05/01/23 1
Shock External Bleeding Control
05/01/23 2
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
05/01/23 3
Red Blood Cells Red Blood Cells
White Blood CellsWhite Blood Cells
Plasma Plasma
Platelets Platelets
Components of Blood Components of Blood
05/01/23 4
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.
05/01/23 5
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
05/01/23 6
ShockShockThe Perfusion Triangle
05/01/23 7
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
05/01/23 9
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
05/01/23 10
Blood Loss and ShockBlood Loss and Shock
05/01/23UN Security Officers’
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
05/01/23 UN Security Officers’ ETB/BFA Course 12
05/01/23 13
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.
05/01/23 14
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
05/01/23 UN Security Officers’ ETB/BFA Course 15
05/01/23 16
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?
05/01/23 17
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?
05/01/23 18
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
05/01/23 19
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
05/01/23 UN Security Officers’ ETB/BFA Course 20
05/01/23 21
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
Wad
Shot
ActionChamber
Barrel
Magazine(Clip)
05/01/23 22
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
05/01/23 23
Impaled ObjectsImpaled Objects• Expose and Examine
•Control hemorrhage
• Stabilize object in place with bulky dressings
05/01/23UN Security Officers’
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
05/01/23 UN Security Officers’ ETB/BFA Course 25
05/01/23 UN Security Officers’ ETB/BFA Course 26
05/01/23 UN Security Officers’ ETB/BFA Course 27
05/01/23 28
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
05/01/23 29
Thank You!Thank You!