Bleeding, Burns, and Shock

Bio Medicine Emergency Medicine #2 Dr. Spencer Shimabukuro

Control of Bleeding

Bleeding
Many minor wounds will stop bleeding without intervention. The first responder is simply helping with the process. Severe, uncontrolled bleeding, however, is life threatening. Direct pressure on the wound will control most bleeding. Apply direct pressure until the bleeding has stopped completely or professional rescuers arrive.

BLOOD VESSELS
ARTERIES
Flexible thick walled.

Three layers
1) Endothelium made of epithelial tissue usually found in the organs and serves as a protective layer 2) Middle layer contains smooth muscle and elastic tissue 3) Outer layer also elastic and made of collagen and other supporting tissue Largest- Aorta

Arterial bleeding: Bright red blood spurting from wound.

*Arterial bleeding is the most serious due to the amount & speed of blood loss, & it is the hardest type to control*

BLOOD VESSELS
CAPILLARIES
Only one layer thick and at its smallest only wide enough for one blood cell to pass-thru in single file Supply blood to the other vessels as well as the heart at the end of the capillary system, blood passes into venules ( the smallest of the veins and then into veins for transport back to the heart) Capillary bleeding: Blood slowly draining or oozing from wound.

BLOOD VESSELS
VEINS

Three layered walls less elastic and more pliable than arteries Veins can collapse, arteries cannot Venous bleeding: Dark red blood slowly flowing from the wound at a steady rate.

Types of Wounds
Laceration
Clean break in the skin usually made with a sharp object.

Types of Wounds
Puncture
Usually deep with minimal bleeding. Greatest chance of infection.

Types of Wounds
Impaled object
Foreign body penetration Leave object in place, as it may slow the bleeding Use bulky dressing & adhesive tape to stabilize object in place

Types of Wounds
Abrasion
Painful scraping away of skin

Types of Wounds
Amputation Loss of a body part
Apply pressure Salvage amputated part; wrap in dry sterile gauze. Put gauze in plastic bag. Put plastic bag into second bag filled with ice. Do not let ice come into direct contact with body part or immerse in water. Create a tourniquet around body part

Types of Wounds
Avulsion A tearing injury in which a piece of skin or other tissue is completely or partially torn from the body
Fold or replace torn skin if possible Wrap the wound as a laceration

Minor Wound Treatment

Universal precautions Apply direct pressure Cleanse with soap & water. Irrigate for 5 minutes with clean tap water. Apply a triple antibiotic ointment, if no allergy Cover with a sterile dressing See physician for tetanus shot

Serious Wound Treatment

Assess the scene & get first aid kit Universal precautions ABCDS Apply direct pressure Treat for shock elevate legs & maintain body temperature Add dressings as they become soaked with blood Use an elastic or roller bandage to secure dressings in place & apply pressure Follow up with a physician Watch for signs of infection; redness, warmth, increased pain, drainage, swelling, fever
DO NOT remove them!

APPLYING A ROLLER BANDAGE

Elevate the injured part, check PMSC Secure the end of the bandage. Roll toward heart Completely cover dressings. Do not cover fingers or toes , recheck PMSC If blood soaks through, apply additional dressings.

Nosebleeds

Nosebleeds
Nosebleeds are common and rarely life-threatening. The exception is a patient with a history of hypertension. This may be a warning sign of an impending stroke.

Treatment
Sit patient in chair & lean slightly forward Pinch nostrils for several minutes Apply ice pack to bridge of nose if does not interfere with pressure DO NOT tilt head back or put head between knees. Call 911 if bleeding is very heavy, does not stop in 15 minutes, or difficulty breathing.

SHOCK

Shock Management
Shock is a life-threatening condition that occurs when there is inadequate blood flow to the vital organs and body tissues. Shock requires immediate medical treatment, or vital organs may fail. The goal of first aid care is to treat the underlying cause of shock, improve blood flow to the core of the body, and get medical help.

