ECC 7-9

ECC Chap 7-9

Introduction to Shock

  • Adequate blood and oxygen must be provided to all cells in the body.

  • Hypoperfusion: The cardiovascular system fails, and blood circulation ceases.

  • Damage Caused by Shock:

    • Brain: 4 to 6 minutes

    • Abdominal organs: 45 to 90 minutes

    • Skin and muscle cells: 3 to 6 hours

Perfusion Triangle

  • The circulatory system has three components:

    1. Heart (pump)

    2. Blood vessels (pipes)

    3. Blood (fluid)

  • Shock occurs when one or more sides of the perfusion triangle fail.

Causes of Shock

  • Cardiovascular Causes:

    • Pump failure: Cardiogenic shock

    • Loss of fluid/blood: Hypovolemic or hemorrhagic shock

    • Poor vessel function: Neurogenic shock

    • Combined vessel and content failure: Septic shock

  • Noncardiovascular Causes:

    • Respiratory insufficiency: Chest injury, airway obstruction

    • Anaphylactic shock: Medications, food, insect stings

    • Psychogenic shock: Fainting (due to fear, bad news, unpleasant sights)

Progression of Shock

  • Compensated shock: The body compensates for the lack of perfusion.

  • Decompensated shock: The body can no longer compensate (i.e increasing heart rate and blood pressure)

  • Irreversible shock: Permanent damage occurs (the body's systems are failing and death is imminent)

What to Look for in Shock

  • Altered mental status, pale/cold/clammy skin, cyanotic lips/nail beds

  • Nausea/vomiting, rapid breathing, rapid heart rate

  • Unresponsiveness (severe cases)

How to Treat Shock Victim

  • Treat injuries, keep the person flat on their back (if responsive and breathing normally)

  • Raise the feet 6–12 inches (if no injury)

  • If unresponsive, roll onto the side, prevent heat loss, call 9-1-1

  • Do not give food or drink.

Cardiovasculaar vs. Non-Cardio Vascular Methods of Shock:

  • Cardiovascular: Cardiogenic, Hypovolemic, Neurogenic, Septic, Hemorrhagic

  • Non-Cardiovascular: Psychogenic, Respiratory insufficiency, Anaphylaxis

Anaphylaxis: What to Look For

  • Shortness of breath, swelling of tongue/mouth/nose

  • Intense itching, flushed skin, sneezing, coughing, wheezing

  • Tightness in the throat, chest, increased heart rate, dizziness

  • History of previous severe reactions, medical ID tag

Anaphylaxis: What to Do

  • Call 9-1-1, monitor breathing

  • Administer epinephrine (if available), give antihistamine if person can swallow

Using an Epinephrine Auto-Injector

  • Find injection site on the outer midthigh, remove the safety cap

  • Push against thigh and hold for 10 seconds, then pull the auto-injector out

  • Rub the area for 10 seconds.

Mild Allergic Reaction: What to Look For

  • Itchy eyes, sneezing, runny nose, rash (localized)

Mild Allergic Reaction: What to Do

  • Help person self-administer asthma inhaler, take an antihistamine

Fainting: What to Do

  • If a person collapses, check breathing and start CPR if needed

  • Keep the person flat on their back, check for injuries, wipe forehead with cool cloth

  • If about to faint, prevent fall by lying down or sitting.

Impaled Objects: What to Do

If an object is impaled in the cheek or eye, it is important to avoid removing the object, as doing so could cause further injury or bleeding. Here’s what to do:

  1. For Impaled Object in the Cheek:

    • Do not remove the object: Removing it can cause excessive bleeding or damage to blood vessels, nerves, or tissues.

    • Stabilize the object: Gently hold the object in place to prevent movement, as this could worsen the injury.

    • Apply pressure around the base: If bleeding is present, apply gentle pressure around the base of the object with a sterile dressing, gauze, or clean cloth.

    • Call 9-1-1: Immediate medical attention is needed to safely remove the object and manage the injury.

  2. For Impaled Object in the Eye:

    • Do not remove the object: The eye is very delicate, and removing the object can cause further damage.

    • Stabilize the object: If the object is still lodged in the eye, do not let it move. Place a clean dressing around the object to prevent it from shifting.

    • Protect the eye: Use a shield or an object like a paper cup (with the bottom cut off) to cover the eye without pressing on the object. Tape the shield in place around the uninjured eye to keep both eyes still.

    • Seek medical help immediately: The person should be taken to the hospital as quickly as possible for appropriate care.

Bleeding & Wounds

  • Average Blood Volume: 5-6 quarts (5-6L) in adults. Loss of 1 quart (1L) can lead to shock or death.

  • Types of External Bleeding:

    • Arterial: Spurting

    • Venous: Flowing

    • Capillary: Oozing

Body’s Response to Bleeding

  • Blood vessel spasm: Constriction of severed vessels.

  • Clotting: Platelets form a protective clot.

Types of Open Wounds

Open wounds are injuries where the skin or mucous membranes are broken, exposing underlying tissues. There are several types of open wounds, each with its own care approach:

  1. Abrasions:

    • Description: These occur when the outer layer of skin (epidermis) is scraped or rubbed off, often caused by friction or rough surfaces.

    • Appearance: Shallow, red, painful, with the area possibly bleeding slightly.

    • Care: Clean the wound with mild soap and water, apply an antiseptic, and cover with a sterile dressing to protect against infection. These usually heal on their own within a few days.

