BLEEDING AND SHOCK

PIPES, PUMP, AND FLUIDREALLY, ITS

THAT SIMPLE!

CARDIOVASCULAR SYSTEM
HEART
ARTERIES
VEINS
CAPILLARIES
BLOOD

CARDIOVASCULAR SYSTEM
TRANSPORTS O2 AND FUEL TO THE CELLS, TISSUES,
AND ORGANS.
REMOVES CO2 AND WASTES FROM THE CELLS FOR
ELIMINATION FROM THE BODY.
MUST BE ABLE TO MAINTAIN SUFFICIENT FLOW
THROUGH THE CAPILLARY BEDS TO MEET THE CELLS
O2 AND FUEL NEEDS

BLEEDING
INTERNAL

EXTERNAL

INTERNAL BLEEDING

TRAUMA
CLOTTING DISORDERS
RUPTURE OF BLOOD VESSELS
FRACTURES (INJURY TO NEARBY VESSELS)
CAN RESULT IN RAPID PROGRESSION TO
HYPOVOLEMIC SHOCK & DEATH

INTERNAL BLEEDING S/S

THINK ABOUT MOI OR NOI!
ANXIETY, RESTLESSNESS, IRRITABILITY
PALE, DIAPHORETIC SKIN
SUSTAINED TACHYCARDIA
HYPOTENSION
UNSTABLE VITALS SIGNS (POSTURAL CHANGES)
VOMITING BRIGHT RED BLOOD OR COFFEE GROUND MATERIAL

BLEEDING FORM ANY BODY ORIFICE

DARK, TARRY STOOLS (MELENA)
TENDER, RIGID, OR DISTENDED ABDOMEN
PAIN, DISCOLORATION, SWELLING, TENDERNESS AT INJURY
SITE

MANAGING INTERNAL BLEEDING

ABCS
HIGH CONCENTRATION OXYGEN
ASSIST VENTILATIONS
CONTROL EXTERNAL BLEEDING
STABILIZE FRACTURES
RICE
TRANSPORT RAPIDLY TO APPROPRIATE
FACILITY

EXTERNAL BLEEDING
ARTERIAL BLEED
BRIGHT RED, SPURTING

VENOUS BLEED
DARK RED, STEADY FLOW

CAPILLARY BLEED
DARK RED, OOZING

CONTROL OF EXTERNAL BLEEDING

DIRECT
PRESSURE:
GLOVED HAND
OR
DRESSING AND
BANDAGE

Elevation:
Raise extremity
above the level of the
heart

Pressure
Dressing:
Use bandage to
secure dressing
in place

ARTERIAL PRESSURE POINTS

UPPER
EXTREMITY:
BRACHIAL
RADIAL

LOWER
EXTREMITY:
FEMORAL
POPLITEAL

TOURNIQUETS
FINAL RESULT WHEN ALL ELSE FAILS
USED FOR AMPUTATIONS
3-4 WIDE (BLOOD PRESSURE CUFFS)
WRITE TK AND TIME OF APPLICATION ON FOREHEAD
OF PATIENT
NOTIFY OTHER PERSONNEL
ONCE APPLIED, DO NOT REMOVE

EPISTAXIS (NOSEBLEED)
CAUSES

FRACTURED SKULL
FACIAL INJURIES
SINUSITIS, OTHER URIS
HIGH BP
CLOTTING DISORDERS
DIGITAL INSERTION (NOSE
PICKING)

MANAGEMENT OF EPISTAXIS
SIT UP, LEAN FORWARD
PINCH NOSTRILS TOGETHER
KEEP IN SITTING POSITION
KEEP QUIET
APPLY ICE OVER NOSE (15 MIN)

CAN RESULT IN LIFE-THREATENING BLOOD LOSS!

SHOCK
INADEQUATE PERFUSION(BLOOD FLOW) LEADING TO
INADEQUATE OXYGEN DELIVERY TO TISSUES
IS A STATE OF CIRCULATORY HYPOVOLEMIA (LOW VOLUME)
ASSOCIATED WITH A FALL OF BLOOD PRESSURE WHICH LEADS
TO THE LOSS OF VITAL FUNCTIONS WHICH EVENTUALLY
THREATENS THE PATIENTS LIFE

SHOCK
PUMP FAILURE (HEART)
PIPE FAILURE (VESSELS)
LOSS OF VOLUME
(BLOOD)

STAGE OF SHOCK

CLASSIFICATION AND ETIOLOGY OF SHOCK

1. CARDIOGENIC SHOCK
2. DISTRIBUTIVE SHOCK
SEPTIC SHOCK
ANAPHYLACTIC SHOCK
NEUROGENIC SHOCK

3. OBSTRUCTIVE SHOCK
4. HYPOVOLEMIC SHOCK

CARDIOGENIC SHOCK
PUMP FAILURE
HEARTS OUTPUT DEPENDS ON
HOW OFTEN IT BEATS (HEART RATE)
HOW HARD IT BEATS (CONTRACTILITY)

