Bleeding and Shock Trauma - MOI

• Circulatory system

  • Heart
  • Arteries
  • Arterioles
  • Capillaries
  • Venules
  • Veins
• Body will go into shock if blood loss is greater than 20%
• Significant blood loss

  • Adult: 1 liter
  • Child: 1/2 liter
  • Infant: 100-200 mL
• Hypovolemic shock

  • Serious bleed
  • Hypoperfusion
• Types of bleeding

  • Arterial
  • Venous
  • Capillary
• Arterial bleeding


  • Bright red
  • Spurts
  • Difficult to control
• Venous bleeding


  • Darker red
  • Flows steady
• Capillary bleeding


  • Dark red
  • Oozes
  • More easily managed
  • Often clots spontaneously
• Hemophilia


  • Patient lacks blood clotting factors
  • Bleeding may occur spontaneously
• External bleeding control

  • Direct pressure
  • Pressure bandage
  • Tourniquet
• Wound closure devices

  Wound clamp
• Shock (Hypoperfusion)


  Inadequate tissue perfusion (blood flow) leading to inadequate O₂ delivery to tissues
• Adequate perfusion


  
  

  It's required to provide cells with O2 and nutrients and remove waste products
• Inadequate perfusion


  Transportation of waste products out of tissues is impaired, resulting in dangerous buildup
• Insufficient circulation causes the body to redirect blood
• Inadequate tissue perfusion (blood flow)


  • Leads to inadequate O₂ delivery to tissues
• Perfusion


  circulation of blood through an organ structure
• Shock


  • Inadequate tissue perfusion
• Organs most susceptible to shock

  • Heart
  • Brain
  • Spinal cord
  • Kidneys
  • Skeletal muscle
• Golden Hour


  Time it takes for patient to reach Definitive Care
• Platinum 10 minutes

  Maximum time EMS team should devote to an-scene activities
• High Index of Suspicion

  Presumption that a patient has severe injuries if there's any indication at all that this is possible
• Adequate Flow

  Adequate Perfusion
• Cardiovascular System

  Consists of: 1. Pump, 2. Blood vessels, 3. Blood
• When patient is in shock, one or more of the 3 parts of the cardiovascular system is not working right
• Causes of Hypoperfusion


  • Bleeding/Fluid loss from vessels (leaking)
  • Trauma to vessels/tissues
  • Fluid loss from GI tract
• As the body loses blood, peripheral perfusion is drastically reduced
• Compensated Shock (Early Shock)


  Body is still able to compensate for absolute/relative blood loss
• Compensated Shock (Early Shock)


  • Earliest signs: Agitation, anxiety, restlessness, pallor
• Decompensated Shock (Late Shock)


  Body's compensating mechanisms are unable to maintain adequate perfusion to brain and vital organs
• Decompensated Shock occurs when blood volume is reduced by more than 30%
• Decompensated Shock (Late Shock)


  • Late signs: Falling BP, dull eyes, dilated pupils
• Hypovolemic Shock


  Low blood volume in blood and fluid compartment
• Distributive Shock


  Widespread dilation of small arterioles, venules
• Cardiogenic Shock


  Not enough O₂: poor pump function
• Obstructive Shock


  Conditions that cause mechanical obstruction of cardiac muscle also affect pump function
• Cardiac Tamponade


  Compression of heart as a result of buildup of blood/fluid in pericardial sac
• Tension Pneumothorax


  Accumulation of air/gas in pleural cavity that progressively increases pressure in chest and interferes with cardiac function
• Pulmonary Embolism


  One or more arteries in lungs become blocked by blood clot
• Septic Shock


  Caused by severe infection (usually bacterial infection in bloodstream)