Bleeding and Shock Management

Overview

This lecture covers the recognition, assessment, and management of life-threatening bleeding, discussing both external and internal bleeding, their impact on perfusion and shock, and the emergency interventions required.

Bleeding Basics and Cardiovascular System Review

Bleeding (hemorrhage) is a critical threat leading to hypoperfusion (shock) if uncontrolled.
The cardiovascular system consists of the heart (pump), blood vessels (container), and blood/fluid (content).
Blood moves from arteries to arterioles to capillaries, then to venules and veins, returning to the heart.
Red blood cells carry oxygen, platelets form clots, and plasma is the fluid matrix.
Clotting requires platelets, vessel wall changes, and proper coagulation function.

Perfusion and Shock

Perfusion is blood circulation that delivers oxygen/nutrients and removes waste from tissues.
Key organs (heart, brain, lungs, kidneys) require uninterrupted perfusion to prevent dysfunction or death.
Hypoperfusion (shock) results when blood volume is insufficient, causing organ failure.

External Bleeding

External bleeding is visible, from open wounds or orifices.
Severe hemorrhage is defined by poor appearance, signs of shock, significant/rapid blood loss, or uncontrollable bleeding.
Arterial bleeding is bright red and spurts; venous is dark and flows steadily; capillary oozes slowly.
Body cannot tolerate loss of >20% blood volume; children and infants are more sensitive to blood loss.

Internal Bleeding

Internal bleeding occurs within body cavities and may have few outward signs.
Causes include trauma (blunt/penetrating), fractures, or medical conditions (ulcers, aneurysms, ectopic pregnancy).
Symptoms: pain, swelling, bruising (ecchymosis), vomiting blood, blood in urine, or shock.
Early signs of shock: anxiety, altered mental status, pale or cool skin, tachycardia.

Assessment of Bleeding

Scene safety and PPE are priorities before patient contact.
Primary assessment: control major external bleeding immediately, then address airway, breathing, and circulation (ABCs).
Assess for shock, check skin color/capillary refill, mental status, and vital signs.
History: ask about blood thinners and pre-existing conditions.
Secondary assessment: look for hidden injuries, record vital signs, and reassess frequently.

Emergency Management of External Bleeding

Follow standard precautions (gloves, eye protection).
Apply direct pressure with a sterile dressing as the first-line intervention.
If direct pressure fails, use a pressure dressing, then a tourniquet proximal to the wound.
Do not remove dressings; reinforce as needed. Mark tourniquet time/location.
For wounds where tourniquet placement is impossible, use wound packing with hemostatic dressings.
Splints and pelvic binders help control bleeding from fractures.

Special Bleeding Situations

For nosebleeds (epistaxis), pinch nostrils, sit patient forward, apply ice, and maintain pressure for 15 minutes.
Do not stop blood flow from ears/nose after head trauma; cover loosely and avoid pressure.
Internal bleeding often requires transport for definitive care; splint extremities and provide high-flow oxygen.

Key Terms & Definitions

Hemorrhage — significant and dangerous blood loss.
Perfusion — adequate blood flow to tissues for oxygen and waste exchange.
Clotting — the process of blood solidifying to stop bleeding.
Hemophilia — inherited disorder affecting blood clotting.
Ecchymosis — bruising from blood pooling under the skin.
Tourniquet — device applied to limbs to stop severe external bleeding.
Hemostatic dressing — gauze with chemicals to promote clotting.
Hypoperfusion (Shock) — inadequate tissue perfusion due to low blood volume.

Action Items / Next Steps

Review Skill Drills 26-1 through 26-5 for bleeding control techniques.
Practice applying direct pressure, tourniquets, and wound packing as described.
Prepare for hands-on assessment scenarios involving both internal and external bleeding.
Read Chapter 13 for detailed discussion on shock.