RATE OR CONTRACTILITY PROBLEMS CAUSE PUMP

FAILURE

CARDIOGENIC SHOCK
CAUSES
ACUTE MYOCARDIAL INFARCTION
VERY LOW HEART RATES (BRADYCARDIAS)
VERY HIGH HEART RATES (TACHYCARDIAS)

CARDIOGENIC SHOCK S/S

CHEST PAIN
WEAK, IRREGULAR PULSE
HYPOTENSION (HTN WITH CHF)
CYANOSIS, SIGNS OF INADEQUATE PERFUSION
COOL, CLAMMY SKIN
ANXIETY

DISTRIBUTIVE SHOCK (SEPTIC)

RESULTS FROM BODYS RESPONSE TO BACTERIA IN
BLOODSTREAM
VESSELS DILATE, BECOME LEAKY

SEPTIC SHOCK S/S

ANXIETY, RESTLESSNESS, IRRITABILITY
FEBRILE, WARM SKIN
HYPOTENSION
TACHYCARDIA
INCREASED RESPIRATORY RATE
CHANGE IN MENTAL STATUS

DISTRIBUTIVE SHOCK (ANAPHYLACTIC)

RESULTS FROM SEVERE ALLERGIC REACTIONS
BODY RESPONDS TO ALLERGEN BY RELEASING HISTAMINE
HISTAMINE RELEASE CAUSES VESSELS TO DILATES AND BECOME
LEAKY

ANAPHYLACTIC SHOCK S/S

SUDDEN ONSET
MILD ITCHING, RASH, UTICARIA, HIVES
BURNING SENSATION (SKIN)
HYPOTENSION
GENERALIZED EDEMA
ANGIODEMA, AIRWAY COMPROMISE
RESPIRATORY DISTRESS
COMA, RAPID DEATH

DISTRIBUTIVE SHOCK (NEUROGENIC)

SPINAL CORD INJURIES THAT RESULT IN THE
INTERRUPTION OF COMMUNICATION PATHWAYS
BETWEEN CNS AND REST OF BODY
VESSELS BELOW THE INJURY SITE DILATE LEADING TO
DECREASED VASCULAR RESISTANCE

NEUROGENIC SHOCK S/S

ANXIETY, RESTLESSNESS, IRRITABILITY
BRADYCARDIA
HYPOTENSION
SKIN ABOVE INJURY SITE: PALE, COOL, CLAMMY
SKIN BELOW INJURY SITE: WARM, PINK, DRY
SIGNS OF SPINAL INJURY

OBSTRUCTIVE SHOCK
INTERFERENCE WITH BLOOD FLOW THROUGH THE
CARDIOVASCULAR SYSTEM
TENSION PNEUMOTHORAX
CARDIAC TAMPONADE
PULMONARY EMBOLISM

OBSTRUCTIVE SHOCK S/S

ANXIETY, IRRITABILITY, RESTLESSNESS
WEAK, IRREGULAR PULSE
CHEST PAIN, SHORTNESS OF BREATH
HYPOTENSION
PALE, COOL, CLAMMY SKIN
JVD, DISCOLORATION ABOVE NIPPLE LINE

HYPOVOLEMIC SHOCK
LOSS OF VOLUME
CAUSES:
BLOOD LOSS FROM TRAUMA
PLASMA LOSS FROM BURNS
FLUID/ELECTROLYTE LOSS FROM VOMITING, DIARRHEA,
SWEATING, INCREASED URINE OUTPUT, INCREASE
RESPIRATORY LOSS
THIRD SPACE FLUID SHIFTS

HYPOVOLEMIC SHOCK S/S

ANXIETY, RESTLESSNESS, IRRITABILITY
RAPID, WEAK PULSE
CHANGE IN MENTAL STATUS
SIGNS OF INADEQUATE PERFUSSION (DIAPHORESIS,
CYANOSIS, PALE/CLAMMY SKIN)
INCREASED RESPIRATORY RATE

TREATMENT
ABCS
APPLY O2, ASSIST VENTILATIONS AS NEEDED
KEEP PATIENT IN POSITION OF COMFORT
CONTROL BLEEDING, STABILIZE FRACTURES
PREVENT LOSS OF BODY HEAT
ASSIST WITH MEDICATIONS (QUALIFIED DR/ PHARMACIST)
NOTHING BY MOUTH
CALM AND REASSURE
RUN FLUID RESUSCITATION (IV) IN HYPOVOLEMIC SHOCK
(IF QUALIFIED)