Chapter 25 Bleeding Perfusion (1 of 2) lcirculation within tissues in adequate amounts to meet the cells needs for oxygen, nutrients, and waste
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1 Chapter 25 Beeding Perfusion (1 of 2) Circuation within tissues in adequate amounts to meet the ces needs for oxygen, nutrients, and waste remova Some tissues and organs need a constant suppy of bood whie others can survive on very when at rest. Perfusion (2 of 2) The heart demands a constant suppy of bood. The brain and spina cord can survive for 4 to 6 minutes without perfusion. The kidneys may survive 45 minutes. The skeeta musces may ast hours. The Significance of Beeding Hemorrhage = beeding The body wi not toerate an acute bood oss of greater than 20% of the bood voume. In the typica adut, 20% is iter or 2 pints. A 1-year-od infant typicay has 800 ml. A oss of 200 ml is significant. Anatomy and Physioogy of the Cardiovascuar System Three parts Pump (heart) Container (bood vesses) Fuid (bood and body fuids) The Heart Needs a rich and we-distributed bood suppy Works as two paired pumps Upper (atrium) Lower chamber (ventrice) Bood Vesses and Bood Types of bood vesses 1
2 Types of bood vesses Arteries: carry bood away from the heart Arterioes: connect the and capiaries Capiaries: ink arterioes and venues Venues: empty into the veins Veins: carry bood from the tissues to the heart Bood Vesses and Bood Oxygen and nutrients pass from the capiaries into the ces, and waste and carbon dioxide diffuse into the capiaries. Bood Vesses and Bood Bood contains Red bood ces bood ces Pateets Pasma Bood cot formation depends on severa factors Autonomic Nervous System Monitors the body s needs Adjusts bood fow Automaticay redirects bood to the, brain, ungs, and kidneys in an emergency. Adapts to maintain homeostasis and perfusion Significance of Externa Beeding (1 of 3) Hemorrhage means beeding. With serious externa beeding, it may be difficut to the amount of bood oss. Bood wi ook different on different surfaces. Important to estimate the amount of externa bood oss Significance of Externa Beeding (2 of 3) Body wi not toerate a bood oss greater than 20% of bood voume 2
3 Body wi not toerate a bood oss greater than 20% of bood voume Changes in vita signs may occur with significant bood oss. Increase in rate Increase in respiratory rate Decrease in bood pressure Significance of Externa Beeding (3 of 3) How we peope compensate for bood oss is reated to how rapidy they beed. An adut can comfortaby donate 1 unit (500 ml) of bood over 15 to 20 minutes. If a simiar bood oss occurs in a much shorter time, the person may rapidy deveop symptoms of shock. Consider age and preexisting heath. Characteristics of Externa Beeding (1 of 2) Arteria beeding Pressure causes bood to and makes beeding difficut to contro. Typicay brighter red and spurts in time with the puse Venous beeding Dark red Does not spurt and is easier to manage Characteristics of Externa Beeding (2 of 2) Capiary beeding Beeding from damaged capiary vesses Dark red, steadiy but sowy Characteristics of Beeding Capiary Venous Arteria 3
4 Capiary Venous Arteria Conditions with Possibe Serious Beeding Significant mechanism of injury Poor genera a of patient Assessment reveas signs of shock Significant amount of bood oss noted The bood oss is rapid. If you cannot contro externa beeding. Signs of Hypoperfusion Change in menta status Tachycardia Weakness Thirst Nausea or vomiting Cod, skin Shaow, rapid breathing Du eyes Diated pupis Weak, rapid puse Decreased bood pressure Atered eve of consciousness Vita Signs Changes Significant changes in vita signs may occur if the typica adut oses more than 1 L of bood. Increase in rate Increase in respiratory rate Decrease in bood pressure Bood Cotting Beeding normay stops within 10 minutes Some interfere with cotting Some injuries wi be unabe to cot 4
5 Some injuries wi be unabe to cot Hemophiia Patient acks factors. Beeding may occur spontaneousy. A injuries, no matter how trivia, are potentiay serious. Patients shoud be transported immediatey. Factors Affecting Cotting Movement Medications of bandages Externa environment Body temperature Severe injury Interna Beeding Interna beeding is any beeding in a or space inside the body. May not be readiy apparent. Assess patient s: -Mechanism of Injury -Nature of Iness Signs and Symptoms of Interna Beeding (1 of 2) Ecchymosis: Bruising Hematoma: Beeding the skin Hematemesis: Bood in vomit Meena: Back, tarry stoo Signs and Symptoms of Interna Beeding (1 of 2) Hemoptysis: Coughing up bood Pain, tenderness, bruising, guarding, or sweing Broken ribs, bruises over the ower chest, or rigid, distended abdomen Other S/S of shock Conditions Causing Interna Beeding Possibe conditions causing interna beeding: Stomach ucer 5
6 Possibe conditions causing interna beeding: Stomach ucer Lacerated iver Ruptured speen Broken bones, especiay the ribs or femur Pevic fracture NOI for Interna Beeding Beeding is not aways caused by. Nontraumatic causes incude: Beeding ucers Beeding from coon Ruptured ectopic pregnancy Aneurysms Scene Safety/Size-up Foow BSI precautions Wear goves and eye protection in a situations. Avoid direct with body fuids. Thorough hand washing between patients and after runs is important. Determine mechanism of injury/nature of iness. Consider the need for spina immobiization and additiona resources. Controing Externa Beeding Foow BSI precautions Ensure patient has an open and adequate breathing Provide oxygen if necessary Contro obvious, ife-threatening beeding as quicky as possibe Controing Externa Beeding Externa beeding is controed by: Direct, even and eevation Pressure dressings and/or spints Tourniquets It wi often be usefu to combine these methods. 6
