BLEEDING AND SHOCK Katarina Zadrazilova FN Brno, October 2011 Why are we talking about CPR Overview •Monitoring vital sings •Bleeding ▫Types of wounds ▫Severe bleeeding and management •Shock ▫Types and management Monitoring vital signs •Level of response •Breathing •Pulse • •Temperature • 09021bg Level of response •A – Alert – opening eyes, respond to question •V – Respond to voice, answers question, obeys command •P – respond to pain, opens eyes or moves if pinched •U – Unresponsive to any stimulus 625px-Checking_respiration Breathing •Rate – breaths/minute •Depth – deep or shalow ? •Ease – easy, difficult or painfull •Noise – quiet, noise – what type ? What is adult´s normal breathing ? Recognition of airway obstruction • •Partial obstruction • •Stridor obstruction above larynx •Wheeze lower airway •Gurgling semisolid/liquid FB •Snoring soft palate/epiglotis •Crowing laryngeal spasm Pulse •Rate number of beats per minute •Strenght strong or weak •Rhytm regular or irregular What is adult´s normal pulse ? Where to check for pulse ? f-aidradpuls1 9800 9 infantpulsecheck Carotid artery Brachial artery Radial artery Polar_bear_swimming Temperature •Normal body temperature 36 – 37°C •> 37°C and < 38°C fever •> 38°C pyrexia •< 35°C hypothermia • BLEEDING • •Arterial •Venous •Capillary BLEEDING •Mixed BLEEDING External Internal Trauma Spontaneous ANd9GcT1i1aeaiCYfAVe4cJPeypIHiBm2I00z9kDRW9LB45feix_DDDJZmwLnxE BLEEDING •Adults are 60% fluid by weight •Only 13% of this fluid is located in bloodstream •Acute loss of 40% of the blood volume can be fatal •Blood: ▫ 60% plasma fraction ▫ 40% erythrocyte volume Hemoglobin and Hematocrit 19462 Clotting •Platelet activation •Release of chemicals •Fibrin formation Types of wounds •Laceration •Abration •Contution • si55551558 hand%20contusion 800px-Hand_Abrasion_-_32_minutes_after_injury •Puncture wound •Stab wound •Gunshot wound puncture-wound 1603817-1607640-1680082-1723275 Types of wounds wpba4e5e6f Severe bleeding – first aid •Often arterial •Apply direct pressure over wound •Raise and support injurt arm •Prevent and minimize • effects of shock amputee_hr1f Arterial bleed – pressure dressing 17 Sterile cover Thick dressing of gauze Bandage 29 Severe bleeding - amputation Tying of knots Application of tourniquet Nosebleed Nosebleed •Rupture of blood vessels (sneezing, picking, blowing the nose) •High blood pressure, clotting abnormality •Till head forward – allow the blood to drain •Breath through mouth •Pinch the soft part of the nose, keep pinching (10 min) •After 10 min. release the pressure • important-icon Thin, watery blood – leakage of fluid around brain ! Bleeding from the ear •Connected with trauma •Half sitting position •Head tilted to the injured side – allow blood to drain away, do not plug the ear •Sterile dressing or a clean pad in place on the ear •Send to hospital important-icon Thin, watery blood – leakage of fluid around brain ! Bleeding from the mouth •Cuts the tongue, lips •Dental extraction •Blood may be inhaled into the lungs! •Sitting position, head forward •Allow blood to drain from the mouth •Place a gauze pad over the wound, hold the pad and press on the wound for 10 min. Eye wound •Potentially serious •Pain and spasm of the eyelid •Visible leakage of blood or clear fluid • •First aid ▫Sterile cover ▫Keep both eyes still ▫Send to hospital SHOCK • •Tissue perfusion inadequate for the metabolic needs of the patient shock shock Organizační diagram SHOCK Hypovolemic Cardiogenic Low resistance Basic Physiology 1. Pump generates blood pressure 2. Pressure drives blood flow (cardiac output)…. 