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Ch 26 Emergency Care for Bleeding Management

Apr 15, 2025

Chapter 26: Bleeding - Emergency Care and Transportation of the Sick and Injured (12th Edition)

Key Learnings

  • Understanding the circulatory system and bleeding characteristics.
  • Importance of personal protective equipment (PPE) in treating bleeding.
  • Characteristics of external vs. internal bleeding.
  • Conducting a patient assessment.
  • Methodologies for controlling bleeding.

Overview

  • Bleeding can be external (obvious) or internal (hidden).
  • Uncontrolled bleeding can lead to hypoperfusion, shock, and death.

Circulatory System: Anatomy and Physiology

  • Components: Heart (pump), Blood vessels (container), Blood and body fluids (fluid).
  • Heart: Two paired pumps (atrium - upper, ventricles - lower) with one-way valves.
  • Blood Vessels: Arteries, arterioles, capillaries, venules, veins.
  • Blood Composition: Red blood cells (oxygen transport), White blood cells (infection fight), Platelets (blood clots), Plasma (liquid part).

Autonomic Nervous System

  • Monitors body's needs, adjusts blood flow, maintains homeostasis.
  • Failure leads to shock due to insufficient circulation.

Perfusion and Pathophysiology

  • Perfusion: Circulation of blood to meet cell needs.
  • Requires adequate blood flow for oxygen, nutrients, and waste exchange.
  • Critical for organ function; lack of blood flow can lead to organ/system failure.

External Bleeding

  • Hemorrhage: Visible bleeding.
  • Significance: Loss of >20% blood volume is critical.
  • Types:
    • Arterial: Bright red, spurts with pulse, difficult to control.
    • Venous: Dark red, steady flow, easier to manage.
    • Capillary: Oozes, more likely to clot spontaneously.

Clotting Process

  • Vasoconstriction: Vessel narrowing to reduce bleeding.
  • Clot formation: Essential to stop bleeding unless vessel is cut off completely.
  • Hemophilia: Lacks clotting factors; requires immediate transport.

Internal Bleeding

  • Detection: Hard to detect, can cause hypovolemic shock.
  • Causes: Ulcers, liver lacerations, spleen rupture, broken bones.
  • Signs: Pain, swelling, distension, bruising, bleeding from orifices.

Hypoperfusion (Shock)

  • Symptoms: Anxiety, restlessness, weakness, dizziness, tachycardia, nausea.
  • Later Signs: Dilated pupils, weak pulse, altered mental status.

Patient Assessment

  • Scene Size-Up: Check for hazards, standard precautions.
  • Primary Assessment: General impression, life threats, AVPU scale.
  • ABCs/D (Airway, Breathing, Circulation, Decision): Ensure oxygenation, control bleeding, rapid transport.
  • History and Secondary Assessment: Chief complaint, SAMPLE history, D-CAP-BTLS for injuries.
  • Reassessment: Frequent checks, especially for unstable patients.

Emergency Care

  • PPE: Use gloves, mask, eye protection, gown.
  • Methods to Control Bleeding:
    • Direct Pressure: Most effective.
    • Pressure Dressings/Splints.
    • Tourniquets.
    • Hemostatic Dressings/Wound Packing.

Special Situations

  • Nose, Ear, Mouth Bleeding: Skull fractures, high blood pressure, epistaxis (nosebleeds).
  • Internal Bleeding Care: Keep patient calm, provide oxygen, maintain body temperature.

Key Concepts

  • Direct Pressure: Immediate action for external bleeding.
  • Tourniquet: For uncontrollable extremity bleeding.
  • Junctional Tourniquets: For areas like groin, axilla.
  • Pelvic Binder: For unstable pelvic fractures.
  • Epistaxis Management: Pinch nostrils.
  • Internal Bleeding: Requires surgical intervention.

Conclusion

  • Understanding bleeding management crucial for EMTs.
  • Standard precautions and rapid intervention improve patient outcomes.

Review Questions

  1. Which is not a component of the cardiovascular system? Lungs.
  2. Perfusion definition: Circulation of adequate oxygen and nutrients.
  3. Highest treatment priority in injuries: Arterial bleeding.
  4. Vital signs least indicative of internal bleeding: Option A (least extreme symptoms).
  5. First step in internal bleeding care: Take standard precautions.
  6. Quickest way to control external bleeding: Direct pressure.
  7. Tourniquet application: Avoid joints; apply above the bleeding site.
  8. Contributing factor to nosebleed: High blood pressure.
  9. Prevent aspiration in epistaxis: Lean forward.

End of Chapter 26: Bleeding

For more detailed demonstrations and techniques, refer to the skill drills in the textbook.

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