Abrasion
Puncture woundsPuncture wounds
Amputation Amputation
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Internal BleedingInternal Bleeding
Not always obviousNot always obvious
Suspicion based on mechanism of injurySuspicion based on mechanism of injury
– FallsFalls
– Blast injuriesBlast injuries
– Penetrating traumaPenetrating trauma
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Sources of BleedingSources of Bleeding
ArterialArterial
Rapid, profuse and pulsating; bright red Rapid, profuse and pulsating; bright red in colorin color
VenousVenous
Steady flow; dark red or maroon in colorSteady flow; dark red or maroon in color CapillaryCapillary
Slow and oozing; often clots Slow and oozing; often clots spontaneouslyspontaneously
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Hypovolemic ShockHypovolemic Shock
Inadequate tissue perfusionInadequate tissue perfusion CausesCauses
HemorrhageHemorrhage
Severe burnsSevere burns
Severe vomiting and/or diarrheaSevere vomiting and/or diarrhea
Core Skills Control Bleeding 23
Clinical Signs of Acute HemorrhageClinical Signs of Acute Hemorrhage
ClassClass % Blood % Blood LossLoss
Clinical SignsClinical Signs
II Up to 750 Up to 750 ml (15%)ml (15%)
Slight increase in HR; no change in Slight increase in HR; no change in BP or respirationsBP or respirations
IIII 750-1500 750-1500 ml (15-ml (15-30%)30%)
Increased HR and respirations; Increased HR and respirations; increased diastolic BP; anxiety, increased diastolic BP; anxiety, fright or hostilityfright or hostility
IIIIII 1500-2000 1500-2000 ml (30-ml (30-40%)40%)
Increased HR and respirations; fall Increased HR and respirations; fall in systolic BP; significantin systolic BP; significant AMSAMS
IVIV >2000 >2000 (>40%)(>40%)
Severe tachycardia; severe Severe tachycardia; severe lowering of BP; cold, pale skin; lowering of BP; cold, pale skin; severe AMSsevere AMS
Core Skills Control Bleeding 24
Other Common Signs of Other Common Signs of Hypovolemic ShockHypovolemic Shock
Cold, clammy skinCold, clammy skin Cyanosis- nail beds, lips and ear lobesCyanosis- nail beds, lips and ear lobes Weak, thready, rapid pulseWeak, thready, rapid pulse Shallow respirationsShallow respirations OliguriaOliguria Listlessness, stupor, LOCListlessness, stupor, LOC Excessive thirstExcessive thirst
Core Skills Control Bleeding 25
Internal Signs of HemorrhageInternal Signs of Hemorrhage
Soft tissue bruisingSoft tissue bruising Abdominal tendernessAbdominal tenderness HemoptysisHemoptysis HematemesisHematemesis MelenaMelena
Core Skills Control Bleeding 26
Treatment-Direct PressureTreatment-Direct Pressure
First, expose the wound!!!First, expose the wound!!! Place a sterile dressing Place a sterile dressing
over the wound and over the wound and apply pressure apply pressure
Use a bandage or Use a bandage or cravat to tie a knot over the cravat to tie a knot over the dressing covering the wounddressing covering the wound
Core Skills Control Bleeding 27
Treatment-ElevationTreatment-Elevation
Raise injured extremity above the Raise injured extremity above the heartheart
Used together with direct pressureUsed together with direct pressure Use an object to maintain Use an object to maintain
elevationelevation Utilize bystandersUtilize bystanders
Core Skills Control Bleeding 28
Treatment-Pressure DressingTreatment-Pressure Dressing
Use a pressure dressing if bleeding Use a pressure dressing if bleeding is NOT controlled with direct is NOT controlled with direct pressurepressure
Place Kerlex, ace wrap or cravat Place Kerlex, ace wrap or cravat over previous dressingover previous dressing
Wrap this dressing over Wrap this dressing over the wound and previous the wound and previous dressing dressing
Core Skills Control Bleeding 29
Pressure PointsPressure Points
Severe bleedingSevere bleeding Bleeding not controlled by direct pressure Bleeding not controlled by direct pressure
and elevation and elevation Apply pressure to appropriate pressure Apply pressure to appropriate pressure
pointpoint
(
Core Skills Control Bleeding 31
Pressure PointsPressure Points TemporalTemporal
CarotidCarotid
BrachialBrachial
RadialRadial
FemoralFemoral
Posterior/ Posterior/ Anterior Anterior tibialastibialas
(
Core Skills Control Bleeding 32
Brachial Pressure PointBrachial Pressure Point
Lower part of the upper arm Lower part of the upper arm Above the elbow in the groove between Above the elbow in the groove between
musclesmuscles Using fingers or thumbUsing fingers or thumb Apply pressure to the inside of the arm Apply pressure to the inside of the arm
over the boneover the bone
Core Skills Control Bleeding 34
Femoral Pressure PointFemoral Pressure Point
Control severe Control severe bleeding of thigh and bleeding of thigh and lower leglower leg
Front, center part of Front, center part of crease crease in the groin the groin
Core Skills Control Bleeding 35
Application of Pressure Application of Pressure PointsPoints
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 artery Press directly over artery
– Press heel of other handPress heel of other hand on fingertips on fingertips
Core Skills Control Bleeding 36
SplintingSplinting
Immobilization is one of the best ways to Immobilization is one of the best ways to stop bleedingstop bleeding
Broken bone fragments may grate on Broken bone fragments may grate on blood vesselsblood vessels
Muscular activity can increase rate of Muscular activity can increase rate of blood flow blood flow
Air splints used to apply direct pressureAir splints used to apply direct pressure
Core Skills Control Bleeding 38
TourniquetTourniquet
Direct pressure, elevation, pressure Direct pressure, elevation, pressure dressings or pressure points will not stop dressings or pressure points will not stop some bleedingsome bleeding
In these cases, a In these cases, a tourniquet may be tourniquet may be lifesavinglifesaving
Core Skills Control Bleeding 39
TourniquetTourniquet
Forceful, arterial bleeding Forceful, arterial bleeding (amputation) may require early (amputation) may require early use of a tourniquet.use of a tourniquet.