3. Through a tight network of vessels providing a resistance Hypovolemic shock •Severe bleeding – hemorrhagic shock •Loss of other body fluids ▫Burns – loss of plasma through the burned skin surface ▫Dehydration – loss of water and electrolytes due to diarrhea, vomiting ▫Ileus - Blockage in the intestine Hemorrhagic shock •Internal bleeding •Bleeding from body openings (orifices) •Mouth: bleeding in the lungs (bright red, • cough up blood) • : bleeding within digestive system • (vomited blood red or dark brown) •Ear, Nose: injury to the inner ear, rupture blood • vessels in the nostril (fresh, bright red) • : leakage of fluid from around brain • (watery blood) • •Bleeding from body openings •Anus: hemorrhoids • (fresh, bright red), • disease or injury to the intestine • (black – melena) •Urethra: bleeding from the bladder, • kidneys or urethra •Vagina: pregnancy or recent childbirth, injury ana_3_127_circulatory_shock_in_trauma_05_t1_01_med Hemorrhagic shock Cave: hidden bleeding from internal organs blood escaping into blood cavity bleeding from demage blood vessels due to a closed fractures Traumatic shock •Bleeding combined with exudation into • tissue, toxic effect of fragments of • damaged tissue • ana_3_127_circulatory_shock_in_trauma_03_01_med Hypovolemic shock •Mild ▫Loss of 10-20 % of the circulatory volume • (500-1000 ml) •Moderate ▫Loss of 20-40 % of blood volume • (1000 – 2000 ml) •Severe ▫Loss of more than 40 % of the circulation volume (> 2000 ml) Heart Rate Blood pressure 50% 30% PERCENTAGE BLOOD LOSS Cardiogenic shock •Caused by primary failure of the heart • adequate blood volume but the heart is unable to pump the blood Ø ØSevere heart disease ØHeart attack (IM) Monitoring vital signs •Level of response •Breathing •Pulse • •Temperature • 09021bg •Pale, cold, clummy, sweating •Breathing heavily •Fast jerky /sharp pulse, BP may be low •Nauseated, confused, yawning •Concentrated or no urine • • Loss of consciousness (coma) Shock – recognised clinically ana_3_127_circulatory_shock_in_trauma_06_01_med Management of shock •no excitement Management of shock •Silence – no excitement: do not leave the victim •Position: lay the victim down on a blanket •Raise and support legs to improve the blood supply to the vital organs (autotransfusion position) •Loosen tight clothing at the neck, chest – to reduce constriction Management of shock •Warmth – use a blanket, not hot/water bottle or other direct source of heat •Do not let the victim eat, drink, smoke •Fluids i.v. (moisten lips with a little water) •Pain relief •Transport •Monitor vital functions Treatment of hemorrhagic shock • •Control of bleeding •Fluid and blood replacement •Vasopresors ana_3_127_circulatory_shock_in_trauma_15_01_med Organizační diagram SHOCK Hypovolemic Cardiogenic Low resistance Basic Physiology 1. Pump generates blood pressure 2. Pressure drives blood flow (cardiac output)…. 3. Through a tight network of vessels providing a resistance Basic Physiology 1. Pump generates blood pressure 2. Pressure drives blood flow (cardiac output)…. 3. Through a tight network of vessels providing a resistance •Septic – caused by bacterial toxins leading to leaking capilaries and dilated vessels - vasodilatation • •Neurogenic – loss of vessel tone, spinal cord injury Anaphylactic shock •Severe allergic reaction •Contact with trigger factor •Develop within seconds or minutes •Triggers: skin or airborne contact with • particular material • the injection of drug • the sting of insect • food (shrimps, peanuts) ana_3_067_07_01_50 •Allergen may trigger an immune response that sensities the body to subsequent exposure •Release of chemicals(inflmmatory mediators) •Increased leakage of capillaries •Reduced vascular smooth • muscle tone •Constriction of air passages (bronchoconstriction) • • Anaphylactic shock Anaphylacticshock – recognised clinically •Rash •Watery eyes •Skin – flushed or pale •Swelling of tongue, throat •Wheezing - bronchocontriction •GI tract : nausea, vomiting, abdo pain •Fast jerky pulse •Low blood pressure anaphylactic-shock Anaphylactic shock - treatment ▫Adrenalin (auto-injector) ▫Or 0,5 mg i.m. •Oxygen •Iv fluids •Antihistaminics •Steroids Effects of adrenaline •Reverses vasodilation •Reduces swelling •Improves heart work •Supressess chemicals release Organizační diagram SHOCK Hypovolemic Cardiogenic Low resistance SUMMARY •Severe bleeding – pressure and elevate, watch for sighs of shock • •Shock – recognise, treat obvious causes •Hypovolemic shock – fluids, blood •Anaphylactic shock - adrenaline • • Questions ? ana_1_075_anaphylaxis_13_01_med ana_3_127_circulatory_shock_in_trauma_06_01_med