4. Shock and Bleeding Control

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Shock External Bleeding Control

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ObjectivesObjectives Understand the signs and symptoms of shock.Understand the signs and symptoms of shock.

Understand basic treatment for shock. Understand basic treatment for shock.

Understand blood loss as it relates to hypovolumic shock.Understand blood loss as it relates to hypovolumic shock.

Understand and Practice Bleeding Control. Understand and Practice Bleeding Control.

Be familiar with the injury patterns associated with Be familiar with the injury patterns associated with gunshot wounds. gunshot wounds.

Understand what to do in case of an impaled objectUnderstand what to do in case of an impaled object

Understand what to do in case of a severed extremity Understand what to do in case of a severed extremity

Be familiar with the Emergency and ExcelArrest BandagesBe familiar with the Emergency and ExcelArrest Bandages

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Red Blood Cells Red Blood Cells

White Blood CellsWhite Blood Cells

Plasma Plasma

Platelets Platelets

Components of Blood Components of Blood

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Perfusion Perfusion

The supply of oxygen and the The supply of oxygen and the removal of wastes from the cells removal of wastes from the cells and tissues of the body as a result and tissues of the body as a result of the flow of blood.of the flow of blood.

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PerfusionPerfusion

Signs of Adequate PerfusionSigns of Adequate Perfusion Normal skin signsNormal skin signs Normal Mental StatusNormal Mental Status Normal Vital SignsNormal Vital Signs

RespirationsRespirations Adult 12 – 20 / minuteAdult 12 – 20 / minute

Blood PressureBlood Pressure Adult 120/90 Adult 120/90

PulsePulse 60 to 100 and regular60 to 100 and regular

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ShockShockThe Perfusion Triangle

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ShockShockHypoperfusionHypoperfusion

Inadequate perfusion of blood to an organ or organs – also called shock. Inadequate perfusion of blood to an organ or organs – also called shock.

Compensated ShockCompensated ShockWhen the patient is developing shock, but the body is still able to maintain When the patient is developing shock, but the body is still able to maintain perfusion. perfusion.

Signs includeSigns include – increased respirations, increased pulse rate, – increased respirations, increased pulse rate, pale/cool/clammy skin and altered mental status. pale/cool/clammy skin and altered mental status.

Decompensated ShockDecompensated ShockWhen the body can no longer compensate for low blood volume or lack of When the body can no longer compensate for low blood volume or lack of perfusion. perfusion. Signs include – Decreased respirations, decreased pulse – periphery pulses Signs include – Decreased respirations, decreased pulse – periphery pulses absent, Decreased to absent blood pressure, unresponsive mental status absent, Decreased to absent blood pressure, unresponsive mental status

“Hypovolumic shock: A rude unhinging in the machinery of life.”

Samuel G. Gross MD, 1872.

05/01/23UN Security Officers’

ETB/BFA Course8

ShockShock

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ShockShockTreatment Treatment 1.1. Treat any cause of shock you can remedy – bleeding controlTreat any cause of shock you can remedy – bleeding control

2.2. Lay the casualty down, keeping his/her head low, raise and Lay the casualty down, keeping his/her head low, raise and support the legs. support the legs.

3.3. Loosen tight clothing, braces, straps or belts to reduce Loosen tight clothing, braces, straps or belts to reduce constriction. constriction.

4.4. Cover with thermal blanket. Cover with thermal blanket.

5.5. Establish Intravenous Fluid TreatmentEstablish Intravenous Fluid Treatment

6.6. Monitor vital signs during transport or while waiting Monitor vital signs during transport or while waiting evacuation evacuation

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Blood Loss and ShockBlood Loss and Shock

ETB/BFA Course11

I II III IV

Blood loss (%) < 15 15 - 30 30 - 40 >40

Volume (ml) <750 800 - 1500 1500 - 2000 >2000

Pulse rate Slight Tachycardia 100 - 120/Min >120/Min Thready >140/Min V. Thready

Blood Pressure

Systolic Unchanged Normal Reduced Very Low

Diastolic Unchanged Raised Reduced Very Low, Unrecordable

Pulse Pressure Normal / Increased Decreased Decreased Decreased

Capillary Refill Normal Slow (>2 Sec) Slow (>2 Sec) Undetectable

Respiratory Rate Normal Normal Tachyponea Tachyponea

(14-20 Resp/Min) (20-30 Resp/Min) (30-40 Resp / Min) (>35 Resp/Min)

Urine Output >30ml/Hr 20 - 30 Ml/Hr 5 - 15 Ml/Hr 0 - 10ml/Hr

Extremities Normal Pale Pale Pale And Cold

Complexion Normal Pale Pale Ashen

Mental State Alert Anxious/Aggressive Anxious/Aggressive DrowsyLethargic Or Unconscious

CLASS OF SHOCK

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Bleeding Bleeding Types of bleedingTypes of bleeding

Arterial BleedingArterial Bleeding-Highly pressurized - spurts, generally bright red.-Highly pressurized - spurts, generally bright red.

