Bleeding and Shock

External or internal bleeding common with trauma patients

Control bleeding quickly to prevent shock

Bleeding

Risk of infectious disease from contact with the patient’s blood or body fluids

Follow standard precautions Serious injury may prevent effective

clotting Significant blood loss will cause shock and

possibly death

Bleeding, continued

Types of External Bleeding

Perform the standard assessment

Estimate severity of blood loss

Assess the patient for shock

Assessing External Bleeding

Skill:Bleeding Control

Apply roller bandage.

Used to control bleeding

Prevents contaminationDressings should be:◦Sterile◦Larger than the wound◦Thick, soft, compressible◦Lint free (no cotton balls)

Dressings

Gauze padsAdhesive strips

Trauma dressings

Improvise

Types of Dressings

Hemorrhage: Rapid blood loss◦Adult: 1 quart may lead to shock◦Child: 1 pint loss of blood

Dressing◦A protective covering for a wound –

Bandage◦A material used to hold a dressing in place

Definitions

Application◦Wash hands◦Dressing should extend over edges of wound

◦Do not touch dressing surface that is to be next to the wound

◦Cover with a bandage

Dressings

Holding dressings in placeApplying pressurePrevent or reduce swellingProvide support or stability

Bandages Are Used For:

Leave toes and fingers exposed if possible◦Bandage too tight? Check for color, circulation, temperature

Wrap towards the heart◦Small end of bone to large end

Application of Bandages

Roller gauze Improvised Triangular Adhesive / paper

tape Adhesive strips Tourniquets are

rarely recommended◦Damage to nerves

and vessels

Types of Bandages

HemophiliacsAspirin

Problem Bleeders

Protruding boneSkull fractureEmbedded object

Stick Shrapnel

When Not To Apply Direct Pressure

Abrasion – scrape Incision – smooth edged cut Laceration – jagged irregular edges Puncture – deep, narrow stab wound

◦High rate of infection (animal bites) Avulsion – flap of skin torn loose Amputation – cutting off a body part

Types of Open Wounds

Crushing◦ Poor chance of reattachment

Guillotine◦ Clean cut◦ Good chance of reattachment

(fingertips of kitchen counter) De-gloving

◦ Skin peeled off

Amputations

Control bleedingTreat for shockRecover body partTransport

Amputation: What To Do

Wrap in dry clean cloth◦Do not wrap in wet dressing

Place in waterproof container

Place bag on bed of iceTransport immediately

Care For Amputated Part

DO NOT REMOVE !!!!!!!!!!!! Control bleeding Stabilize object Shorten object only if necessary One exception:

◦If impaled in cheek and > l hour from help and Pencil is through & through Control bleeding Dressings inside and outside of cheek

Impaled Object

Do not apply pressure to eye

Place padding around object

Stabilize object◦Paper cup

Cover both eyes◦Explain to victim

Impaled Eye

Flush 20 minutes with low pressure water◦Remove contacts◦Flush outward◦Roll eyeball

Loosely bandage both eyes with cold, wet dressings

Chemical Burn to the Eye

Dust off chemicalProtect yourselfThen rinse 20 minutes

Dry Chemical Burns

Do not replace in socket

Cover loosely with moistened sterile dressing

Pad around areaCover with paper cup etc.Cover uninjured eye

Eye Avulsion

Watery blood could mean a skull fracture

Allow victim to sit up and tilt the affected ear lower to let blood drain out

Only if no Spinal Injury Suspected Cover ear with loose dressing but DO

NOT apply pressure

Bleeding from within the Ear

Knocked out tooth Broken tooth

Dental Injuries

Rinse mouth / rinse tooth if dirty Place roll of gauze in the socket Do not scrub or use alcohol or

mouthwash on the tooth Never touch root Transport in cold, whole milk

Knocked Out Tooth

Broken tooth?◦ Clean area◦ Cold compress◦ Remote area? Candle wax,

gum Fractured jaw?

◦ Immobilize◦ Medical attention

Broken Tooth / Fractured Jaw

Suspect spine injury

Profuse bleeding

Skull or brain exposure?

Indentation in skull?

Control bleeding

Scalp Wounds

Depressed skull fracture?◦ Apply pressure around edges

of wound◦ Elevate head and shoulders if

appropriate Lessens bleeding

Do not remove impaled objects◦ Immobilize with bulky

dressings

Scalp Wounds #2

Signs and symptoms◦Penetrating wound◦Point tenderness◦Deformity

Skull Fractures

◦ Bleeding from ears or nose◦ Leakage of clear or pink watery

fluid from ears or nose (CSF fluid) Halo effect

◦ Discoloration under eyes or behind ears

◦ Unequal pupils◦ Profuse bleeding

Skull Fractures #2

Monitor ABC’s Apply dressing Control bleeding as best as possible Stabilize neck (elevate head if

appropriate) Do not clean open skull

fracture Do not stop CSF flow

Skull Fracture: What To Do

QUESTION???????