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Chapter 13: Bleeding, Shock, and Soft-Tissue Injuries
Chapter 13 Bleeding, Shock, and Soft-Tissue Injuries Bleeding, Shock, and Soft-Tissue Injury • Damage to soft tissues and organs can be life threatening. • More trauma patients die from shock than from any other reason. Body Substance Isolation • Most soft-tissue injuries involve bleeding. • Take appropriate measures to prevent contact with patient’s body fluids. • Gloves must be worn to avoid contact with patient’s blood. • You may also need a mask and eye protection. Circulatory System Review • The pump – Heart functions as system’s pump. – Consists of four chambers • The pipes – Arteries – Capillaries – Veins
(1 of 2) Circulatory System Review • The fluid – Consists of blood cells and other components – Liquid part is plasma. • Pulse – Pressure wave generated by pumping of heart
(2 of 2) Shock • Collapse of the cardiovascular system • Inadequate tissue perfusion • Main causes: – Pump failure – Pipe failure – Fluid loss Pump Failure • Cardiogenic shock • Heart cannot pump enough blood. • Can cause blood to back up in the vessels of the lungs – Known as congestive heart failure Pipe Failure • Caused by expansion of capillaries • Blood pressure may drop rapidly. • Types – Fainting (psychogenic shock) – Anaphylactic shock (extreme allergic reaction) – Spinal shock (spinal cord injuries) Fluid Loss • Excessive bleeding (hemorrhage) • Fluid level in the circulatory system drops until pump cannot operate. • Loss of 2 or more pints of blood can produce shock. Signs and Symptoms of Shock • Confusion, restlessness, anxiety • Cold, clammy, sweaty, pale skin • Rapid breathing • Rapid, weak pulse
(1 of 2) Signs and Symptoms of Shock • Increased capillary refill time • Nausea, vomiting • Weakness or fainting • Thirst
(2 of 2) General Treatment for Shock • Position patient correctly. • Maintain patient’s ABCs. • Control bleeding. • Maintain body temperature. • Do not give anything to eat or drink. • Provide oxygen, if available. • Arrange for immediate and prompt transport. Anaphylactic Shock • Treatment: – Keep patient lying down with legs elevated. – If patient has epinephrine auto- injector, help patient use it. – Maintain ABCs. – Arrange for rapid transport. External Blood Loss • Treatment for shock caused by external blood loss: – Control bleeding. – Keep patient lying down with legs elevated. – Maintain ABCs and body temperature. – Do not allow patient to eat or drink. – Provide oxygen. Types of Bleeding • Capillary – Blood oozes out. • Venous – Has a steady flow • Arterial – Blood spurts or surges. – Can result in death from blood loss
(1 of 2) Types of Bleeding
Recognizing the types of external bleeding.
A. Capillary. B. Venous. C. Arterial. (2 of 2) Controlling External Blood Loss • Use proper BSI. • Apply direct pressure using sterile dressings, if available. • Elevate extremity if you do not suspect a fracture. • Locate and apply pressure to brachial or femoral pressure points. Pressure Points • Prevents blood from flowing into injured limb • Like stepping on a garden hose to stop water flow • Two options – Brachial artery in upper arm – Femoral artery in the groin
(1 of 2) Pressure Points
Applying pressure to the brachial and femoral arteries.
(2 of 2) Open vs. Closed Wounds • Open: • Closed: – Abrasion – Bruise – Puncture – Skin remains intact. – Laceration – Avulsion Punctures • Sharp object remains in skin. • Do not bleed freely • Gunshot wounds – May appear as an insignificant hole – Can do massive damage – Usually have an entrance wound and an exit wound Avulsions and Amputations • Tearing away of body tissue • Part may be totally severed from body or attached by flap of skin. • Locate amputated part, place in clean plastic bag, and keep cool. Principles of Wound Treatment • Control bleeding as quickly as possible. • Prevent further contamination of wound. • Immobilize injured part. • Stabilize impaled object. Dressings • An object placed directly on a wound to control bleeding • Sterile dressings come in many different sizes. • Touch only one corner of the dressing when opening a sterile package. Bandages • Used to hold dressings in place • Roller gauze and triangular bandages commonly used in the field. • Wrap bandage just tightly enough to control bleeding. – Ensure that circulation is not cut off. Face and Scalp Wounds • Cause large amounts of bleeding • Most bleeding can be controlled by applying pressure. Eye Injuries • For lacerations, cover entire eye. • For impaled objects: – Cover injured eye with a dressing. – Place a paper cup over injured eye. – Bandage both eyes. Chest and Back Wounds • May affect lungs, large vessels, and heart • Any wound involving these organs is life threatening. • Use an occlusive dressing to secure wound. • Place patient in a comfortable position. • Administer high-flow oxygen. Occlusive Dressings Closed Abdominal Wounds • Usually result from a direct blow with a blunt object • Abdomen may be swollen, rigid, or boardlike. • Give nothing by mouth. • Arrange for prompt transport. Open Abdominal Wounds • Apply dry, sterile dressings to wounds. • Maintain patient’s body temperature. • Place patient on back with legs elevated.
(1 of 2) Open Abdominal Wounds • If patient is having difficulty breathing, place in semireclining position. • Administer high-flow oxygen. • To bandage, apply a sterile dressing and wrap the bandage. semireclining position.
(2 of 2) Genital Wounds • Both male and female genitals have a rich blood supply. • Apply direct pressure with a dry, sterile dressing. • Patient can suffer critical blood loss. Extremity Wounds • Apply dry, sterile dressing and bandage. • Elevate area to decrease bleeding and swelling. • Splint injured area if fracture is suspected. Gunshot Wounds • Establish ABCs. • Control any external bleeding. • Examine for entrance and exit wounds. • Treat for shock. • Arrange for prompt transport. • Be prepared to perform CPR. Depth of Burns • Superficial (first-degree): Skin is reddened and painful. • Partial-thickness (second-degree): Blisters are present. • Full-thickness (third-degree): Destroys underlying muscle and other tissues Extent of Burns • Rule of Nines – Method for determining what percentage of the body has been burned Thermal Burns • Caused by heat • Cool burned area. • Cover with a dry, sterile dressing or burn sheet. • Do not remove clothing. • Arrange for transport.
(1 of 2) Thermal Burns
Applying a sterile burn sheet.
(2 of 2) Respiratory Burns • Signs and symptoms: – Burns around face – Singed nose hairs – Soot in mouth and nose – Difficulty breathing – Pain while breathing – Unconsciousness Care for Respiratory Burns • Watch patient carefully. • Monitor the ABCs. • Administer high-flow oxygen. • Arrange for prompt transport. Chemical Burns • Remove patient from exposure. • Brush off dry chemicals. • Flush contaminated skin for 10 minutes. • Cover area with dry, sterile dressing.
(1 of 2) Chemical Burns • Chemicals are extremely dangerous to eyes. • Flush chemical burns to eyes for at least 20 minutes.
(2 of 2) Electrical Burns • Make sure there is no contact with power sources. • Unplug, disconnect, or turn off power. • Examine patient. • Assess ABCs. • Arrange for prompt transport.