Venous BleedingVenous Bleeding-Steady Flow and may appear darker than arterial blood.-Steady Flow and may appear darker than arterial blood.

Capillary bleedingCapillary bleeding-Minor scrapes and abrasions.-Minor scrapes and abrasions.

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Stopping the bleeding:Stopping the bleeding:

Anti-Shock Posture Anti-Shock Posture

Elevate the Wound Elevate the Wound

Direct Pressure Direct Pressure – – with compressing bandage with compressing bandage if available (up to 10 minutes)if available (up to 10 minutes)

Indirect Pressure (for limbs) Indirect Pressure (for limbs) Brachial/Femoral (up to 10 minutes) Brachial/Femoral (up to 10 minutes)

Tourniquet – USUALLY A LAST RESORTTourniquet – USUALLY A LAST RESORT

Establish I.V. Fluid ResuscitationEstablish I.V. Fluid Resuscitation

Cover the casualty Cover the casualty

Follow the line of a jacket sleeve to find the brachial pressure point

The femoral pressure point lies where a trouser crease crosses the bottom edge of a pair of briefs

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Scenario 1Scenario 1You come upon a staff member screaming in front his tent You come upon a staff member screaming in front his tent with bright red blood coming from his forearm (between with bright red blood coming from his forearm (between his wrist and his elbow).his wrist and his elbow).

SafetySafety Scene?Scene?

TraumaTrauma Immediate phone callImmediate phone call

Situation? Situation? Consciousness? Consciousness? Airway?Airway? Anti-shock posture?Anti-shock posture? Direct Pressure with compressing bandageDirect Pressure with compressing bandage Indirect pressure: Indirect pressure:

Brachial artery Brachial artery Open airwayOpen airway

Apply Tourniquet Apply Tourniquet What else can you do to prevent shock?What else can you do to prevent shock?

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Scenario 1Scenario 1You come upon a staff member screaming in front his tent You come upon a staff member screaming in front his tent with bright red blood coming from his calve (between his with bright red blood coming from his calve (between his ankle and his knee).ankle and his knee).

SafetySafety Scene?Scene?

TraumaTrauma Immediate phone callImmediate phone call

Situation? Situation? Consciousness? Consciousness? Airway?Airway? Anti-shock posture?Anti-shock posture? Direct Pressure with compressing bandageDirect Pressure with compressing bandage Indirect pressure: Indirect pressure:

Femoral artery Femoral artery Open airwayOpen airway

Apply Tourniquet Apply Tourniquet What else can you do to prevent shock?What else can you do to prevent shock?

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Gunshot WoundsGunshot Wounds1.1. Ensure personal safety before attempting to provide careEnsure personal safety before attempting to provide care2.2. An ideal safe place provides both: An ideal safe place provides both:

CoverCover – something thought capable of providing ballistic protection – something thought capable of providing ballistic protection ConcealmentConcealment – something thought capable of concealing one from – something thought capable of concealing one from

view view

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Gunshot WoundsGunshot WoundsAll Firearms fall into one of the following basic categories:All Firearms fall into one of the following basic categories:

HandgunsHandguns Single shot weaponsSingle shot weapons Revolvers Revolvers Semi-Automatic pistolsSemi-Automatic pistols

RiflesRifles ShotgunsShotguns Full Automatic WeaponsFull Automatic Weapons

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Gunshot WoundsGunshot Wounds

What Happens when the Trigger is Pulled?What Happens when the Trigger is Pulled?1.1. Primer ignitesPrimer ignites2.2. Intense flame created by the primer fills the Intense flame created by the primer fills the

chamberchamber3.3. Powder burnsPowder burns4.4. Pressure created by the burning powder Pressure created by the burning powder

pushes out the bullet (or shot) pushes out the bullet (or shot)

ShotgunHandgun Rifle

Primer

Flash Hole

Powder

bullet

Primer

ActionChamber

Barrel

Magazine(Clip)

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Gunshot WoundsGunshot Wounds

What damage do bullets cause? What damage do bullets cause? Damage from the bullet itselfDamage from the bullet itself

Permanent CavityPermanent Cavity Damage from the energy of the bullet – shock wavesDamage from the energy of the bullet – shock waves

Temporary CavityTemporary Cavity

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Impaled ObjectsImpaled Objects• Expose and Examine

•Control hemorrhage

• Stabilize object in place with bulky dressings

ETB/BFA Course24

Amputated ExtremitiesAmputated Extremities Wrap part in sterile Wrap part in sterile

dressing.dressing.

Place wrapped part in Place wrapped part in sealed plastic bagsealed plastic bag

Place bag on cold packPlace bag on cold packYour care affects possibility of reattachment

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