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Bleeding PowerPoint Presentation

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Description : Check out this medical presentation on Emergency Medical Services (EMS), which is titled "Bleeding", to know about bleeding that can cause weakness, shock, and death. Learn how as an EMT, you must understand how to control external bleeding.

Tags : Emergency Medical Services, EMS, Bleeding

Published on : Aug 06, 2021 | Views : 2201 | Downloads : 10

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Slide 1-

Chapter 23 Bleeding
Slide 2-

Introduction Important to be able to: Recognize bleeding Understand how bleeding affects the body Bleeding can be external or internal. Bleeding can cause weakness, shock, and death.
Slide 3-

Anatomy and Physiology of the Cardiovascular System (1 of 3) Functions of the cardiovascular system Circulate blood to cells and tissues Deliver oxygen and nutrients Carry away metabolic waste products
Slide 4-

Anatomy and Physiology of the Cardiovascular System (2 of 3)
Slide 5-

Anatomy and Physiology of the Cardiovascular System (3 of 3) Three parts Pump (heart) Container (blood vessels) Fluid (blood and body fluids)
Slide 6-

The Heart (1 of 4) The heart is a hollow muscular organ about the size of a clenched fist. Has its own regulatory system Works as two paired pumps Upper chamber (atrium) Lower chamber (ventricle)
Slide 7-

The Heart (2 of 4) Blood leaves each chamber through a one-way valve. Right side receives oxygen-poor blood from veins Left side supplies oxygen-rich blood to arteries
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The Heart (3 of 4)
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The Heart (4 of 4)
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Blood Vessels (1 of 4) Arteries Small blood vessels that carry blood away from the heart Arterioles Smaller vessels that connect the arteries and capillaries
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Blood Vessels (2 of 4) Capillaries Small tubes that link arterioles and venules Venules Very small, thin-walled vessels that empty into the veins Veins Blood vessels that carry blood from the tissues to the heart
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Blood Vessels (3 of 4) As blood flows out of the heart, it passes into the aorta, the largest artery in the body. Oxygen and nutrients easily pass from the capillaries into the cells, and waste and carbon dioxide diffuse from the cells into the capillaries.
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Blood Vessels (4 of 4)
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Blood (1 of 3) Red blood cells Responsible for the transportation of oxygen to the cells Responsible for transporting carbon dioxide away from the cells to the lungs White blood cells
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Blood (2 of 3) Source: © Phototake/Alamy Images
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Blood (3 of 3) Platelets Responsible for forming clots A blood clot forms depending on blood stasis, changes in the vessel walls, and the body’s ability to clot. Plasma
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Autonomic Nervous System Constantly adapting to maintain homeostasis and perfusion Monitors the body’s needs Adjusts blood flow and vascular tone Automatically redirects blood away from other organs to the heart, brain, lungs, and kidneys in an emergency
Slide 18-

Pathophysiology and Perfusion (1 of 5) Blunt trauma can cause injury and significant bleeding that is unseen inside a body cavity or region. Significant amounts of blood loss cause hypoperfusion, or shock. In penetrating trauma, the patient may have only a small amount of bleeding that is visible.
Slide 19-

Pathophysiology and Perfusion (2 of 5) Perfusion is the circulation of blood within an organ or tissue to meet the cells’ needs for oxygen, nutrients, and waste removal.
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Pathophysiology and Perfusion (3 of 5) Some tissues need a constant supply of blood while others can survive with very little.
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Pathophysiology and Perfusion (4 of 5) All organs and organ systems are dependent on adequate perfusion to function properly. Death of an organ system can quickly lead to death of the person.
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Pathophysiology and Perfusion (5 of 5) The heart requires a constant supply of blood. Brain and spinal cord may last 4 to 6 minutes. Kidneys may survive 45 minutes. Skeletal muscles may last 2 hours. Times are based on a normal body temperature.
Slide 23-

External Bleeding Hemorrhage means bleeding. Examples include nosebleeds and bleeding from open wounds. As an EMT, you must understand how to control external bleeding.
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Significance of External Bleeding (1 of 4) With serious external bleeding, it may be difficult to tell the amount of blood loss. Presentation and assessment of the patient will direct care and treatment. Body will not tolerate a blood loss greater than 20% of blood volume.
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Significance of External Bleeding (2 of 4) Significant changes in vital signs may occur if the typical adult loses more than 1 L of blood. Increase in heart rate Increase in respiratory rate Decrease in blood pressure
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Significance of External Bleeding (3 of 4) How well people compensate for blood loss is related to how rapidly they bleed. An adult can comfortably donate 1 unit (500 mL) of blood over 15 to 20 minutes. If a similar blood loss occurs in a much shorter time, the person may rapidly develop hypovolemic shock. Consider age and preexisting health.
Slide 27-

