Chapter 22 page 650 The Significance of Bleeding When patient have serious external blood loss it is often difficult to determine the amount of blood that is present because it may be absorbed into the surface the patient is on or clothing ID: 195273
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Slide1
Bleeding:
Chapter 22 page 650Slide2
The Significance
of
Bleeding
When patient have serious external blood loss it is often difficult to determine the amount of blood that is present because it may be absorbed into the surface the patient is on or clothing.
It
may also be diluted when mixed with other
liquidSlide3
Blood Volume
The body will not tolerate more than 20% blood volume loss
Blood volume
: 70mL per 1kg of body weight
Adult= about 6L
1 year old infant= about 800mLSlide4
Hypovolemic shock
Hypovolemic
shock
- a condition in which low blood volume results in inadequate perfusion
Be aware for the following conditions:
Significant
MOIPoor General AppearanceAssessment reveals signs and symptoms of shock:Pale
Clammy/diaphoreticIncreased pulseDecreased BPYou note significant blood lossBlood loss is rapid
You cannot control bleeding*all bleeding should be treated as soon as the airway is managed and the patient is breathingSlide5
Characteristics of Bleeding
Arterial-
Blood is bright red and spurts.
Venous-
Blood is dark red and does not spurt.
Capillary- Blood oozes out and is controlled
easilySlide6
Coagulation
Bleeding normally stops within 10 minutes due to
coagulation
-the process in which a clot forms to close a hole in a blood vessel
Some medications interfere with clotting
Some injuries will be unable to clot
Patients with hemophilia lack clotting factorsSlide7
Emergency Medical Care
Follow BSI precautions
Ensure patient has an open airway and adequate breathing
Provide oxygen if necessary
There are several methods to control bleeding
Direct pressure and elevation
Pressure bandagePressure pointsSplintsAir splintsPneumatic anti-shock garment
TourniquetSlide8
Direct
Pressure
and
Elevation:
Direct pressure is the most common and effective way to control bleeding
Apply pressure with gloved finger or hand
Elevating a bleeding extremity often stops venous bleedingUse both direct pressure and elevation whenever possibleApply a pressure dressingSlide9
Pressure Points
If bleeding continues, apply pressure on pressure point.
Pressure points are located where a blood vessel lies near a bone
Be familiar with the location of pressure
pointsSlide10
Splints
Splints can help control bleeding associated with a
fracture
Air splints can be used to control bleeding of soft-tissue
injuriesSlide11
Pneumatic
Antishock
Garment (PASG
)
Stabilizes fractures of the pelvis and proximal femurs
Controls significant internal bleeding
Controls massive soft-tissue bleeding of the lower extremities
(Refer to local protocol)Contraindications include:PregnancyPulmonary edema
Acute heart failurePenetrating chest injuriesGroin injuriesMajor head injuriesLess than 30 minute transport time Slide12
Tourniquet
Only to be used as a last resort for uncontrolled bleeding
Application:
Fold a triangular bandage into 4˝ cravat
Wrap the bandage
Use a stick as a handle to twist and secure the stick
Write “TK” and time. Place on patientPrecautions:Place as close to injury as possible, but not over jointNever use narrow materialUse wide padding under the tourniquet
Never cover a tourniquet with a bandageDo not loosen the tourniquet once appliedSlide13Slide14
Bleeding from the Nose, Ears, and Mouth
Causes include:
Skull fractures
Facial injuries
Sinusitis
High blood pressureCoagulation disorders
Digital traumaSlide15
Controlling a Nose Bleed
Epistaxis
-
Nose
Bleed
Follow BSI precautions
Help the patient sit and lean forwardApply direct pressure by pinching the patient’s nostrilsOr place a piece of gauze bandage under the patient’s upper lip and gumApply ice over the noseProvide
transportSlide16
Bleeding from skull fractures
Do not attempt to stop the blood flow
Loosely cover bleeding site with sterile gauze
If cerebrospinal fluid is present, a target (or halo) sign will be
apparentSlide17
Internal Bleeding
NOTE: Internal bleeding may not be readily apparent.
Assess patient’s:
Mechanism of injury
Nature of illnessSlide18
Signs and Symptoms
Ecchymosis
: Bruising
Hematoma
: Bleeding beneath the skin
Hematemesis: Blood in vomitMelena
: Black, tarry stoolHemoptysis: Coughing up bloodPain, tenderness, bruising, guarding, or swellingBroken ribs, bruises over the lower chest, or rigid, distended abdomeSlide19
Hypoperfusion
Signs and Symptoms:
Change in mental status
Tachycardia
Weakness
ThirstNausea or
vomitingCold, moist skinShallow, rapid breathing Dull eyes
Dilated pupilsWeak, rapid pulseDecreased blood pressureAltered level of consciousnessSlide20
Treatment of Hypoperfusion
Follow BSI precautions
Maintain airway and administer oxygen
Control external bleeding and care for any internal bleeding
Monitor and record vital signs
Elevate legs and keep patient warm
Transport immediately