  2. Incisions:

    • Description: Clean, straight cuts caused by sharp objects such as knives, glass, or metal.

    • Appearance: Clean edges, sometimes deep, with moderate to severe bleeding.

    • Care: Control bleeding with direct pressure. Clean the wound gently, then apply a sterile dressing or bandage. If the incision is deep or the bleeding doesn’t stop, seek immediate medical attention for stitches.

  3. Lacerations:

    • Description: Irregular, jagged cuts caused by blunt trauma or tearing of the skin.

    • Appearance: Jagged edges, bleeding, and sometimes tissue damage.

    • Care: Apply direct pressure to control bleeding, clean the wound with water or saline, and apply a dressing. If the laceration is deep, seek medical attention for stitches or closure.

  4. Avulsions:

    • Description: A wound where tissue or skin is torn away from the body, often leaving a flap of skin or soft tissue.

    • Appearance: Flaps of skin or tissue hanging loosely, with severe bleeding.

    • Care: Apply pressure to control bleeding. If there’s a skin flap, try to place it back into position and cover it with a sterile dressing. Transport the individual to the hospital immediately. If the torn-off tissue is available, it should be wrapped in a clean, moist dressing and brought with the person to the hospital.

  5. Punctures:

    • Description: Wounds caused by sharp objects (e.g., nails, needles, animal bites) that penetrate the skin deeply but may not cause much bleeding on the surface.

    • Appearance: Small, deep hole with little external bleeding but possibly internal injury.

    • Care: Clean the wound gently, apply antiseptic, and cover with a sterile bandage. Puncture wounds have a high risk of infection, especially from objects like animal bites, so it’s important to seek medical attention for proper cleaning and possible tetanus shots.

  6. Amputation: Complete detachment of body parts
    Wound Care

    • Wound Dressing: Should be sterile, clean, and lint-free.

    • Bandages: Hold dressings in place, not necessarily sterile.

    • When to Seek Medical Care: For high-risk wounds (e.g., embedded foreign materials, animal bites, large/deep wounds, visible bone/tendon, infections).

  7. Tetanus

    • Prevention: Vaccines and boosters (every 10 years, or every 5 years for contaminated wounds).

    • Symptoms: Muscle contraction (lockjaw).

  8. Amputations & Avulsions

    • Amputations: Can often be reattached. Apply pressure to control bleeding, treat for shock, and preserve the amputated part (wrap in sterile cloth, place in waterproof container with ice).

    • Avulsions: Gently reposition the skin, apply pressure, and consider a tourniquet if bleeding continues.

  9. Blisters

    • Symptoms: Fluid-filled bubble under the skin, caused by friction.

    • Treatment:

      • For non-painful blisters, use blister bandages or tape.

      • For painful blisters, drain carefully using a sterilized needle and apply antibiotic ointment.

  10. Impaled Objects

    • Small Objects: Remove with tweezers and clean the area.

    • Large Objects: Stabilize the object, apply pressure around its base, and call 911.

  11. Gunshot Wounds

    • Action: Monitor breathing, control bleeding, apply sterile dressings, and seek medical care immediately. Legal implications include documenting the scene and preserving evidence. Any gunshot related injury must be reported to the police

  12. Reasons Blood Clotting may be Inhibited

    • someone who is taking aspirin

    • hemophiliacs

    • someone suffering from severe liver damage

    • someone who is anemic

  13. **emetic + suffering from internal bleeding→ upper GI tract is affected

  14. Once the gauze is soaked with blood the rescuer should consider:

    • Pressing harder and over a wider area

    • Adding more gauze

    • Applying a pressure bandage

  15. External vs. Internal Bleeding

    • Signs/symptoms of internal bleeding: bright red blood from mouth, blood in urine, vomiting blood. Treatment: Monitor breathing, call 911, if it is in an extremity, apply a spint

    • Care for external bleeding: Wear gloves!! (always the  first step), expose wound to find source of bleeding, place sterile gauze pad or clean coth over wound (apply pressure + hold direct pressure for at least 5 min), if bleed does not stop w/ in 10 min add dressings and press harder over a wider area, apply a pressure bandage over the dressing, if bleeding continues cal 911 and consider using a tourniquent if needed, dispose of gloves + wash hands

    • Seek Medical Care: For wound cleaning, stitches, or tetanus immunization.

    • Conditions to apply a hemostatic dressing (A gauze-style dressing saturated with an agent that stops bleeding) 1)Direct pressure is not effective 2) A tourniquet is not available, is ineffective, or cannot be applied

  16. MISC. (Vocab +Q/A):

    • degloving- An injury in which the skin is peeled off the extremity

    • dressing- a sterile gauze pad or clean cloth covering placed over an open wound.

    • incision- A wound that is usually made deliberately in connection with surgery. The edges are cleanly cut as opposed to a laceration.

    • A myocardial infarction is an example of which type of shock? Cardiogenic

    • Hypoperfusion- the medical term for shock

    • Extreme, persistent emesis leads to what kind of shock? Hypovolemic

    • Injuring the spinal cord may lead to this type of hypoperfusion. Neurogenic

    • When should stitches be considered: Deep laceration, Open wound to the face that is an inch or longer, or Any wound that is deep and over an inch in length

    • which type of cell is responsible for coagulation? thrombocyte