Significance of External Bleeding (4 of 4) Serious conditions with bleeding: Significant MOI Patient has a poor general appearance and is calm. Signs and symptoms of shock Significant blood loss Rapid blood loss Uncontrollable bleeding
Slide 28-

Characteristics of External Bleeding (1 of 2) Arterial bleeding Pressure causes blood to spurt and makes bleeding difficult to control. Typically brighter red and spurts in time with the pulse Venous bleeding Dark red, flows slowly or severely Does not spurt and is easier to manage
Slide 29-

Characteristics of External Bleeding (2 of 2) Capillary bleeding Bleeding from damaged capillary vessels Dark red, oozes steadily but slowly Capillary Venous Arterial
Slide 30-

Clotting (1 of 2) Bleeding tends to stop rather quickly, within about 10 minutes. When a person is cut, blood flows rapidly. The cut end of the vessel begins to narrow, reducing the amount of bleeding. Then a clot forms. Bleeding will not stop if a clot does not form.
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Clotting (2 of 2) Despite the efficiency of the system, it may fail in certain situations. Movement Medications Removal of bandages External environment Body temperature Severe injury
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Hemophilia Patient lacks blood clotting factors. Bleeding may occur spontaneously. All injuries, no matter how trivial, are potentially serious. Patients should be transported immediately.
Slide 33-

Internal Bleeding (1 of 2) Bleeding in a cavity or space inside the body Can be very serious, yet with no outward signs Injury or damage to internal organs commonly results in extensive internal bleeding. Can cause hypovolemic shock
Slide 34-

Internal Bleeding (2 of 2) Possible conditions causing internal bleeding: Stomach ulcer Lacerated liver Ruptured spleen Broken bones, especially the ribs or femur Pelvic fracture
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MOI for Internal Bleeding (1 of 3) High-energy MOI Internal bleeding is possible whenever the MOI suggests that severe forces affected the body. Blunt trauma Penetrating trauma
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MOI for Internal Bleeding (2 of 3) Signs of injury (DCAP-BTLS) Deformities Contusions Abrasions Punctures/penetrations
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MOI for Internal Bleeding (3 of 3) Signs of injury (DCAP-BTLS) (cont’d) Burns Tenderness Lacerations Swelling
Slide 38-

NOI for Internal Bleeding (1 of 3) Bleeding is not always caused by trauma. Nontraumatic causes include: Bleeding ulcers Bleeding from colon Ruptured ectopic pregnancy Aneurysms
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NOI for Internal Bleeding (2 of 3) Frequent signs Abdominal tenderness Guarding Rigidity Pain Distention
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NOI for Internal Bleeding (3 of 3) In older patients, signs include: Dizziness Faintness Weakness Ulcers or other GI problems may cause: Vomiting of blood Bloody diarrhea or urine
Slide 41-

Signs and Symptoms of Internal Bleeding (1 of 4) Pain (most common) Swelling in the area of bleeding Distention Bruising Dyspnea, tachycardia, hypotension Hematoma Bleeding from any body opening
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Signs and Symptoms of Internal Bleeding (2 of 4) Hematemesis Melena Hemoptysis Broken ribs, bruises over the lower part of the chest, or a rigid, distended abdomen Hypoperfusion
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Signs and Symptoms of Internal Bleeding (3 of 4) Later signs of hypoperfusion: Tachycardia Weakness, fainting, or dizziness at rest Thirst Nausea and vomiting Cold, moist (clammy) skin Shallow, rapid breathing
Slide 44-

Signs and Symptoms of Internal Bleeding (4 of 4) Later signs of hypoperfusion (cont’d): Dull eyes Slightly dilated pupils Capillary refill of more than 2 seconds in infants and children Weak, rapid (thready) pulse Decreasing blood pressure Altered level of consciousness
Slide 45-

Patient Assessment for External and Internal Bleeding Patient assessment steps Scene size-up Primary assessment History taking Secondary assessment Reassessment
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Scene Size-up (1 of 2) Scene safety Be alert to potential hazards. At vehicle crashes, ensure the absence of leaking fuel and energized electrical lines. In violent incidents, make sure the police are on the scene. Follow standard precautions.
Slide 47-

