Chapter 23

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  • 1.Chapter 23Bleeding

2. National EMS EducationStandard Competencies (1 of 3)TraumaApplies fundamental knowledge to providebasic emergency care and transportationbased on assessment findings for an acutelyinjured patient. 3. National EMS EducationStandard Competencies (2 of 3)Bleeding Recognition and management of: Bleeding Pathophysiology, assessment, andmanagement of: Bleeding 4. National EMS EducationStandard Competencies (3 of 3)PathophysiologyApplies fundamental knowledge of thepathophysiology of respiration and perfusionto patient assessment and management. 5. Introduction Important to be able to: Recognize bleeding Understand how bleeding affects the body Bleeding can be external or internal. Bleeding can cause weakness, shock, anddeath. 6. Anatomy and Physiology of the Cardiovascular System (1 of 3) Functions of the cardiovascular system Circulate blood to cells and tissues Deliver oxygen and nutrients Carry away metabolic waste products 7. Anatomy andPhysiology of the CardiovascularSystem (2 of 3) 8. Anatomy and Physiology of the Cardiovascular System (3 of 3) Three parts Pump (heart) Container (blood vessels) Fluid (blood and body fluids) 9. The Heart (1 of 4) The heart is a hollow muscular organ aboutthe size of a clenched fist. Has its own regulatory system Works as two paired pumps Upper chamber (atrium) Lower chamber (ventricle) 10. The Heart (2 of 4) Blood leaves each chamber through a one-way valve. Right side receives oxygen-poor blood fromveins Left side supplies oxygen-rich blood toarteries 11. The Heart (3 of 4) 12. The Heart (4 of 4) 13. Blood Vessels (1 of 4) Arteries Small blood vessels that carry blood away fromthe heart Arterioles Smaller vessels that connect the arteries andcapillaries 14. Blood Vessels (2 of 4) Capillaries Small tubes that link arterioles and venules Venules Very small, thin-walled vessels that empty intothe veins Veins Blood vessels that carry blood from the tissuesto the heart 15. Blood Vessels (3 of 4) As blood flows out of the heart, it passesinto the aorta, the largest artery in the body. Oxygen and nutrients easily pass from thecapillaries into the cells, and waste andcarbon dioxide diffuse from the cells into thecapillaries. 16. Blood Vessels (4 of 4) 17. Blood (1 of 3) Red blood cells Responsible for the transportation of oxygen tothe cells Responsible for transporting carbon dioxideaway from the cells to the lungs White blood cells 18. Blood (2 of 3)Source: Phototake/Alamy Images 19. Blood (3 of 3) Platelets Responsible forforming clots A blood clot formsdepending onblood stasis,changes in thevessel walls, andthe bodys ability toclot. Plasma 20. Autonomic Nervous System Constantly adapting to maintainhomeostasis and perfusion Monitors the bodys needs Adjusts blood flow and vascular tone Automatically redirects blood away fromother organs to the heart, brain, lungs, andkidneys in an emergency 21. Pathophysiology andPerfusion (1 of 5) Blunt trauma can cause injury andsignificant bleeding that is unseen inside abody cavity or region. Significant amounts of blood loss causehypoperfusion, or shock. In penetrating trauma, the patient may have only a small amount of bleeding that is visible. 22. Pathophysiology and Perfusion (2 of 5) Perfusion is the circulation of blood within an organ or tissue to meet the cells needs for oxygen, nutrients, and waste removal. 23. Pathophysiologyand Perfusion (3 of 5) Some tissuesneed a constantsupply of bloodwhile others cansurvive withvery little. 24. Pathophysiology and Perfusion (4 of 5) All organs and organ systems aredependent on adequate perfusion tofunction properly. Death of an organ system can quickly lead todeath of the person. 25. Pathophysiology and Perfusion (5 of 5) The heart requires a constant supply ofblood. Brain and spinal cord may last 4 to 6 minutes. Kidneys may survive 45 minutes. Skeletal muscles may last 2 hours. Times are based on a normal bodytemperature. 26. External Bleeding Hemorrhage means bleeding. Examples include nosebleeds and bleedingfrom open wounds. As an EMT, you must understand how tocontrol external bleeding. 27. Significance of ExternalBleeding (1 of 4) With serious external bleeding, it may bedifficult to tell the amount of blood loss. Presentation and assessment of the patientwill direct care and treatment. Body will not tolerate a blood loss greaterthan 20% of blood volume. 28. Significance of External Bleeding (2 of 4) Significant changes in vital signs may occurif the typical adult loses more than 1 L ofblood. Increase in heart rate Increase in respiratory rate Decrease in blood pressure 29. Significance of External Bleeding (3 of 4) How well people compensate for blood lossis related to how rapidly they bleed. An adult can comfortably donate 1 unit(500 mL) of blood over 15 to 20 minutes. If a similar blood loss occurs in a much shortertime, the person may rapidly develophypovolemic shock. Consider age and preexisting health. 