C191W003 Control Bleeding and Hypovolemic Shock

Control Bleeding and
Hypovolemic Shock
Introduction
 Review methods of controlling bleeding
 Hemorrhage control save lives
 ABC Measures
– Clear the airway/restoring breathing
– Stop the bleeding
– Protect the wound
– Treat/prevent shock
 A-B-C measures apply to all injuries
Core Skills Control Bleeding 2

Right Atrium Left Atrium
Left
Ventricle
Right
Ventricle

Function of Blood
 Transport O² and nutrients to the cells

 Removes CO² and other waste products
 Detoxification and elimination

Plasma
 Serum, protein and chemical substances
 Watery, salty fluid
 Constitutes over half the volume of blood
 Transports substances to various
structures
 Transports waste products
 Carries red and white blood cells and platelets

Red Blood Cells
 Erythrocytes
 Primary function
– Carry oxygen to tissues
– Carry carbon dioxide
away from tissues
 Red color to blood
White Blood Cells
 Leukocytes
 Destroy
microorganisms
 Produce antibodies

Platelets
 Thrombocytes
 Membrane-enclosed
fragments of specialized
cells
 Release chemical factors
to form blood clots
Pulses
 Left ventricle contracts
 Peripheral pulse
– Radial
– Brachial
– Posterior tibial
– Dorsalis pedis
 Central pulses
– Carotid
– Femoral
Blood Pressure
 Exerts pressure against blood vessels walls
 Systolic
– Pressure created in the
arteries
– Reported first
 Diastolic
– Left ventricle relaxed and
refilling
– Reported second

Blood
 Hemorrhage or bleeding
 Escape of blood from capillaries, veins,
and arteries
 Adult body:
– Contains approximately 5 to 6 liters of blood
– 1 pint of blood without harmful effects
– 2 pints may cause shock

External Bleeding
 Incision
 Laceration
 Abrasion
 Puncture wounds
 Amputation

Laceration

Puncture Wound

Amputation

Abrasion

Incision

Internal Bleeding
 Not always obvious
 Suspicion based on mechanism of injury
– Falls
– Blast injuries
– Penetrating trauma

Internal Bleeding

Injured Internal Organs

Sources of Bleeding
 Arterial
Rapid, profuse and pulsating; bright red in
color
 Venous
Steady flow; dark red or maroon in color
 Capillary
Slow and oozing; often clots spontaneously

Hypovolemic Shock
 Inadequate tissue perfusion
 Causes
Hemorrhage
Severe burns
Severe vomiting and/or diarrhea

Clinical Signs of Acute Hemorrhage
Class % Blood Clinical Signs

Loss
I Up to 750 ml Slight increase in HR; no change in BP
(15%) or respirations
II 750-1500 ml Increased HR and respirations;
(15-30%) increased diastolic BP; anxiety, fright or
hostility
III 1500-2000 Increased HR and respirations; fall in
ml (30-40%) systolic BP; significant AMS
IV >2000 Severe tachycardia; severe lowering of
(>40%) BP; cold, pale skin; severe AMS
Other Common Signs of
Hypovolemic Shock
 Cold, clammy skin

 Cyanosis- nail beds, lips and ear lobes
 Weak, thready, rapid pulse
 Shallow respirations
 Oliguria
 Listlessness, stupor, LOC
 Excessive thirst
Internal Signs of Hemorrhage
 Softtissue bruising
 Abdominal tenderness
 Hemoptysis
 Hematemesis
 Melena

Treatment-Direct Pressure
 First, expose the wound!!!