TYPES OF SHOCK
Hemorrhagic/Hypovolemic Fluid or blood loss Cardiogenic Heart related Anaphylactic Allergic reaction Neurogenic Spinal injury Sepsis Blood stream infection Trauma Burns Psychogenic Fainting spell

Signs of Shock
Restlessness and anxiety Altered/decreasing LOC Pale, cool, moist skin Nausea and vomiting Very low blood pressure (delayed capillary refill) Rapid breathing Rapid/weak pulse Increased thirst

CARE FOR SHOCK

Treatment ABCDS Call 911 Lay patient down & elevate feet about 12 Control external bleeding Maintain body temperature Monitor vital signs & mental status every 5min DO NOT give the patient anything to eat or drink.

Shock Position
Shock Position
Victim is supine with legs elevated 12 inches.

DO NOT elevate the legs if:

Head or Neck Injury danger of increased pressure to brain. Heart Attack or Respiratory Distress danger of extra work on the heart & lungs Leg Fracture danger of blood clots traveling to heart Back Injury danger of spinal cord damage

BURNS

BURNS
Fast, effective burn treatment can reduce the degree of injury and even save a life. The young and the elderly have the most difficulty recovering from severe burns. Critical burn areas include:
Head Neck Hands Feet Genitals

BURNS Caused by heat, chemical, electricity or

radiation 2.5 million/yr. seek care for burns. 100,000 are hospitalized and 4000 die. Fire is the leading cause of burns and the 5th leading cause of death in the US You can also burn a patient from a heat lamp, moxa, or E-stim machine!

TYPES OF BURNS
First Degree/Superficial:
Involves only the epidermis Appears red and dry Surrounding area may swell Painful Heals in a few days Example: Sunburn

TYPES OF BURNS
Second Degree/Partial Thickness:
Burns the epidermis & dermis Appears moist/glistening Ranges in color from red to cherry red May have a blistered splotchy appearance and begin to peel off. Very painful Sensitive to exposure to air, touch and temperature changes Can have damaged nerve endings Heal in 3-4 weeks May scar

TYPES OF BURNS
Third Degree/Full Thickness:
Involves all dermal layers & may involve underlying muscles, organs, and bones. No chance of spontaneous regeneration. Appears dry leathery and may be covered with a charred stiff covering called eschar which is hard burned skin The eschar does not expand and thus when swelling occurs, underlying impairment to circulation may occur. No Pain in the burn area, but will experience extreme pain in the surrounding areas May take months to heal Will scar

Thermal Burns
Thermal burns are caused by direct or radiant heat exposures to extreme temperatures. They result from fire, steam, or other exposure to increased temperature.

Chemical Burns
Large amounts of water are required to flush chemicals from the skin. Powdered chemicals should first be brushed from the skin, followed by flushing with water for 20 minutes. Ensure run-off water does not flow over unaffected skin or onto rescuer.

Electrical Burn
The most important consideration when treating a victim with an electrical burn is to ensure scene safety. DO NOT touch the victim until the power has been turned off at the source. Once you are certain the power supply has been turned off, treat the burn. Electricity follows the path of least resistance through the body. Commonly there is an entrance and exit wound. ALL victims of electrical burns need to be evaluated by a physician.

Critical Burns
Call 911 for all Critical Burns! Burns to head, neck, hands, feet or genitals Large burn areas or covers more than one body part (multiple burn sites) Burn to the airway or causes breathing difficulty
Airway burns cause swelling which may close the airway http://www.youtube.com/watch?v=J-4OaQ9j7kE

Any full or partial burn to children or elderly Chemical or electrical burn Burn with other traumatic injuries

CARE FOR BURNS

Minor Burns: Cool the area with room temperature water or normal saline Cover the area with a dry sterile dressing Elevate the area and treat for shock Remove clothing or jewelry that does not stick Stop cooling process if patient begins to shiver Maintain an open airway & continue to monitor breathing

CARE FOR BURNS

NEVER NEVER NEVER NEVER

Break blisters Apply ice directly to the skin Apply butter, ointment or creams to severe burns