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Unformatted text preview: Ch. 6-Bleeding and Shock 1 Bleeding Bleeding
The severity of bleeding depends on How fast the blood is flowing from the vessel The size of the vessel Whether the vessel is a vein or an artery Whether the bleeding is internal or external Where the bleeding originated The victim’s age and weight The victim’s general physical condition Whether or not the bleeding is a threat to the airway and respiration 2 3 Effects of Bleeding When bleeding is uncontrolled, the body can’t compensate quickly enough, and shock results A loss of 2 pints in an adult is serious A loss of 3 pints of blood can be fatal The most difficult bleeding to control comes from arteries 4 Controlling Bleeding Controlling
Initial first aid steps in the bleeding victim: 1. Stop the bleeding. 2. Determine the cause and source of the bleeding and the general condition of the victim. 3. Place the victim in a position in which he or she will be least affected by the loss of blood. 4. Maintain an open airway. 5 Infection-Control Precautions Infection-Control Place a barrier between you and the victim’s blood Avoid touching your mouth, nose, or eyes As soon as you finish treating the victim, wash your hands thoroughly with soap and hot water Wash all items that have the victim’s blood or body fluids on them in hot, soapy water 6 Types of Pressure Types Direct: Applied directly to the wound Indirect: Applied to a pressure point 7 Applying Direct Pressure Applying
1. Place a sterile dressing over the wound so that it is covered completely. 2. Press firmly over the dressing with your finger tips or palm directly to the site of bleeding. 3. Elevate the bleeding part above heart level unless you suspect a fracture, dislocation, impaled object, or spinal injury. 4. You can use a cold pack over the wound as you apply direct pressure and elevation 5. Check the dressing every few minutes. 6. Never apply direct pressure to a wound if there is an object embedded in the wound or if a bone is protruding from the wound. 8 Using a Pressure Bandage Using
1. Cover the wound completely with a thick dressing; make sure all edges of the wound are covered. 2. Holding the dressing in place, wrap the pressure bandage around the dressing tightly enough to exert moderate pressure. 3. Periodically check the distal pulses, and frequently check for mottled skin or blanched nails, signs that the pressure bandage is too tight. 9 Direct pressure Pressure bandage Pressure bandage 10 10 11 11 Indirect pressure 12 12 Air splint Air splint 13 13 Using an Air Splint Using
1. Cover the wound with a thick, sterile dressing. 2. Slip the splint over the dressing, taking care not to shift or remove the dressing. 3. Inflate the splint. Take care not to over inflate— you should be able to depress the surface of the splint at least half an inch with your fingertips. 4. Check distal pulses often if they are not covered by the splint; check frequently for mottled skin or blanched nails, signs that the splint is too tight. 14 Using a Blood Pressure Cuff Using Secure it well so the Velcro does not pop open. Inflate it to a pressure that causes the bleeding to stop, usually 10 to 20 mm Hg above the systolic blood pressure. Never deflate the cuff unless a physician orders you to do so. 15 Tourniquets Used rarely and only as a last resort Used only if bleeding is life threatening example: large artery has been severed or a limb has been partially or totally severed Any material greater than 3 inches wide can be used Never remove a tourniquet with out doctors orders 16 16 Applying a Tourniquet Applying
1. Hold the appropriate pressure point to control bleeding temporarily, then place the tourniquet between the heart and 2 inches from the wound 2. Put a thick pad over the tissue that will be compressed. 3. Wrap the tourniquet material tightly around the limb twice, then tie it in a halfknot on the upper surface of the limb. 4. Place a short stick or other similar object at the halfknot, then tie a square knot. 5. Twist the stick to tighten the tourniquet only until the bleeding stops. 6. Write a note detailing the location of the tourniquet, the time it was applied, and the vital signs at the time you applied it. 17 Tourniquet
18 18 Tourniquet Internal Bleeding Internal Signs and Symptoms Restlessness, cool clammy skin, weak rapid pulse, low blood pressure First Aid Care 1. Secure and maintain an open airway, and monitor the ABCDs. 2. Check for fractures; splint if appropriate. 3. Keep the victim quiet. Position and treat the victim for shock. 4. Monitor vital signs every 5 minutes until emergency personnel arrives.