DO NOT WASTE TIME attempting a DO NOT WASTE TIME attempting a pressure dressing in these casespressure dressing in these cases
Core Skills Control Bleeding 40
Tourniquet Tourniquet
Use a cravat, if available. If not, use:Use a cravat, if available. If not, use:
a belta belt
a ropea rope
a BP cuffa BP cuff
roperope
strap from LBEstrap from LBE
or any other material availableor any other material available
Core Skills Control Bleeding 41
Apply a TourniquetApply 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 extremity Wrap tourniquet around extremity Tie half-knot on upper surfaceTie half-knot on upper surface Place short stick on half-knotPlace short stick on half-knot Tie a square knotTie a square knot Twist stick to tightenTwist stick to tighten UNTIL BLEEDING STOPSUNTIL BLEEDING STOPS
Core Skills Control Bleeding 42
Apply a TourniquetApply a Tourniquet
Never cover a tourniquetNever cover a tourniquet 'T" on casualty's forehead'T" on casualty's forehead Never loosen or remove a Never loosen or remove a
tourniquettourniquet
Core Skills Control Bleeding 43
AmputationAmputation
Apply dressing to cover end of the stumpApply dressing to cover end of the stump Control BleedingControl Bleeding
– Blood vessels collapse, retract Blood vessels collapse, retract or curl closed to limit bleedingor curl closed to limit bleeding
– Direct pressure, pressure Direct pressure, pressure dressing or tourniquetdressing or tourniquet
Core Skills Control Bleeding 44
Preservation of Amputation Preservation of Amputation PartsParts
Rinse amputated part free of debris Rinse amputated part free of debris Wrap loosely in saline-moistened sterile gauzeWrap loosely in saline-moistened 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 freeze Place in a cool container, do not freeze NeverNever place amputated part in water place amputated part in water NeverNever place amputated part directly on ice place amputated part directly on ice NeverNever use dry ice to cool an amputated part use dry ice to cool an amputated part
Core Skills Control Bleeding 45
Hemostatic AgentsHemostatic Agents
QuickclotQuickclot hemostatic powder hemostatic powder
ChitosanChitosan hemostatic dressing hemostatic dressing
Core Skills Control Bleeding 46
Treatment GoalsTreatment Goals
Directed at adequate oxygenation Directed at adequate oxygenation and ventilationand ventilation
STOP THE BLEEDINGSTOP THE BLEEDING Maintain circulation with fluid Maintain circulation with fluid
replacementreplacement
Core Skills Control Bleeding 47
TreatmentTreatment
ABCsABCs Circulation and hemorrhage controlCirculation and hemorrhage control -IV access-IV access -Control external bleeding -Control external bleeding Baseline vitalsBaseline vitals Brief neuro examBrief neuro exam Position casualty and expose Position casualty and expose
hemorrhage siteshemorrhage sites
Core Skills Control Bleeding 48
TreatmentTreatment
Maintain body temperatureMaintain body temperature IV fluid administration- 2 large IV fluid administration- 2 large
bore IVsbore IVs Perform serial neurological exams Perform serial neurological exams
every 5 minutesevery 5 minutes Perform vital signs every 5 minutesPerform vital signs every 5 minutes Transport to medical facility ASAPTransport to medical facility ASAP
Core Skills Control Bleeding 49
HextendHextend
Superficial (> 50% of injuredSuperficial (> 50% of injured
Significant extremity or truncalSignificant extremity or truncal
Significant blood lossSignificant blood loss
• IncoherentIncoherent
• Loss of radial pulse Loss of radial pulse
Core Skills Control Bleeding 50
Summary Summary
A&P of Circulatory SystemA&P of Circulatory System Identify Hemorrhage and Hypovolemic Identify Hemorrhage and Hypovolemic
ShockShock Provide Treatment for HemorrhageProvide Treatment for Hemorrhage Provide Treatment for Hypovolemic Provide Treatment for Hypovolemic
ShockShock