Scene Size-up (2 of 2) Mechanism of injury/nature of illness Determine the NOI or MOI. Consider the need for spinal stabilization and additional resources. Consider environmental factors such as weather.
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Primary Assessment (1 of 4) Do not be distracted from identifying life threats. Form a general impression. Note important indicators of the patient’s condition. Be aware of obvious signs of injury. Determine gender and age. Assess skin color and the LOC.
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Primary Assessment (2 of 4) Airway and breathing Consider the need for spinal stabilization. Ensure a patent airway. Look for adequate breathing. Check for breath sounds. Provide high-flow oxygen or assist ventilations with a bag-mask device or nonrebreathing mask.
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Primary Assessment (3 of 4) Circulation Assess pulse rate and quality. Determine skin condition, color, and temperature. Check capillary refill time. Control external bleeding. Treat for shock.
Slide 51-

Primary Assessment (4 of 4) Transport decision Assessment of ABCs and life threats will determine the transport priority. Signs that imply rapid transport: Tachycardia or tachypnea Low blood pressure Weak pulse Clammy skin Tachycardia
Slide 52-

History Taking (1 of 3) Investigate the chief complaint. Look for signs and symptoms of other injuries due to the MOI and/or NOI. You may have identified severe bleeding in the primary assessment. Note obvious signs of internal bleeding. Determine if there are any preexisting illnesses.
Slide 53-

History Taking (2 of 3)
Slide 54-

History Taking (3 of 3) SAMPLE history Ask the patient about blood-thinning medications. If the patient is unresponsive, obtain history from medical alert tags or bystanders. Look for signs and symptoms of shock. Determine the amount of blood loss.
Slide 55-

Secondary Assessment (1 of 5) Record vital signs. Complete a focused assessment of pain. Attach appropriate monitoring devices. With a critically injured patient or a short transport time, there may not be time to conduct a secondary assessment.
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Secondary Assessment (2 of 5) Physical examinations Should include a systematic full-body scan Assess the respiratory system. Assess the airway for patency. Determine the rate and quality of respirations. Look for distended neck veins and a deviated trachea.
Slide 57-

Secondary Assessment (3 of 5) Physical examinations (cont’d) Check for paradoxical movement of the chest wall and bilateral breath sounds. Assess the cardiovascular, neurologic, and musculoskeletal systems. Determine the level of consciousness. Examine pupil size and reactivity. Assess motor and sensory response.
Slide 58-

Secondary Assessment (4 of 5) Assess all anatomic regions. Check the head for raccoon eyes, Battle’s sign, and drainage of blood or fluid from the ears or nose. Feel all four quadrants of the abdomen for tenderness or rigidity. Record pulse, motor, and sensory function in all four extremities.
Slide 59-

Secondary Assessment (5 of 5) Vital signs Assess vital signs to observe the changes that may occur during treatment. A systolic blood pressure of less than 100 mm Hg with a weak, rapid pulse should suggest the presence of hypoperfusion. Cool, moist skin that is pale or gray is an important sign.
Slide 60-

Reassessment (1 of 3) Repeat the primary assessment in areas that showed abnormal findings. Signs and symptoms of internal bleeding are often slow to present. Assess interventions and treatments. Vital signs show how well your patient is doing internally. In severe cases, assess every 5 minutes.
Slide 61-

Reassessment (2 of 3) Interventions Provide high-flow oxygen. Provide treatment for shock and transport rapidly. Do not delay transport of a patient to complete an assessment.
Slide 62-

Reassessment (3 of 3) Communication and documentation Communicate all relevant information to the staff at the receiving hospital. Give an estimate of the amount of blood loss that has occurred. Describe the MOI/NOI and the signs and symptoms. Document all injuries, the care provided, and the patient’s response.
Slide 63-

Emergency Medical Care for External Bleeding (1 of 2) Follow standard precautions. Wear gloves, eye protection, and possibly a mask or gown. Make sure the patient has an open airway and is breathing adequately. Provide high-flow oxygen.
Slide 64-

Emergency Medical Care for External Bleeding (2 of 2) Several methods are available to control external bleeding. Direct, even pressure and elevation Pressure dressings and/or splints Tourniquets It will often be useful to combine these methods.
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Direct Pressure (1 of 2) Most effective way to control external bleeding Pressure stops the flow of blood and permits normal coagulation to occur. Apply pressure with your gloved fingertip or hand over the top of a sterile dressing.
Slide 66-

Direct Pressure (2 of 2) Never remove an impaled object from a wound. Hold uninterrupted pressure for at least 5 minutes.
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Elevation Elevate a bleeding extremity by as little as 6" while applying direct pressure. Never elevate an open fracture to control bleeding. Fractures can be elevated after splinting. Splinting helps control bleeding.
Slide 68-

