Bleeding and Shock

Ifran saleh

Consultan Orthopaedic and Spine Surgeon

Division of Orthopaedic and Traumatology
Department of Surgery, faculty of Medicine
University of Indonesia
Cipto Mangunkusumo Hospital
Jakarta

Bleeding and Shock

Bleeding

Is condition where the blood is leakage

from its circulatory system, could be
internal or external body

Natural Body Responds

Bleeding Blood vessel constriction

Blood clotting

Bleeding and Shock

Stage of Hemorrhage

Class I (Up to 15% blood loss)

Body Responds
Constricting blood vessel
Effect on patient

Remain alert

BP within normal limits

Pulse within normal limits

Pulse quality strong

RR, Skin color, temperature remain normal

Bleeding and Shock

Stage of Haemorrhage

Class 2 ( up to 30% blood loss)

Body responds

Vasoconstriction, continue
Blood flows is shunted to vital organs
Flow to intestines, kidney and skin

Effect on patient

Become confuse and restless

Skin: pale, cool and dry
Diastolic pressure
Pulse pressure narrows HR > 100 beats
RR
Pulse quality weakens
Delayed capillary refill

Bleeding and Shock

Stage of Haemorrhage

Class 3 (up to 40% blood loss)

Body responds

Compensatory mechanism become overtaxed

Cardiac output and tissue perfusion
Potentially life threatening
patient still recover with prompt treatment

Effect on patient

More confuse restless and anxious

Classic sign f shock:

Rapid HP

BP

Rapid RR

Could and clammy extremities

Bleeding and Shock

Stage of Hemorrhage

Class 4 ( > 40% blood loss)

Body responds

Failure of compensatory vasoconstriction

impairing tissue perfusion and cellular
oxygenation

Effect on patient

Become lethargic, drowsy or stuporous

Sign of shock more pronounced
Lack of blood flow to brain and vital organ
Organ failure death

Bleeding and Shock

Sign symptoms

Pulse quickens
Level of responsiveness falls
Breathing rate
BP drops

Uncontrolled bleeding
lead to shock death

Bleeding and Shock

External bleeding

Type:

Arterial
Venous
capillary

Bleeding and Shock

External bleeding

Arterial bleeding

Venous bleeding

Bright red blood and spurting from a wound

Dark red blood, flows steadily from a wound

Capillary bleeding

Dark red blood, oozes slowly from the wound

Clots spontaneously

Bleeding and Shock

External bleeding

Emergency medical care

After patient airway and breathing takes precedence

Apply direct pressure to the wound

Elevate the bleeding extremity

Assess the bleeding extremity

Use pressure points

Splints

Use a tourniquet (Be careful can cause permanent

damage to nerves, muscles and blood vessels)

Bleeding and Shock

Internal bleeding
Bleeding inside the body due to internal
organ injured or damage.
It may result from a blunt trauma, abnormal
clotting, rupture of a blood vessel or fracture

Bleeding and Shock

Suspect internal bleeding

Scrapes and bruises

Swelling
Deformity
Impact marks
Penetrating wounds to skull,
chest or abdomen
Unexplained shock

Bleeding and Shock

Internal bleeding

Sign and symptoms

Discolored, tender, swollen and hard tissue

RR and pulses rates
Pale, cool, clammy skin
Nausea, vomiting bright red blood or blood the color of
dark coffee grounds
Thirst
Changes in mental status (anxiety, restlessness, or
combativeness)
Dark tarry stools
Tender, rigid or distended abdomen
Weakness, faintness or dizziness

Bleeding and Shock

Internal bleeding

Emergency medicine care

Maintain an open airway and adequate

breathing
Control any external bleeding
Keep the patient warm (Not due over
heat)
Treat for shock

Bleeding and Shock

Shock

Shock or hypo perfusion is a a condition

that results from inadequate delivery of
oxygen blood. It will cause cell failure,
organ failure and death
Perfusion is circulation of blood to delivers
oxygen and nutrient to the bodys cells
and removes waste products

Bleeding and Shock

Shock

Caused by :

Failure of he heart
Abnormal dilation of blood vessels
Blood volume loss

Bleeding and Shock

Shock
Failure of the heart

Heart attack
Coronary artery disease
Heart valve disease
Pulmonary embolism
Tension pneumothorax
Cardiac tamponade

Bleeding and Shock

Shock

Abnormal dilation of blood vessels

Results of spine or head injury
blood vessels dilate, BP

Blood volume loss

By external or internal bleeding

Bleeding and Shock

Stages of Shock

Compensatory
Decompensated
Irreversible

Bleeding and Shock

Compensatory shock
The body uses its defenses to try to
maintain normal function
Sign and symptoms

Pale skin
Slightly rapid heart rate
BP normal
Restlessness or anxiety
Delayed capillary refill (in infant or child)

Bleeding and Shock

Decompansated shock

The body no longer make up for reduced perfusion.