 Place a sterile dressing
over the wound and
apply pressure
 Use a bandage or
cravat to tie a knot over the dressing
covering the wound

Treatment-Elevation
 Raise injured extremity above the heart
 Used together with direct pressure
 Use an object to maintain elevation
 Utilize bystanders

Treatment-Pressure Dressing
 Use a pressure dressing if bleeding is
NOT controlled with direct pressure
 Place Kerlex, ace wrap or cravat over
previous dressing
 Wrap this dressing over
the wound and previous
dressing

Pressure Points
 Severe bleeding
 Bleeding not controlled by direct pressure
( and elevation
 Apply pressure to appropriate pressure
point

Pressure Points

Pressure Points
 Temporal
 Carotid
 Brachial
(
 Radial
 Femoral
 Posterior/
Anterior
tibialas

Brachial Pressure Point
 Lower part of the upper arm
 Above the elbow in the groove between
muscles
 Using fingers or thumb
 Apply pressure to the inside of the arm
over the bone

Brachial Pressure Point

Femoral Pressure Point
 Control severe
bleeding of thigh and
lower leg
 Front, center part of
crease in the groin

Application of Pressure Points
 Position the casualty on his or her back
 Kneel on opposite side from wound
 Place heel of hand directly on pressure point
 Lean forward to apply pressure
 If bleeding is not controlled
– Press directly over artery
– Press heel of other hand on fingertips

Splinting
 Immobilization is one of the best ways to
stop bleeding
 Broken bone fragments may grate on
blood vessels
 Muscular activity can increase rate of
blood flow
 Air splints used to apply direct pressure
Air Splints

Tourniquet
 Direct pressure, elevation, pressure

dressings or pressure points will not stop
some bleeding
 In these cases, a
tourniquet may be
lifesaving

Tourniquet
 Forceful, arterial bleeding (amputation)

may require early use of a tourniquet.
 DO NOT WASTE TIME attempting a
pressure dressing in these cases

Tourniquet
 Use a cravat, if available. If not, use:
a belt
a rope
a BP cuff
rope
strap from LBE
or any other material available
Apply a Tourniquet
 Place tourniquet between heart and wound
 Place pad over artery to be compressed
 Wrap tourniquet around extremity
 Tie half-knot on upper surface
 Place short stick on half-knot
 Tie a square knot
 Twist stick to tighten
 UNTIL BLEEDING STOPS
Apply a Tourniquet
 Never cover a tourniquet
 'T" on casualty's forehead
 Never loosen or remove a
tourniquet

Amputation
 Apply dressing to cover end of the stump
 Control Bleeding
– Blood vessels collapse, retract
or curl closed to limit bleeding
– Direct pressure, pressure
dressing or tourniquet

Preservation of Amputation Parts
 Rinse amputated part free of debris
 Wrap loosely in saline-moistened sterile gauze
 Seal amputated part in a plastic bag or cravat
 Place in a cool container, do not freeze
 Never place amputated part in water
 Never place amputated part directly on ice
 Never use dry ice to cool an amputated part

Hemostatic Agents
Quickclot hemostatic powder

Chitosan hemostatic dressing

Treatment Goals
 Directed at adequate oxygenation and
ventilation
 STOP THE BLEEDING
 Maintain circulation with fluid
replacement

Treatment
 ABCs
 Circulation and hemorrhage control
 -IV access
 -Control external bleeding
 Baseline vitals
 Brief neuro exam
 Position casualty and expose hemorrhage sites

Treatment
 Maintain body temperature
 IV fluid administration- 2 large bore IVs
 Perform serial neurological exams every
5 minutes
 Perform vital signs every 5 minutes
 Transport to medical facility ASAP

Hextend
 Superficial (> 50% of injured

 Significant extremity or truncal
 Significant blood loss
• Incoherent
• Loss of radial pulse

Summary
 A&P of Circulatory System
 Identify Hemorrhage and Hypovolemic
Shock
 Provide Treatment for Hemorrhage
 Provide Treatment for Hypovolemic
Shock

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Control Bleeding and

Core Skills Control Bleeding 2

Core Skills Control Bleeding 3

 Transport O² and nutrients to the cells

Core Skills Control Bleeding 4

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Class % Blood Clinical Signs

 Cold, clammy skin

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 First, expose the wound!!!

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 Direct pressure, elevation, pressure

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 Forceful, arterial bleeding (amputation)

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Quickclot hemostatic powder

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 Superficial (> 50% of injured

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