19 Nosebleed Nosebleed
1. Keep the victim quiet and in a sitting position, leaning forward to prevent aspiration of blood 2. If you do not suspect nasal fracture, pinch the nostrils together. 3. Apply cold compresses to the bridge of the nose. 4. If the bleeding does not stop, insert a clean gauze pad into the nostril and apply pressure 5. Call 911 if a nosebleed lasts longer than 15 minutes. 20 treating a nosebleed treating a nosebleed 21 21 Shock 22 22 Shock Shock is the collapse and progressive failure of the cardiovascular system If untreated it is fatal Onset can be gradual or rapid 23 23 Causes of Shock Causes
Shock is caused by inadequate tissue perfusion when: 1. Fluid is lost from the circulatory system (generally a result of bleeding, burns, or dehydration). 2. The heart fails to pump the blood effectively. 3. The blood vessels dilate, causing blood to pool in extremities and nonvital areas. 4. The body’s supply of oxygen is inadequate. 24 25 25 Stages of Shock
First Stage: Compensatory shock The first stage of shock, in which the body attempts to overcome the decrease in tissue perfusion Second Stage: Progressive (decompensatory) shock The second stage of shock, in which the compensatory mechanisms have failed, the blood pressure begins to decrease, and the organs are beginning to suffer from the lack of perfusion Third Stage: Irreversible shock The final stage of shock, in which body organs start to die
26 26 Signs & Symptoms of Shock restlessness increased heart rate pale cool skin in hemorrhagic shock warm flushed skin in septic, anaphylactic and neurogenic shock increased respirations decreased body temperature, except in septic
27 27 Compensatory Signs & Symptoms of Shock listlessness, apathy confusion cold, clammy skin cyanotic decreased body temperature confusion, incoherent speech dilated pupils, slow to react shallow, irregular breathing
28 28 Progressive Shock Preventing Shock Preventing Making sure the victim is breathing adequately; if necessary, provide rescue breathing Controlling any bleeding Loosening restrictive clothing Reassuring the victim and staying calm and in control yourself Splinting and immobilizing fractures Taking measures to relieve pain (properly dressing, bandaging, splinting, and positioning the victim) Positioning the victim supine with feet elevated no more than 8–12 inches, if the victim is alert or responding appropriately; if the victim is in an altered mental state, on his or her side Keeping the victim warm without overheating
29 Treatment of Shock Treatment
You must activate EMS 1. Secure an open airway. 2. Place the victim on his or her back unless the victim has an object impaled in the back of the body, difficulty breathing or heart attack symptoms. 3. Control any obvious bleeding. 4. Elevate the legs no more than 8 to 12 inches above heart level. Never tilt the entire body so that the feet are elevated and the head is lower than the body—doing so can impair breathing. 5. Splint any fractures; this can reduce shock by controlling bleeding and relieving pain. 6. Keep the victim warm by conserving body heat, but do not overheat. 7. Keep the victim quiet and still 8. Give the victim nothing by mouth. If the victim complains of intense thirst, moisten his or her lips with a wet towel. 9. Monitor vital signs and mental status at 5minute intervals until emergency personnel arrive. 30 Shock first aid 31 31 Anaphylactic Shock Anaphylactic
Caused by an intense allergic reaction Signs and Symptoms Skin itching, burning, cyanotic, hives, swelling Heart and Blood Vessels weak pulse, low blood pressure Respiratory Tract coughing, wheezing, swelling Gastrointestinal Tract nausea, vomiting, diarrhea, cramps Central Nervous System restlessness, fainting, convulsions, altered mental status
32 Causes of anaphylactic shock
33 33 Symptoms of anaphylactic shock Management of Anaphylactic Shock Shock
1. Secure an open airway. 2. If indicated, begin rescue breathing or CPR. 3. If the victim has an epinephrine auto injector, help the victim use it if allowed by local protocol. 34 EpiPen Administering an EpiPen
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This note was uploaded on 02/17/2011 for the course HK 280 taught by Professor Trembath during the Fall '07 term at Purdue.
- Fall '07