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PREVIEW OF
EMT/EMR BLEEDINGPOWERPOINT TRAINING
PRESENTATION
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ANATOMY REVIEW
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PERFUSION
Definition - circulation of blood through an organ structure
Perfusion delivers oxygen and other nutrients to the cells of all organ systems and the removes waste products
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ARTERIAL BLEEDING
Bright red bleeding “spurting”Difficult to control, due to size of vessels,
volume of blood, and pressure that blood is pushed through arteriesAs blood pressure drops, amount of spurting
blood drops
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VENOUS BLEEDING
Darker red blood can vary from slow to severe stream, depending on size of
veinCan be difficult to control, but easier to control
than arterial bleedsBleeding can be profuse and life-threatening
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CAPILLARY BLEEDING
Blood oozes from woundUsually easy to control or
stop without intervention
Clots spontaneously
Photo by Sean McGinnis
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SEVERITY
Related toVolume of blood lossRate of blood lossAge and pre-existing health of patient
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SEVERITY
The sudden loss of one liter (1000cc) of blood in the adult patient, 1/2 liter (500cc) of blood in the child, and 100- 200cc of the blood volume in an infant is considered serious. (For example, a one year old only has 800cc of blood, therefore 150cc is a major blood loss)
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CLASSES OF HEMORRHAGE
Based upon American College of Surgeons ATLSstandards
4 classes based upon blood volume lost
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CLASSES I
Involves <15% of blood volume lossNormally no changes in vital signs
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BLOOD CLOTTING
Bleeding normally stops within 5-10 minutesClotting disorders & diseases may prevent clottingSome injuries may not be able to clot
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GENERAL ASSESSMENT
Mechanism of injuryPrimary Survey
Identify and manage life threats related to bleedingMental status
Physical ExamBlood pressure is not a reliable indicator of early shockLung soundsPeripheral perfusionSkin parameters
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DIRECT PRESSURE
Application of even pressure to an open injury that includes the area just proximal and distal to the injury
Using a gloved hand and dressings, the wound is coveredand firm pressure applied until bleeding is controlled
Usually effective in capillary and minor venous bleedingIn cases of heavier bleeding or major wounds, multiple
dressings may be necessary; do not remove existingdressings but apply additional dressings on top of
existing dressings in cases of continuing hemorrhage
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TOURNIQUETUse as a last resort to control bleeding of
an amputated extremity when all other methods of bleeding control have failedApplication of a tourniquet can cause permanent damage to nerves, muscles and blood vessels resulting in the loss of an extremity
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TOURNIQUETNotify other emergency personnel who may care for the patient that a tourniquet has been appliedDocument the use of a tourniquet and the
time applied in the prehospital patient reportA continuously inflated blood pressure cuff may be used as a tourniquet until bleeding stops
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TOURNIQUETPrecautions with the use of a tourniquet:
Use a wide bandage and secure tightly
Never use wire, rope, a belt, or any other material that may cut into the skin and underlying tissue
Do not remove or loosen the tourniquet once it is applied unless directed to do so by medical control
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HEMOSTATIC AGENTAKA QUICK CLOT
Powder that can be directly applied to bleeding wound
or impregnated into a bandage
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SIGNS & SYMPTOMS
Bleeding may not slow after much blood lossSome patients may be quiet and calm due to excessiveblood lossThe amount of blood at the scene does not always indicate the amount of blood loss; the patient may moveEstimating the amount of blood loss by the size of a blood pool or the amount on clothing is not accurateAssess for signs and symptoms of shock
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INTERNAL BLEEDING
Definition/descriptionAny bleeding in a cavity or space inside the
bodyInternal bleeding can be severe and life
threateningMay initially go undetected without proper
assessment (mechanism of injury, signs, and symptoms)
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SEVERITY
Internal bleeding can result in severe blood loss with resultant shock and
subsequent deathInjured or damaged internal organs commonly lead to extensive bleeding that
is concealedFractures can lead to serious internal blood
loss
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SEVERITY
Painful, swollen, deformed extremities may also lead to serious internal blood loss
Suspicion and severity of internal bleeding should be based on the mechanism of injury and clinical signs and symptoms
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RELATIONSHIP TO MECHANISM OF INJURY
Blunt traumaFallsMotorcycle crashesPedestrian impactsAutomobile collisionsBlast injuriesLook for evidence of contusions,
abrasions, deformity, impact marks, & swelling
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SOURCES OF HIDDEN BLOOD LOSSSITE AMOUNT OF BLOOD
LOSS% OF BLOOD VOLUME
Abdomen > 1 Liter 40%
Thorax 2 Liters 50%
Femur > 1 liter 20%
Pelvis 0.5 Liters for fracture 10% for fracture
Skull No significant loss unless infant
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SIGNS & SYMPTOMS
Discolored, painful, tender, swollen, or firm tissueIncreased respiratory rateIncreased pulse ratePale, cool skinNausea and vomitingThirstMental status changes
Photo by Glen Bowman
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SIGNS & SYMPTOMS
Guarding, tenderness, deformity, discoloration of the affected area
Coughing up blood, blood in urine, rectal bleeding
Abdominal tenderness, guarding, rigidity, distention
Bleeding from a body orifice.Signs of shock
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MANAGEMENT STRATEGIES
Stabilize Body TemperaturePsychological SupportTransport Considerations
Trauma centerAeromedical transportALS mutual aid
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INTERNAL BLEEDING
Injured or damaged internal organsMay lead to extensive, concealed bleedingMay cause unexplained shock
Injuries to the extremities may lead to serious internal blood loss from long bone
fractures
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MANAGEMENT OF BLEEDING SOFT TISSUE INJURIES
Expose the woundControl the bleedingApply fingertip pressure (use flat part of
fingers) directly on the point of bleedingLarge wounds may require sterile gauze and direct hand pressure if fingertip pressure
does not control bleeding
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MANAGEMENT OF BLEEDING SOFT TISSUE INJURIES (CONT.)
If bleeding oozes through dressing, do not lift off; apply another gauze dressing on top of
the first and continue to apply pressureConsider other measures for bleeding control based on local guidelinesPrevent further contaminationApply sterile dressing to the wound and
bandage securely in place with tape or roller gauze
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MANAGEMENT OF BLEEDING SOFT TISSUE INJURIES (CONT.)
Keep patient warmPosition patient flat on backDo not give food or drink if shock is suspectedTreat other injuries
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NOSEBLEED
AKA EpistaxisCausesGeneral assessment findings
& symptomsTechniques to stop bleeding in conscious patient
if no risk of spine injury
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CAUSES
TraumaNasal fracture Nose pickingMiddle ear barotrauma
MedicalDrynessHigh blood pressureCocaine snorting
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GENERAL ASSESSMENT FINDINGS & SYMPTOMS
Pain or tendernessBleeding from noseVomitVomits swallowed bloodCan block airway if patient is unresponsive
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TECHNIQUES TO STOP BLEEDING IN CONSCIOUS PATIENT
IF NO RISK OF SPINE INJURY
Sit patient up and lean forwardPinch the nostrils together
firmlyTell patient not to sniffle or
blow nose
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COMPLICATIONS
Blood can run up in the nasolacrimal duct (tear duct) into the eye
Blood can drain into the stomach causing nausea & vomitingAbout 4 deaths in the US each year
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GERIATRIC COMPLICATIONS
Anticoagulant medicines, thinning of the nasal mucosa, & high blood pressure can be
predispositions for elderly males
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