emt chapter 26: bleeding

bleed can cause…

can cause weakness, shock, and death

blood loss can be…

external or internal

important to recognize ________ and understand how it affects the body

bleeding

blood clotting depends on …

flow, vessel wall condition, and clotting ability

platelets collect at the ______ ____ and red blood cells clump together

injury site

autonomic nervous system

monitors body needs and adjusts blood flow; !!! automatically redirects blood to heart, brain, lungs, and kidneys in emergencies; !!! maintains homeostasis and perfusion

hemorrhage definition

bleeding

external bleeding

visible hemorrhage

significance of external bleeding

hard to tell blood loss amount; estimate volume; body can’t tolerate >20% blood loss; signs = ↑ HR, ↑ RR, ↓ BP; faster bleeding = worse symptoms; health and age matter

characteristics of external bleeding

serious signs: significant MOI, poor appearance, shock, fast or uncontrollable bleeding

arterial external bleeding

bright red, spurts with pulse

venous external bleeding

dark red, steady flow

clotting

bleeding usually stops within 10 minutes; vessels narrow, clot forms; bleeding continues if clot doesn’t form

internal bleeding can be…

severe and hard to detect; often from internal organ injury; can cause hypovolemic shock

MOI for internal bleeding

determine cause of injury; look for DCAP-BTLS: deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, swelling

NOI for internal bleeding

can be nontraumatic; causes include ulcers, colon bleeding, ruptured ectopic pregnancy, aneurysm

s/s of internal bleeding

pain, swelling, distention, dyspnea, tachycardia, hypotension, hematoma, bruising, bleeding from openings, hematemesis, melena, guarding, rigid abdomen, hypoperfusion

hypoperfusion signs

early: pale skin, weakness, dizziness on standing, AMS; late: tachycardia, fainting, nausea, cold clammy skin, shallow breathing, dull eyes, weak pulse, ↓ BP, altered LOC

scene size up

check scene safety, determine MOI/NOI, consider spinal immobilization, extra help, and weather factors

primary assessment

listen to lungs; check pulse, skin color/temp, cap refill; treat for shock even if unsure

history taking

use SAMPLE; ask about blood thinners

secondary assessment

check all areas for DCAP-BTLS; record vitals; attach monitors; skip if transport time is short or patient is critical

emergency medical care for external bleeding

control with direct pressure, pressure dressings, splints, tourniquets, hemostatic dressings, or wound packing

pressure dressing

use sterile bandage around wound; wrap firmly but not too tight; don’t remove dressing until doctor checks; use tourniquet if pressure fails

hemostatic agents

use gauze for large wounds where pressure or tourniquet doesn’t work; dressing has clot-promoting chemicals

tourniquets

use for severe limb bleeding; several commercial types exist; very painful but life-saving

splints

air/soft splints help control bleeding (internal or external) and stabilize injury

bleeding from the nose, ears, and mouth

can be from skull fracture, facial injury, infection, high BP, clotting disorder, or trauma; !!! epistaxis (nosebleed) is common and can cause shock; pinch nostrils to stop

bleeding from nose/ears after head injury

may mean skull fracture; don’t try to stop bleeding; lightly cover with gauze; halo stain = cerebrospinal fluid leakage

emergency medical care for internal bleeding

often needs surgery; keep patient calm and still; give high-flow O₂; maintain temperature; splint injured area (air splint)