30. Significance of External Bleeding (4 of 4) Serious conditions with bleeding: Significant MOI Patient has a poor general appearance and iscalm. Signs and symptoms of shock Significant blood loss Rapid blood loss Uncontrollable bleeding 31. Characteristics of External Bleeding (1 of 2) Arterial bleeding Pressure causes blood to spurt and makesbleeding difficult to control. Typically brighter red and spurts in time with thepulse Venous bleeding Dark red, flows slowly or severely Does not spurt and is easier to manage 32. Characteristics of External Bleeding (2 of 2) Capillary bleeding Bleeding from damaged capillary vessels Dark red, oozes steadily but slowlyCapillar VenousArterial y 33. Clotting (1 of 2) Bleeding tends to stop rather quickly, withinabout 10 minutes. When a person is cut, blood flows rapidly. The cut end of the vessel begins to narrow,reducing the amount of bleeding. Then a clot forms. Bleeding will not stop if a clot does not form. 34. Clotting (2 of 2) Despite the efficiency of the system, it mayfail in certain situations. Movement Medications Removal of bandages External environment Body temperature Severe injury 35. Hemophilia Patient lacks blood clotting factors. Bleeding may occur spontaneously. All injuries, no matter how trivial, arepotentially serious. Patients should be transported immediately. 36. Internal Bleeding (1 of 2) Bleeding in a cavity or space inside thebody Can be very serious, yet with no outwardsigns Injury or damage to internal organs commonlyresults in extensive internal bleeding. Can cause hypovolemic shock 37. Internal Bleeding (2 of 2) Possible conditions causing internalbleeding: Stomach ulcer Lacerated liver Ruptured spleen Broken bones, especially the ribs or femur Pelvic fracture 38. MOI for Internal Bleeding (1 of 3) High-energy MOI Internal bleeding is possible whenever theMOI suggests that severe forces affectedthe body. Blunt trauma Penetrating trauma 39. MOI for Internal Bleeding (2 of 3) Signs of injury (DCAP-BTLS) Deformities Contusions Abrasions Punctures/penetrations 40. MOI for Internal Bleeding (3 of 3) Signs of injury (DCAP-BTLS) (contd) Burns Tenderness Lacerations Swelling 41. NOI for Internal Bleeding (1 of 3) Bleeding is not always caused by trauma. Nontraumatic causes include: Bleeding ulcers Bleeding from colon Ruptured ectopic pregnancy Aneurysms 42. NOI for Internal Bleeding (2 of 3) Frequent signs Abdominal tenderness Guarding Rigidity Pain Distention 43. NOI for Internal Bleeding (3 of 3) In older patients, signs include: Dizziness Faintness Weakness Ulcers or other GI problems may cause: Vomiting of blood Bloody diarrhea or urine 44. Signs and Symptoms of Internal Bleeding (1 of 4) Pain (most common) Swelling in the area of bleeding Distention Bruising Dyspnea, tachycardia, hypotension Hematoma Bleeding from any body opening 45. Signs and Symptoms ofInternal Bleeding (2 of 4) Hematemesis Melena Hemoptysis Broken ribs, bruises over the lower part ofthe chest, or a rigid, distended abdomen Hypoperfusion 46. Signs and Symptoms of Internal Bleeding (3 of 4) Later signs of hypoperfusion: Tachycardia Weakness, fainting, or dizziness at rest Thirst Nausea and vomiting Cold, moist (clammy) skin Shallow, rapid breathing 47. Signs and Symptoms of Internal Bleeding (4 of 4) Later signs of hypoperfusion (contd): Dull eyes Slightly dilated pupils Capillary refill of more than 2 seconds in infantsand children Weak, rapid (thready) pulse Decreasing blood pressure Altered level of consciousness 48. Patient Assessment forExternal and Internal Bleeding Patient assessment steps Scene size-up Primary assessment History taking Secondary assessment Reassessment 49. Scene Size-up (1 of 2) Scene safety Be alert to potential hazards. At vehicle crashes, ensure the absence ofleaking fuel and energized electrical lines. In violent incidents, make sure the police are onthe scene. Follow standard precautions. 50. Scene Size-up (2 of 2) Mechanism of injury/nature of illness Determine the NOI or MOI. Consider the need for spinal stabilization andadditional resources. Consider environmental factors such asweather. 51. Primary Assessment (1 of 4) Do not be distracted from identifying lifethreats. Form a general impression. Note important indicators of the patients condition. Be aware of obvious signs of injury. Determine gender and age. Assess skin color and the LOC. 52. Primary Assessment (2 of 4) Airway and breathing Consider the need for spinal stabilization. Ensure a patent airway. Look for adequate breathing. Check for breath sounds. Provide high-flow oxygen or assist ventilationswith a bag-mask device or nonrebreathingmask. 53. Primary Assessment (3 of 4) Circulation Assess pulse rate and quality. Determine skin condition, color, andtemperature. Check capillary refill time. Control external bleeding. Treat for shock. 54. Primary Assessment (4 of 4) Transport decision Assessment of ABCs and life threats will determine the transport priority. Signs that imply rapid transport: Tachyca