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Hemorrhage
Sanil Varghese
Dec 23, 2013 • 115 likes • 35,255 views

 19 of 24  

Health & Medicine

Hemorrhage or bleeding

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Hemorrhage Natural Way
1. Hemorrhage
2. Hemorrhage • Hemorrhage – Abnormal internal or external loss of blood
4. Hemorrhage Classification
5. External Hemorrhage • Results from so! tissue injury. • The seriousness of the injury is dependent on: – Anatomical source
of the hemorrhage (arterial, venous, capillary) – Degree of vascular disruption – Amount of blood loss that can be tolerated by
the patient
6. Internal Hemorrhage • Can result from: – Blunt or penetrating trauma – Acute or chronic medical illnesses • Internal
bleeding that can cause hemodynamic instability usually occurs in one of four body cavities: – – – – Chest Abdomen Pelvis
Retroperitoneum
7. Internal Hemorrhage • Signs and symptoms : – Bright red blood from mouth, rectum, or other orifice – Co"ee-ground
appearance of vomitus – Melena (black, tarry stools) – Dizziness or syncope on sitting or standing – Orthostatic hypotension
8. Internal hemorrhage is associated with higher morbidity and mortality than external hemorrhage.
9. Physiological Response to Hemorrhage • The body’s initial response to hemorrhage is to stop bleeding by chemical means
(hemostasis). – This vascular reaction involves: • • • • Local vasoconstriction Formation of a platelet plug Coagulation Growth of
tissue into the blood clot that permanently closes and seals the injured vessel
10. Hemorrhage Control • External Hemorrhage – Direct pressure and pressure dressing – General management • • • • • • Direct
pressure Elevation Ice Pressure points Constricting band Tourniquet – May use a BP cu" by inflating the cu" 20–30 mmHg
above the SBP – Release may send toxins to heart » Lactic acid and electrolytes
11. Tourniquets are ONLY used as a last resort!
12. Internal Hemorrhage Control • Hematoma – Epistaxis: Nose Bleed • Causes: trauma, hypertension • Treatment: lean
forward, pinch nostrils – Pocket of blood between muscle and fascia • General Management – Immobilization, stabilization, el
evation – – – – – Hemoptysis Esophageal Varices Melena Diverticulosis Chronic Hemorrhage • Anemia
13. Stages of Hemorrhage • 60% of body weight is fluid. – 7% circulating blood volume (CBV) in men • 5 L (10 units) – 6.5% CBV
in women • 4.6 L (9–10 units)
14. Stages of Hemorrhage Stage 1 • 15% loss of CBV – 70 kg pt = 500–750 mL • Compensation – Vasoconstriction – Normal BP,
pulse pressure, respirations – Slight elevation of pulse – Release of catecholamines • Epinephrine • Norepinephrine – Anxiety,
slightly pale and clammy skin
15. Stages of Hemorrhage Stage 2 • 15–25% loss of CBV – 750–1250 mL • Early decompensation – Unable to maintain BP –
Tachycardia and tachypnea
16. Stages of Hemorrhage Stage 2 • Decreased pulse strength • Narrowing pulse pressure • Significant catecholamine release –
Increase PVR – Cool, clammy skin and thirst – Increased anxiety and agitation – Normal renal output
17. Stages of Hemorrhage Stage 3 • 25–35% loss of CBV – 1250–1750 mL • Late decompensation (early irreversible) –
Compensatory mechanisms unable to cope with loss of blood volume
18. Stages of Hemorrhage Stage 3 • Classic Shock – Weak, thready, rapid pulse • Narrowing pulse pressure – Tachypnea –
Anxiety, restlessness – Decreased LOC and AMS – Pale, cool, and clammy skin
19. Stages of Hemorrhage Stage 4 • >35% CBV loss – >1750 mL • Irreversible – – – – – – Pulse: Barely palpable Respiration:
Rapid, shallow, and ine"ective LOC: Lethargic, confused, unresponsive GU: Ceases Skin: Cool, clammy, and very pale Unlikely
survival
20. Hemorrhage Assessment • Initial Assessment – General Impression • Obvious bleeding – Mental Status – CABC –
Interventions • Manage as you go – – – – O2 Bleeding control Shock BLS before ALS!
21. Hemorrhage Assessment Fractures and Blood Loss • • • • Pelvic fracture: Femur fracture: Tibia/fibula fracture: Hematomas
and contusions: 2,000 mL 1,500 mL 500–750 mL 500 mL
22. Hemorrhage Assessment (5 of 5) • Ongoing Assessment – Reassess vitals and mental status: • Q 5 min: UNSTABLE patients
• Q 15 min: STABLE patients – Reassess interventions: • • • • Oxygen ET IV Medication actions – Trending: improvement vs.
deterioration • Pulse oximetry • End-tidal CO2 levels
23. Bleeding Severe Bleeding is a life-threatening condition, therefore the bleeding must be controlled quickly. There are 4
procedures to follow; Apply Pressure Elevate Dress the Wound Monitor 4. Monitor 1. Apply Direct Pressure This is to try and
stop the flow of blood and encourage a clot to form. 2. Apply a Dressing Applying a sterile non-flu"y dressing covers the wound
protecting it and preventing the spread of infection. If the wound is severe you may need to monitor the player as they may go
into shock due to blood loss. You may also want to check that the dressing isn’t too tight and restricting circulation. 3.
Elevation Elevate the bleeding limb or area above player’s heart (if practicable). This will reduce the amount of blood flow to
the wound.
24. Thank you

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