Pressure Dressing (1 of 2) Firmly wrap a sterile, self-adhering roller bandage around the entire wound. Cover the entire dressing above and below the wound. Stretch the bandage tight enough to control bleeding. You should still be able to palpate a distal pulse.
Slide 69-

Pressure Dressing (2 of 2) Do not remove a dressing until a physician has evaluated the patient. Bleeding will almost always stop when the pressure of the dressing exceeds arterial pressure. Follow the steps in Skill Drill 23-1.
Slide 70-

Tourniquet (1 of 3) If direct pressure fails, apply a tourniquet above the level of bleeding. It should be applied quickly and not released until a physician is present. Follow the steps in Skill Drill 23-2 to apply a commercial tourniquet.
Slide 71-

Tourniquet (2 of 3) Observe the following precautions: Do not apply a tourniquet directly over any joint. Make sure the tourniquet is tightened securely. Never use wire, rope, a belt, or any other narrow material. Use wide padding under the tourniquet.
Slide 72-

Tourniquet (3 of 3) Precautions (cont’d): Never cover a tourniquet with a bandage. Do not loosen the tourniquet after you have applied it.
Slide 73-

Splints (1 of 4) Air splints Can control internal or external bleeding associated with severe injuries Stabilize fractures Act like a pressure dressing Commonly referred to as soft splints or pressure splints
Slide 74-

Splints (2 of 4) Air splints (cont’d) Once the splint is applied, monitor circulation in the distal extremity. Use only approved, clean, or disposable valve stems.
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Splints (3 of 4) Rigid splints Can help stabilize fractures Reduce pain Prevent further damage to soft-tissue injuries Once the splint is applied, monitor circulation in the distal extremity.
Slide 76-

Splints (4 of 4) Traction splints Designed to stabilize femur fractures When the EMT pulls traction to the ankle, countertraction is applied to the ischium and groin. Once the splint is applied, monitor circulation in the distal extremity.
Slide 77-

Bleeding From the Nose, Ears, and Mouth (1 of 3) Several conditions: Skull fracture Facial injuries Sinusitis, infections, use and abuse of nose drops, dried or cracked nasal mucosa High blood pressure Coagulation disorders Digital trauma
Slide 78-

Bleeding From the Nose, Ears, and Mouth (2 of 3) Epistaxis (nosebleed) is a common emergency. Occasionally it can cause enough blood loss to send a patient into shock. Can usually be controlled by pinching the nostrils together Follow the steps in Skill Drill 23-3 to control epistaxis.
Slide 79-

Bleeding From the Nose, Ears, and Mouth (3 of 3) Bleeding from the nose or ears following a head injury: May indicate a skull fracture May be difficult to control Do not attempt to stop blood flow. Loosely cover the bleeding site with a sterile gauze pad. Apply light compression with a dressing.
Slide 80-

Emergency Medical Care for Internal Bleeding (1 of 2) Usually requires surgery or other hospital procedures Keep the patient calm, reassured, and as still and quiet as possible. If spinal injury is not suspected, place the patient in the shock position. Provide high-flow oxygen.
Slide 81-

Emergency Medical Care for Internal Bleeding (2 of 2) Maintain body temperature. Splint the injured extremity (usually with an air splint). Never use a tourniquet to control bleeding from closed, internal, soft-tissue injuries. Follow the steps in Skill Drill 23-4.
Slide 82-

Summary (1 of 6) Perfusion is the circulation of blood in adequate amounts to meet the cells’ current needs for oxygen, nutrients, and waste removal.
Slide 83-

Summary (2 of 6) The cardiovascular system has three main components: Pump (heart) Container (blood vessels) Fluid (blood and bodily fluids)
Slide 84-

Summary (3 of 6) Hypoperfusion (shock) occurs when the cardiovascular system fails to provide adequate perfusion. Both internal and external bleeding can cause shock. You must know how to recognize and control both.
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Summary (4 of 6) The methods to control bleeding, in order, are: Direct, even pressure Elevation Pressure dressings Tourniquets Splinting device
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Summary (5 of 6) Bleeding around the face always presents a risk of airway obstruction or aspiration. Any patient you suspect of having internal bleeding or significant external bleeding should be transported promptly.
Slide 87-

Summary (6 of 6) Signs of serious internal bleeding: Vomiting blood (hematemesis) Black tarry stools (melena) Coughing up blood (hemoptysis) Distended abdomen Broken ribs