Transcript Management of Anaphylactic Shock

Ch. 6-Bleeding and Shock
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6.1 Bleeding and Its Effects
The severity of bleeding depends on
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How fast the blood is flowing from the vessel
The size of the vessel
Whether the vessel is a vein or an artery
Whether the bleeding is internal or external
Where the bleeding originated
The victim’s age and weight
The victim’s general physical condition
Whether the bleeding is a threat to the
airway and respiration 2
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PROGRESS CHECK
1. When bleeding is uncontrolled, the body can’t compensate
quickly enough, and ___________ results. (cardiac
arrest/heart failure/shock)
2. A loss of ____________ pints of blood can be fatal if it
occurs over a period of a few hours. (1/2/3)
3. Blood from an artery is ____________ . (red/bright red/
dark red)
4. Blood from a vein is ____________ . (red/bright red/dark
red)
5. Blood from a capillary is ____________ . (red/dark red/
medium red)
6. The most difficult bleeding to control comes from
____________. (arteries/veins/capillaries)
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6.2 Control of Bleeding
Initial first aid steps in the bleeding victim:
 1. Stop the bleeding.
 2. Determine the cause and source of the
bleeding and the general condition of the
victim.
 3. Place the victim in a position in which he
or she will be least affected by the loss of
blood.
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 4. Maintain an open airway.
Taking Infection-Control
Precautions
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Place a barrier between you and the victim’s blood
Avoid touching your mouth, nose, or eyes or
handling food while providing first aid care
As soon as you finish treating the victim, wash your
hands thoroughly with soap and hot water
Wash all items that have the victim’s blood or body
fluids on them in hot, soapy water
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Applying Direct Pressure and Elevation
1. Place a sterile dressing over the wound so that it is covered completely.
2. Press firmly over the dressing with your finger tips directly to the site of
bleeding.
3. Elevate the bleeding part above heart level unless you suspect a
fracture, dislocation, impaled object, or spinal injury.
4. You can use a cold pack over the wound as you apply direct pressure
and elevation
5. Check the dressing every few minutes.
6. Never apply direct pressure to a wound if there is an object embedded in
the wound or if a bone is protruding from the wound.
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Using a Pressure Bandage
1. Cover the wound completely with a thick dressing;
make sure all edges of the wound are covered.
2. Holding the dressing in place, wrap the pressure
bandage around the dressing tightly enough to exert
moderate pressure.
3. Periodically check the distal pulses, and frequently
check for mottled skin or blanched nails, signs that the
pressure bandage is too tight.
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Using Indirect Pressure
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Brachial Artery
Femoral Artery
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Using an Air Splint
1. Cover the wound with a thick, sterile dressing.
2. Slip the splint over the dressing, taking care not to shift or
remove the dressing.
3. Inflate the splint. Take care not to overinflate— you should
be able to depress the surface of the splint at least half an
inch with your fingertips.
4. Check distal pulses often if they are not covered by the
splint; check frequently for mottled skin or blanched nails,
signs that the splint is too tight.
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Using a Tourniquet
1. Hold the appropriate pressure point to control bleeding
temporarily, then place the tourniquet between the heart
and the wound
2. Put a thick pad over the tissue that will be compressed.
3. Wrap the tourniquet material tightly around the limb twice,
then tie it in a half-knot on the upper surface of the limb.
4. Place a short stick or other similar object at the half-knot,
then tie a square knot.
5. Twist the stick to tighten the tourniquet only until the
bleeding stops.
6. Write a note detailing the location of the tourniquet, the
time it was applied, and the vital signs at the time you
applied it.
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Using a Blood Pressure Cuff
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Secure it well so the Velcro does not pop
open.
Inflate it to a pressure that causes the
bleeding to stop, usually 10 to 20 mm Hg
above the systolic blood pressure.
Never deflate the cuff unless a physician
orders you to do so.
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PROGRESS CHECK
1. Direct pressure is pressure applied directly to the ____________.
(artery/pressure point/wound)
2. If a dressing soaks through with blood, you should ____________.
(remove it/remove and replace it/leave it in place and put another one over it)
3. In addition to direct pressure, ____________ the limb and apply cold packs.
(elevate/compress/ splint)
4. Indirect pressure is applied at ____________. (wound sites/pressure
points/joints)
5. The pressure point that controls bleeding to the arms is the ____________.
(femoral/temporal/brachial)
6. The femoral pressure point is located in the ____________. (neck/inner
arm/groin)
7. Material used for a tourniquet should be at least ____________ inches wide.
(2/3/4)
8. Release a tourniquet only when ____________.
(bleeding has stopped/EMTs arrive/a physician is present)
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6.3 Internal Bleeding
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Signs and Symptoms
First Aid Care
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1. Secure and maintain an open airway, and
monitor the ABCDs.
2. Check for fractures; splint if appropriate.
3. Keep the victim quiet. Position and treat the
victim for shock.
4. Monitor vital signs every 5 minutes until
emergency personnel arrives.
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6.4 Nosebleed
1. Keep the victim quiet and in a sitting position,
leaning forward to prevent aspiration of blood
2. If you do not suspect nasal fracture, pinch the
nostrils together.
3. Apply cold compresses to the bridge of the nose.
4. If the bleeding does not stop, call 911 to activate
EMS.
