Bleeding Management and Hemorrhage

Overview

This lecture covers the recognition, assessment, and management of bleeding, emphasizing key terms, bodily responses, and interventions for both external and internal hemorrhage.

Perfusion and Cardiac Cycle

• Perfusion is the circulation of blood delivering oxygen and nutrients to body tissues.
• Critical organs requiring perfusion include the heart, brain, spinal cord, lungs, and kidneys.
• The cardiac cycle is the repetitive process that pumps blood through the body.
• Preload is the volume or pressure of blood returning to the heart.
• Afterload is the pressure in the aorta or resistance the heart must pump against to circulate blood.
• Adequate stroke volume, hemoglobin, and oxygen are essential for tissue oxygenation.

Hemorrhage Types and Causes

• Hemorrhage is blood loss from a blood vessel, either internally or externally.
• External hemorrhage results from skin breaks; severity varies by injury.
• Internal hemorrhage occurs inside the body, often within thoracic, abdominal, or pelvic cavities, or from bilateral femur fractures.
• Non-traumatic causes include GI bleeds, ectopic pregnancies, and ruptured aneurysms.
• Trauma and medical illnesses can both cause internal bleeding.

Signs, Symptoms, and Body Response

• Signs of internal bleeding: pain at site, swelling, bruising, hematoma, blood in vomit (hematemesis), and mental status changes.
• First signs of hypovolemic shock include altered mental status and light-headedness.
• Vital signs can change significantly with the loss of just one liter of blood.
• The body compensates for bleeding by increasing heart and respiratory rates.

Hemorrhage Management

• Serious bleeding is indicated by significant injury, poor appearance, signs of shock, or uncontrolled rapid bleeding.
• The body stops bleeding via rapid platelet activation and clotting.
• Medications like Warfarin, Xarelto, and aspirin interfere with normal clotting.
• Hemophilia and other blood disorders increase risk from hemorrhage.

Trauma Triad of Death and Assessment

• Trauma Triad of Death: hypothermia, coagulopathy, and acidosis.
• Primary assessment starts with controlling massive bleeding (X-ABC approach).
• Internal bleeding requires rapid transport; pre-hospital treatment focuses on shock management.

External Hemorrhage Interventions

• Control with direct pressure, pressure dressings, and sometimes splints.
• Do not remove applied dressings; add additional layers if needed.
• Tourniquets should be applied above the bleeding site and not removed before hospital care.
• Air splints and rigid splints can help control bleeding and stabilize fractures.
• Hemostatic agents and wound packing are options for uncontrollable external bleeding.
• Pneumatic anti-shock garments (PASG) may help in severe cases.

Special Considerations

• Epistaxis (nosebleed) can be caused by trauma, high blood pressure, or dry sinuses, and may lead to shock.
• Manage nosebleeds by compressing the nose and leaning the patient forward.
• Do not give anything by mouth in patients with internal bleeding.

Monitoring and Transport

• Maintain systolic BP between 80-90 mmHg in trauma to prevent dislodging clots.
• Continuously reassess level of consciousness, pulse, and blood pressure en route.

Key Terms & Definitions

• Perfusion — delivery of oxygen and nutrients to tissues via blood circulation.
• Preload — blood volume/pressure returning to the heart before contraction.
• Afterload — resistance the heart must overcome to empty into the aorta.
• Hemorrhage — bleeding or blood loss from vessels.
• Hypovolemic Shock — shock from insufficient blood volume.
• Trauma Triad of Death — hypothermia, coagulopathy, and acidosis.
• Epistaxis — nosebleed.

Action Items / Next Steps

• Review agency-specific tourniquet applications.
• Memorize the trauma triad of death and key interventions.
• Practice primary and secondary assessment skills for bleeding patients.