PREVIEW OF

EMT/EMR BLEEDINGPOWERPOINT TRAINING

PRESENTATION

ANATOMY REVIEW

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

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

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

CAPILLARY BLEEDING

Blood oozes from woundUsually easy to control or

stop without intervention

Clots spontaneously

Photo by Sean McGinnis

SEVERITY

Related toVolume of blood lossRate of blood lossAge and pre-existing health of patient

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)

CLASSES OF HEMORRHAGE

Based upon American College of Surgeons ATLSstandards

4 classes based upon blood volume lost

CLASSES I

Involves <15% of blood volume lossNormally no changes in vital signs

BLOOD CLOTTING

Bleeding normally stops within 5-10 minutesClotting disorders & diseases may prevent clottingSome injuries may not be able to clot

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

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

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

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

HEMOSTATIC AGENTAKA QUICK CLOT

Powder that can be directly applied to bleeding wound

or impregnated into a bandage

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

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)

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

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

RELATIONSHIP TO MECHANISM OF INJURY

Blunt traumaFallsMotorcycle crashesPedestrian impactsAutomobile collisionsBlast injuriesLook for evidence of contusions,

abrasions, deformity, impact marks, & swelling

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

SIGNS & SYMPTOMS

Discolored, painful, tender, swollen, or firm tissueIncreased respiratory rateIncreased pulse ratePale, cool skinNausea and vomitingThirstMental status changes

Photo by Glen Bowman

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

MANAGEMENT STRATEGIES

Stabilize Body TemperaturePsychological SupportTransport Considerations

Trauma centerAeromedical transportALS mutual aid

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

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

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

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

NOSEBLEED

AKA EpistaxisCausesGeneral assessment findings

& symptomsTechniques to stop bleeding in conscious patient

if no risk of spine injury

CAUSES

TraumaNasal fracture Nose pickingMiddle ear barotrauma

MedicalDrynessHigh blood pressureCocaine snorting

GENERAL ASSESSMENT FINDINGS & SYMPTOMS

Pain or tendernessBleeding from noseVomitVomits swallowed bloodCan block airway if patient is unresponsive

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

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

GERIATRIC COMPLICATIONS

Anticoagulant medicines, thinning of the nasal mucosa, & high blood pressure can be

predispositions for elderly males

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