Bleeding + Shock⚡

Anatomy of the Heart

• Pump (heart)

• Container (blood vessels)

• Fluid (blood + body fluids)

Diseases

• Hemophiliac: don’t clot that much

• Thrombophilia: clots a too much

• Hypovolemic Shock: a condition in which low blood volume results in inadequate perfusion and even death.

Autonomic Nervous system

• Monitors the body’s needs and adjusts blood flow by constricting or dilating blood vessels.

• During an emergency: the ANS will redirect blood to the most important organs such as the heart, brain, lungs, and kidneys.

Brain

• The brain begins to die with 2 minutes of no oxygen to the brain

• After around 6 minutes there are severe detriments

• At 10 minutes they will most likely be on life support for the rest of their life

Kidneys

• 30-60 Minutes until you probably need to go on dialysis

Muscle Tissue

• 2-4 Hours

Our Goal: 2 hours to a trauma center

• The body will not tolerate a blood loss greater than 20% of blood volume

If a patient loses a lot of blood- you want to give them oxygen (even if they look okay) because you want to compensate for the quantity of red blood cells with quality of them

Pediatrics:

• Children will be okay until out of nowhere will they will deteriorate- you want to have a high index of suspicion to recognize the early signs of shock, as their compensatory mechanisms can mask serious underlying issues.

Clotting:

• The cut end of the vessels begin to narrow, reducing the amount of bleeding, then a clot forms. However, bleeding will not stop if a clot doesn’t form

External Bleeding:

• Characteristics

  • Patient has a poor general appearance and no response to external stimuli

  • Assessment reveals signs/symptoms of shock (hypoperfusion)

  • You note a significant amount of blood loss

  • The blood loss is rapid and ongoing

  • You cannot control the bleeding

  • The bleeding is associated with significant MOI

Internal Bleeding:

• Possible conditions that cause internal bleeding

  • Stomach Ulcer, Lacerated Liver, Ruptured Spleen, Broken bones

• MOI for Internal Bleeding

  • DCAP-BTLS

  • Medical Care for External Bleeding

    • Direct Pressure: Apply direct pressure to the wound using a clean cloth or bandage to help control bleeding and promote clotting.

    • Pressure dressings and/or splints

      Ineffective? (Go on!)

    • Tourniquet: apply a tourniquet above the injury site, ensuring it is tight enough to stop blood flow but not so tight that it causes further injury. (Specific to limbs)

    • Junctional Tourniquet (for bleeding near the torso)

    • Hemostatic dressing: A dressing with chemical that slows bleeding

• NOI for internal bleeding

  • Bleeding Ulcers, bleeding from colon, ruptured ectopic pregnancy, ruptured aneurysm

• Signs/Symptoms:

  • Pain,

  • Swelling in the area,

  • distention,

  • dyspnea, tachycardia, hypotension,

  • hematoma,

  • bruising

  • Bleeding from body opening

  • Hematemesis

  • melena

  • pain, tenderness, bruising, guarding, or swelling

  • broken ribs

  • Bruises over lower part of the chest

  • Rigid, distended abdomen

  • Hypoperfusion

    • Change in Mental Status

    • Weakness, faintness, or dizziness on standing

    • Changes in skin color or pallor (pale skin)

    • Tachycardia ← Later sign (Hypovolemic shock signs)

    • Weakness, fainting or dizziness at rest ← Later sign (Hypovolemic shock signs)

    • Thirst nausea vomiting ← Later sign (Hypovolemic shock signs)

    • cold moist (clammy) skin ← Later sign (Hypovolemic shock signs)

    • Shallow, Rapid breathing ← Later sign (Hypovolemic shock signs)

    • Dull eyes ← Later sign (Hypovolemic shock signs)

    • Slightly dilated pupils that are slow to respond ← Later sign (Hypovolemic shock signs)

    • Cap refill >2 in pediatrics ← Later sign (Hypovolemic shock signs)

    • Weak, rapid (thready) pulse← Later sign (Hypovolemic shock signs)

    • Decreasing BP ← Later sign (Hypovolemic shock signs)

    • Altered LOC← Later sign (Hypovolemic shock signs)

Bleeding from the nose, ears, and mouth

• Fracture of the base of the skull

• Facial injuries

• Sinusitis, infections, use, abuse, or nose drops, dried or cracked nasal mucosa

• high BP

• coagulation disorders

• digital trauma

• cancer

Vitals

• Of significant blood loss

  • Increased heart rate, respiratory rate

  • Decrease in Blood pressure

Pediatrics:

• Blood pressure is not a reliable vital

BLS

Splints

• Air Splints: Can help control bleeding and immobilize fractures

• Pelvic Binder: made to splint a suspected pelvic fracture

  • Open-book pelvic fracture: a life threatening fracture of the pelvic caused by a force that displaces one or both side of the pelvis laterally and posteriorly (applied when there is a suspected fracture in the pelvis and has signs of shock)

Third Mid-Quarter Cognitive Study Guide: Shock + Bleeding

• What are the parts of the Cardiovascular System?

  • Heart: Pumps blood throughout the body.

  • Blood vessels: Includes arteries, veins, and capillaries for blood transport.

  • Blood: Carries oxygen, nutrients, and waste materials.

• What do the Systolic and Diastolic parts of the blood pressure measure?

  • Systolic pressure measures the pressure against the walls of arteries when the heart beats and pumps blood, while diastolic pressure indicates the pressure left over in the arteries when the heart is at rest between beats.

  • The pulse pressure is the difference between the systolic and diastolic. 120/80 = 40

• What is required for profusion to be adequate?