The body tries to keep vital organs perfused with
oxygenated blood.
Its results blood away from arms, legs and abdomen
and directs it to the brain, heart and lugs

Signs and symptom

Extreme thirsty
Rapid HR
BP
Cool and moist skin; skin is pale, gray or bluish and
mottled
Major changes in mental status

Bleeding and Shock

Irreversible shock

Blood flow is so low and extremely

rapid pulse.
Blood is shunted away from the liver
and kidneys to the heart and brain.
Damage to vital organs is permanent.
The result of irreversible shock
death

Bleeding and Shock

Shock

Time consideration it must be referred asap

Identifying serious trauma patients

Performing initial assessments and treatment
Preparing patients for transport

Emergency medical care

Maintain an open airway

Prevent further blood loss
Elevate the lower extremities
Keep the patient warm
Provide care for specific injury
Never give anything to eat or drink

Bleeding and Shock

Anaphylactic shock

Result from a severe allergic reaction to a

foreign protein
It cause by:

The most common cause

Insect sting
Food
Medicine
Pollen
Inhaled, ingested or injected substance
Drugs and bee sting

Anaphylactic shock is a life threatening

Bleeding and Shock

Anaphylactic shock

Signs and symptoms

Warn, tingling feeling in the mouth, face,

chest, feet and hands
Itching, hives and flushing
Swelling
Cyanosis
Paleness

Bleeding and Shock

Anaphylactic shock

Signs and symptoms

Respiratory system

Circulatory system

Swelling in the airway leading to airway obstruction

Painful, squeezing sensation in the chest
Cough, horse ness
Rapid breathing
Noisy breathing, stridor, wheezing
HR
BP
Dizziness
Restlessness

General finding

Itchy, watery eyes

Headache

Runny nose

Sense of impending doom

mental status

Bleeding and Shock

Anaphylactic shock

Emergency medical care

Perform initial assessment

Treat all life threatening
Administer 100% high flow oxygen
Medication an epinephrine or
antihistamine injection

Bleeding and Shock

Injures to the chest

Open injury
Closed injury

Types of chest injury

Blunt trauma
Penetrating injury
Compression injury

Bleeding and Shock

Injury to the chest

Signs and symptoms

Shortness of breath or difficulty breathing

Pain during breathing
Failure of the chest to expand normally
Cyanosis
Coughing up blood
Distended neck veins
Rapid, weak pulse
Dropping blood pressure
Bruising to the chest
Chest wall deformity
Pain at injury site
Shock

Bleeding and Shock

Closed injury to the chest

Blunt injury

Pulmonary contusions
Myocardial contusions
Traumatic asphyxia

Bleeding and Shock

Pulmonary contusions

Signs and symptoms

Severe shortness of breath

Rapid pulse
Extensive, obvious bruising of the chest
wall

Bleeding and Shock

Myocardial contusions

Signs and symptoms

Generalized chest pain

Obvious bruising of the chest wall
Rapid, sometimes irregular pulse

Bleeding and Shock

Traumatic asphyxia

Blood is forced the wrong way out of the heart

(from the right side instead of the left).
It is then forced back into the veins particularly
the veins of the head an shoulder
Signs and symptoms

Shock

Distended neck veins

Bloodshot protruding eyes

Cyanotic tongue and lips

Coughing up or vomiting blood

Swollen, cyanotic of the head, neck and

shoulders

Bleeding and Shock

Closed chest injuries

Guidelines for emergency care

Maintain an open airway

Assure adequate ventilations
Control any external bleeding
Allow the patient to get in a position of
comfort
Monitor vital sign regularly

Bleeding and Shock

Injuries to the abdomen

Closed abdominal injuries

Assessment of the patients

Lie down on his or her back

The knees should be flexed and supported
Remove or loosen clothing over the abdomen
Look for:

Bruising

Lacerations or open wounds

Impaled objects

Protruding organ
Watch how the abdomen moves as the patients breathes
Gently feel all four quadrants

Rigidity

Pain and tenderness

Guarding

Bleeding and Shock

Abdominal injuries

Signs and symptoms

Distended or irregularly shaped abdomen

Bruising of the abdomen, back and flanks
Rigid and tender abdomen
Mild discomfort progressing to intolerable pain
Pain radiating to the shoulder, both shoulders or the back
Abdominal cramping
Rapid, shallow breathing
Rapid pulse, low BP
Open wounds, penetrating wounds
Nausea, vomiting
Evisceration
Blood in the urine, vomiting of blood
Shock
Weakness
Thirst

Bleeding and Shock

Abdominal injuries

Emergency medical care

Maintain an open airway. Be alert for

vomiting
Expose the abdomen
Suspect and treat for shock
Control external bleeding
Position the patient

Bleeding and Shock

Injury to the genitalia

Male genitalia
Can cause severe pain but not life threatening
Penis
The skin of the penis can be torn or avulsed or
the penis maybe partial or completely
amputated
Scrotum
Direct blow the scrotum can cause the testis
rupture pain and feeling of pressure

Bleeding and Shock

Injuries to male genitalia

Emergency medical care

Wrap the injury area in a soft, sterile

dressing that is moistened with sterile
saline solution
Apply cold pack

Bleeding and Shock

Injury to female genitalia

Injuries to the internal female organs

rare
Injuries ti the external female genitalia
straddle injury
sexual assault
can cause severe pain and bleeding

Bleeding and Shock