7 Direct Pressure (1 of 2) Most way to contro externa beeding Pressure stops the fow of bood and permits norma coaguation to occur. Appy pressure with your goved fingertip or hand over the top of a sterie dressing. Direct Pressure (2 of 2) Never remove an i object from a wound. Hod uninterrupted pressure for at east 5 minutes. Eevation Eevate a beeding extremity by as itte as 6" whie appying direct pressure. Never eevate an fracture to contro beeding. Fractures can be eevated after spinting. Spinting heps contro beeding. Direct Pressure and Eevation Pressure Dressing (1 of 2) Firmy wrap a sterie, sef-adhering roer bandage around the entire wound. Cover the entire dressing above and beow the wound. Stretch the bandage tight enough to contro beeding. You shoud sti be abe to a dista puse. Pressure Dressing (2 of 2) Do not remove a dressing unti a physician has evauated the patient. Appy additiona pressure through the dressing Add more over the first Beeding wi amost aways stop when the pressure of the dressing exceeds arteria pressure. Hemostatic Agents Any compound that sows or stops beeding by assisting with cot formation 7
8 Any compound that sows or stops beeding by assisting with cot formation Can be used with direct pressure when direct pressure aone is ineffective Be aware of and foow your oca protocos. Tourniquet If direct pressure fais, appy a tourniquet the eve of beeding. Used ony on extremities It shoud be appied quicky and not reeased unti a physician is present. Severa types of commercia tourniquets are avaiabe Appying a Commercia Tourniquet BSI Hod direct pressure over wound Pace tourniquet around the extremity just above the beeding site Cick the bucke into pace and pu the strap tight Turn the dia cockwise unti are no onger papabe beow the tourniquet or unti beeding is controed Reeasing a Commercia Tourniquet To reease the tourniquet at the hospita, or if instructed by medica contro, push the reease button and pu the strap back. Caution: beeding may rapidy return upon tourniquet reease and may need to be rapidy reappied Making and Appying a Tourniquet (1 of 2) Fod trianguar bandages to 4 wide and 6 to 8 ayers thick Wrap the bandage around the extremity twice just the beeding site Tie one knot in the bandage. Pace a stick or rod on the knot and tie the ends of the bandage over the hande Making and Appying a Tourniquet (1 of 2) Twist the hande to tighten the tourniquet unti beeding stops Secure the hande Write and exact time on a piece of tape and appy to patient s forehead A great aternative is the use of a BP cuff 8
9 appy to patient s forehead A great aternative is the use of a BP cuff Making a Tourniquet Tourniquet Precautions Do not appy a tourniquet directy over any. Make sure the tourniquet is tightened securey. Use wide padding under tourniquet if possibe Never use wire, rope, a bet, or any other narrow materia. Do not cover the tourniquet. Do not oosen the tourniquet after you have appied it Spints Rigid spints Immobiize Prevent further soft-tissue damage Spints Air spints can be used to contro beeding of soft-tissue injuries. Can contro interna or externa beeding associated with severe injuries Act as a dressing appied to an extremity Beeding from the Nose, Ears, and Mouth Causes: Sku fractures Facia injuries Sinusitis, infections, dried or cracked nasa mucosa High bood pressure Coaguation disorders trauma Controing a Nosebeed Foow BSI precautions. Hep the patient sit and ean. Appy direct pressure by pinching the patient s nostris. Or pace a piece of gauze bandage under the patient s upper ip 9
10 Appy direct pressure by pinching the patient s nostris. Or pace a piece of gauze bandage under the patient s upper ip and gum. Appy ice over the nose. Provide transport. Occasionay can cause enough bood oss to send a patient into shock Controing a Nosebeed Beeding from Sku Fractures Do not attempt to stop the bood fow. Loosey cover beeding site with sterie gauze. If fuid is present, a target sign (or hao) wi be apparent. Emergency Medica Care for Beeding Foow BSI precautions. Maintain airway and administer oxygen. Contro externa beeding and care for any interna beeding. Monitor and record vita signs. Eevate and keep patient warm. Transport immediatey to hospita. Pneumatic Antishock Garment (PASG) AKA: Miitary Anti-Shock Trousers (MAST) Originay designed by and used by miitary for auto transfusion of bood Shunts bood from ower extremities to vita organs Thus increasing BP PASG Controversies PASG has been one of the most controversia devices in EMS for many years An increase in BP resuts in increase bood oss rate Been proven that this device is appropriate for the treatment of shock The PASG has been removed from the atest EMS curricuum However, many services sti have the PASG and it is a viabe air spint for ower extremities 10
11 However, many services sti have the PASG and it is a viabe air spint for ower extremities PASG Stabiizes fractures of the pevis and proxima femurs Contros massive soft-tissue beeding of the ower extremities Refer to oca protoco PASG Contraindications Pregnancy (do not infate abdomen) Pumonary edema of cardiac origin Acute faiure Penetrating chest injuries Groin injuries Major head injuries Less than 30 minute transport time Appication of PASG Appy the so the top is beow the owest rib. Encose both egs and the abdomen. Open the stopcocks. Infate a three chambers simutaneousy with the foot pump. Check patient s vita signs. 11
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