BLEEDING, SHOCK, POISONING.. FN Brno, October 2010 Why are we talking about CPR Overview •Bleeding •Shock •Allergic reactions •Poisoning •Snake and insect bites •Diabetic emergencies BLEEDING • •Arterial •Venous •Capillary BLEEDING •Mixed BLEEDING •External • •Trauma •Internal •Spontaneous 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 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 •Rupture of blood vessels (sneezing, picking, blowing the nose) •High blood pressure •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 • Nosebleed Bleeding from the ear •Connected with trauma •Half sitting position •Head tilted to the injured side – allow blood to drain away •Sterile dressing or a clean pad in place on the ear •Send to hospital 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. SHOCK • •Tissue perfusion inadequate for the metabolic needs of the patient shock shock Basic Physiology 1. Pump generates blood pressure 2. Pressure drives blood flow (cardiac output)…. 3. Through a tight network of vessels providing a resistance Organizační diagram SHOCK Hypovolemic Cardiogenic Septic Anaphylactic Neurogenic 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 •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 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 CVP 50% 30% PERCENTAGE BLOOD LOSS Organizační diagram SHOCK Hypovolemic Cardiogenic Septic Anaphylactic Neurogenic 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) •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 •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/watter 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 • •Controll of bleeding •Fluid and blood replacement •Vasopresors ana_3_127_circulatory_shock_in_trauma_15_01_med Organizační diagram SHOCK Hypovolemic Cardiogenic Septic Anaphylactic Neurogenic •Septic – caused by bacterial toxins leading to vasodilatation • •Neurogenic - 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 Anaphylactic shock •Chemicals are released to blood •Dilatation of blood vessels •Constriction of air passages (bronchoconstriction) •Swelling of tongue, throat • •Treatment: adrenalin (auto-injector) anaphylactic-shock Organizační diagram SHOCK Hypovolemic Cardiogenic Septic Anaphylactic Neurogenic POISONING Poisoning •Unintentional: result from exposure to or ingestion of toxic substances, including drugs and alcohol, chemicals, contaminated food •Intentional: in cases attempted suicide poison-214x300 Poisoning •The effect depends on the type and amount of substance absorbed •A poison (toxin) may cause temporary or permanent damage •Poisons can be swallowed, absorbed through the skin, inhaled, splashed into the eyes or injected Poisoning •A poison, after entering to the body, may enter the bloodstream and be carried to all organs and tissues •Signs and symptoms: vary with the poison (develop quickly or over a number of days) • : vomiting • : local signs • : systemic signs Swallowed poisons • Drugs and alcohol, cleaning and gardening products, plant poisons, bacterial and viral (food) poisons Effects: nausea, vomiting, abdominal pain, seizure, irregular, fast or slow heartbeat, impaired consciousness Tide-2x-Ultra-Liquid-Detergent-with-Bleach-Alternative-Mountain-Spring-Scent-52-Load-Bottle-Pack-of -4 •Inhaled • • Industrial poisons, fumes from fires, chlorine • Effects: headache, confusion, difficulty breathing, cyanosis • •Absorbed through the skin • • Cleaning and gardening products, plant poisons • Effects: pain, swelling, rash, redness, itching •Splashed in the eyes • • Effects: pain and watering of the eye, blurred vision, inability to open the injured eye • •Injected through the skin • • Venom from stings and bites, drugs • Effects: pain, redness and swelling at injection site, nausea, vomiting, difficulty breathing, seizures, anaphylactic shock foxglove-1 Poisoning first aid •Identify the poison •Monitor victim •Seek medical help •Resuscitate if necessary •Help victim into fresh air •Remove contaminated clothing, • wash area for at least 10 minutes (absorption through the skin) •Irrigate the eye • Alcohol poisoning •Depresses the activity of the central nervous system •Impairs all physical and mental • functions •Risks from alcohol poisoning: ▫inhaling and choking on vomit ▫loosing heat, hypothermia ▫underlying condition often ▫ misdiagnosed • The-Simpsons---Homer---To-Alcohol--.jpg image by danielronin Alcohol poisoning •First aid: • - cover the person with a coat to protect from the cold • - asses the person for any injuries • - monitor and record vital signs (level of response, pulse, breathing) • - if unconsciouss – recovery position Drug poisoning •Prescribed •Over the counter •Drug abuse prescription_drugs Drug poisoning – NS depressants •Unconsciousness, shallow breathing, weak or abnormally slow or fast pulse dormicum15 Drug poisoning- Stimulants and hallucinogens •Stimulants and hallucinogens (amphetamines - Ectasy , LSD, cocaine): •Excitable, hyperactive behavior, wildness, sweating, tremor of the hands, hallucinations articles_ecstasy Food and fungi poisoning muchom_rka zelená food-poisoning3 Food and fungi poisoning •Common •Symptoms may develop rapidly (within 2-6 hours): nausea, vomiting, abdominal pains, headache, fever • mushrooms: vomiting, severe watery diarrhea, hallucinations, poisoning may be fatal •Danger: dehydration • liver failure • Poisoning – hospital management • •Support ABC •Induce vomiting •Orogastric lavage •Activated charcoal •I.v. fluid replacement •Special antidotes • BITES AND STINGS Insect sting asian-giant-hornet1 bee_beard7-330 Insect sting •Sting from a bee, wasp or hornet •Recognition: pain at the site of sting, • swelling, redness •Sting in the mouth or throat – swelling can obstruct the airway •Serious reaction - anaphylactic shock •First aid : • raise the affected part • apply an ice pack or cold compress • Bites pavouk--pavouk Vretenica severná snake_bite Bites •Bites from certain species of scorpions and spiders, snakes (vipers, exotic snakes), sea creatures •Bites in the mouth or throat are dangerous because swelling can obstruct the airway •Be alert to an allergic reaction •Can cause serious illness and may be fatal (spiders, snakes) Bites – First aid • •Raise the affected part •Apply an ice pack or cold compress •Wash the wound, compression bandage above the wound •Immobilize •Note the snakes • appearance 13_elastic_bandage DIABETIC EMERGENCIES Diabetic emergences •Hypoglycemia – low blood sugar • •Hyperglycemia – high blood sugar diabetes1 Hypoglycemia •Develops quickly – over few hours •Weakness, hunger/nausea •Swaeting, cold, clummy •Strange behaviour • •FA : sugary drink, sweet food Hyperglycemia •Develops slowly – over days •Weakness •Warm, dry skin •Drowsiness • •FA :transport ho hospital If in doubt- give sugary drink – little harm in hyperglycemia Questions ? ana_1_075_anaphylaxis_13_01_med ana_3_127_circulatory_shock_in_trauma_06_01_med