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PROGRESS CHECK
1. Internal bleeding is extremely serious because it can cause
____________. (extremity damage/brain damage/shock)
2. If internal bleeding is present the heart rate will be
____________ . (decreased/normal/increased)
3. The most common cause of internal bleeding is ____________.
(blunt and penetrating trauma/perforated ulcer/skull fracture)
4. The signs and symptoms of internal bleeding are much like those
of ____________. (external bleeding/cardiopulmonary
disease/shock)
5. Basic treatment of internal bleeding involves ____________,
opening the airway, and positioning the victim to prevent shock.
(applying pressure/activating the EMS system/ elevating the
affected part)
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PROGRESS CHECK
1. To control nosebleed, keep the victim __________.
(sitting up/lying down/in a position of comfort)
2. Unless you suspect nasal fracture, pinch the nostrils
together, then apply ____________.
(pressure/cold compresses/indirect pressure)
3. If you suspect ____________, do not try to stop a
nosebleed. (heart attack/elevated blood pressure/skull
fracture)
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6.5 Shock
The Causes of Shock:
1. Fluid is lost from the circulatory system (generally a
result of bleeding, burns, or dehydration).
2. The heart fails to pump the blood effectively.
3. The blood vessels dilate, causing blood to pool in
extremities and non-vital areas.
4. The body’s supply of oxygen is inadequate.
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Vocabulary
Shock- Inadequate tissue perfusion
Perfusion- Circulation of oxygen-rich blood to cells
Compensatory shock- The first stage of shock, in which the
body attempts to overcome the decrease in tissue perfusion
Progressive (decompensatory) shock- The second stage
of shock, in which the compensatory mechanisms have
failed, the blood pressure begins to decrease, and the
organs are beginning to suffer from the lack
of perfusion
Irreversible shock- The final stage of shock, in which body
organs start to die
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Management of Shock
1. Secure an open airway. Give extra attention to any victim whose airway is
obviously compromised.
2. Place the victim on his or her back unless the victim has an object impaled in the
back of the body, difficulty breathing or heart attack symptoms.
3. Control any obvious bleeding.
4. Elevate the legs no more than 8 to 12 inches above heart level. Never tilt the
entire body so that the feet are elevated and the head is lower than the body—
doing so can impair breathing.
5. Splint any fractures; this can reduce shock by controlling bleeding and relieving
pain.
6. Keep the victim warm by conserving body heat, but do not overheat.
7. Keep the victim quiet and still; shock is aggravated by rough and/or excessive
handling.
8. Give the victim nothing by mouth because of the possible need for surgery,
possible injury to the digestive system, and possible vomiting. If the victim
complains of intense thirst, moisten his or her lips with a wet towel.
9. Monitor vital signs and mental status at 5-minute intervals
until emergency personnel arrive.
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Preventing Shock
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Making sure the victim is breathing adequately; if necessary,
provide rescue breathing
Controlling any bleeding
Loosening restrictive clothing
Reassuring the victim and staying calm and in control yourself
Splinting and immobilizing fractures
Taking measures to relieve pain (properly dressing, bandaging,
splinting, and positioning the victim)
Positioning the victim supine with feet elevated no more than
8–12 inches, if the victim is alert or responding appropriately; if
the victim is in an altered mental state, on his or her side
Keeping the victim warm without overheating
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PROGRESS CHECK
1. Basically, shock occurs when the heart does not pump adequate amounts of
blood to provide ____________to the cells. (adequate carbon
dioxide/adequate oxygen)
2. The loss of blood causes ____________ shock.
(hemorrhagic/cardiogenic/neurogenic)
3. Congestive heart failure could result in ____________ shock.
(hemorrhagic/metabolic/cardiogenic)
4. A victim with sustained vomiting and diarrhea could develop ____________
shock. (septic/metabolic/neurogenic)
5. Shock is a progressive condition that involves ____________ stages.
(two/three/four)
6. During ____________ shock, the body tries to use its normal defenses to
maintain normal function. (compensatory/progressive)
7. During ____________ shock, the body shunts blood away from the extremities
and abdomen to the heart, brain, and lungs. (compensatory/progressive)
8. Always begin first aid care for shock very ____________ if the victim is a child.
(early/aggressively/gently)
9. The preferred position for a shock victim is supine with the feet _______.
(at heart level/below heart level/above heart level)
10. You should keep a shock victim warm without ____________.
(using sources of artificial heat/ overheating the victim/ shifting
the victim’s position)
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6.6 Anaphylactic Shock
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Signs and Symptoms
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Skin
Heart and Blood Vessels
Respiratory Tract
Gastrointestinal Tract
Central Nervous System
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Management of Anaphylactic
Shock
1. Secure an open airway.
2. If indicated, begin rescue breathing or CPR.
3. If the victim has an epinephrine
autoinjector, help the victim use it if allowed
by local protocol.
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PROGRESS CHECK
1. As a rule, anaphylactic shock occurs most rapidly if
the antigen is ____________. (swallowed/inhaled/injected)
2. Initial signs and symptoms may lead swiftly to
____________ or circulatory collapse.
(loss of consciousness/respiratory failure/irregular heartbeat)
3. To manage anaphylactic shock, activate the EMS system,
then immediately ____________.
(start CPR/secure an open airway/start rescue breathing)
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