• What is the pulse rate that tells you a patient is in shock:

  • If they have a thready pulse (weak and rapid)

• Define the following:

  (these are all types of distributive shock)

  • Anaphylactic Shock: A severe shock as a result of an allergic reaction

  • Psychogenic Shock: a temporary loss of consciousness caused by emotional stress or trauma, leading to a drop in blood flow to the brain. Every blood vessel in your body dilates, causing for your BP to drop and you most likely lose consciousness.

  • Neurogenic Shock: Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation. Commonly seen in patients with spinal cord injuries

  • Septic Shock: Shock caused by a severe infection (usually bacterial)

• Know the parts of the heart and their locations

• What are the parts of the blood and what do they do?

  • White Blood cells: Responsible for defending the body against infections and foreign invaders.

  • Platelets:

  • Plasma

  • Red blood cells

• How much blood can a person donate at one time?

  • ½ L, 2 cups, 1 pint, 500mil (all the same)

  • half of the critical blood loss (10%?)

• What is it called when a person’s blood cannot clot?

  • Hemophilia

• How can you tell if fluid contains cerebrospinal fluid?

• If you dab the blood (primarily in the ears i think) and it appears like a taget or halo this is most likely spinal fluid

• When would you use the following?

  • Pelvic binder: Suspected pelvic injury (especially when shock is probable)

  • KED (Kendrick Extrication Device): Used for immobilizing patients with suspected spinal injuries during extrication from vehicles or confined spaces.

  • Back Board

Shock

First Signs of Shock: The Skin!

• Cool, clammy, possibly cyanosis

Second: Digestive!

Third: Kidneys —— At this point we are circling the drain

Fourth: Brain, lungs, etc.

Anaphylactic shock:

Skin

• Flushed, itchy, burning

• Urticaria

• Edema

• Pallor

• Cyanosis

Circulatory

• Dilated peripheral blood vessels

• Increased vessel permeability

• drop in BP

• weak, barely palpable pulse

Respiratory

• Sneezing or itching in nasal passages

• stridor

• upper airway obstruction

• tightness in the chest with dry cough

• Wheezing and dyspnea

• Secretions of fluid and mucus into bronchial passages, alveoli, and lung tissue, causing coughing

• Constriction of the bronchi; difficulty drawing air into the lungs

• Forced expiration, requiring exertion and accompanied by wheezing

• Cessation of breathing

Other

• Abdominal cramping

• nausea

• vomiting

• Altered MS

• Dizziness

• Fainting and coma

Compensated Shock:

• Agitation

• Anxiety

• Restlessness

• Feeling of impending doom

• weak, rapid (thready) pulse

• Clammy and Pallor

• Cyanosis around lips

• Shallow, rapid breathing

• nausea or vomiting

• cap refill >2 secin pediatrics

• Marked thirst

• Narrowing pulse pressure

Decompensated Shock:

• Falling BP

• Declining MS or altered LOC

• labored/irregular breathing

• Ashen, mottled, or cyanotic skin

• THready or absent peripheral pulse

• Dull eyes, dilated pupils

• Poor urinary output

Progression of Shock

• Multiple severe fractures

• Abdominal or chest injury

• spinal injury

• severe infection

• major heart attack

• anaphylaxis

Care for Shock TIp

• Do not delay transport to apply individual splints; if possible do it during transport

  • Splinting minimizes pain and bleeding

• Provide high-flow oxygen if available, and monitor vital signs closely throughout the journey.

• To minimize loss of body heat cover the patient in blankets (but don’t use anything else)

Terminology

• Hemorrhage = Bleeding

• External Bleeding = visible hemorrhage

• Ecchymosis = A buildup of blood beneath the skin that produces a characteristic blue or black discoloration as the result of an injury

• Contusion = a bruise from an injury causing bleeding beneath the skin

• Hematoma = a mass of blood that has collected within damaged tussue under the skin

• Hemoptysis = coughing up blood

• Hematemesis = vomiting blood, which may indicate a serious gastrointestinal issue.

• Melena = the passage of black, tarry stools due to the presence of digested blood.

• Hematuria = blood in the urine

• Guarding = Involuntary muscle contractions (spasm) of the abdominal wall

• Hypoperfusion = the inadequate supply of blood to the tissues, leading to oxygen deprivation and potential organ failure.

• Junctional Tourniquet = A device that provides proximal compression of severe bleeding near the axial or inguinal junction with the torso

• Hemostatic dressing = a impregnated with a chemical compound that slows or stops bleeding by assisting with clot formation

• Perfusion = the flow of blood through the body tissues and vessels

• Distributive Shock = A condition that occurs when there is widespread dilation of the small arterioles, small venules, or both

• Compensated Shock = a state where the body's compensatory mechanisms, such as increased heart rate and peripheral vasoconstriction, maintain adequate blood flow and oxygen delivery despite decreased perfusion. The early stage of shock, in which the body can still compensate for blood loss

• Decompensated Shock = a more severe stage of shock where the body's compensatory mechanisms begin to fail, leading to inadequate perfusion and oxygenation of tissues, which can result in organ dysfunction and potentially death if not promptly addressed. The late stage of shock when BP fails.

• Irreversible shock = a condition defined by the inability to successfully achieve resuscitation no matter what

• Thready pulse = Rapid & Weak pulse

Case/Scenario

• Patient is switching between 40 resp/min and 14 resp/min = this could be a real problem but it could also be pain or fear

• When you are applying pressure to a patient, don’t take the bottom layer off! The blood is most likely clotting and if you take it off you will undo that and cause more bleeding

• When applying a tourniquet, it comes already in a loop. If you are applying direct pressure undo the loop before putting it on because you should never remove your hand. Make sure you pull it as tight as possible, then twist.

• If you see urticaria on the patients chest area- it likely that they consumed something

• When you are working with a patient in a car accident, do a rapid (including PMS) before you move them, once again in the ambulance (and if you want before you transfer care.