Gemma Anua Claridtte Castillo

Bleeding refers to the loss of blood. It can happen

inside the body (internally) or outside the body

(externally).

Stopping bleeding is essential to the care and survival of patients in an emergency or disaster situation.

Internal-inside the body when blood leaks from blood vessels or organs

Clotting disorders Rupture of blood vessels Fractures (injury to nearby vessels) Trauma

External-Outside the body when blood flows through a natural opening

Vaginal bleeding GI tract bleeding Facial Skin cut Amputation

Assessment:

The patient is assessed for signs and symptoms of shock:

cool, moist, decreasing blood pressure, increasing heart rate, delayed capillary refill, and decreasing urine volume

Goal:

The goals of emergency management are to control the bleeding, maintain adequate circulating blood volume for

tissue oxygenation, and prevent shock.

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Physiological Response to Hemorrhage

Initial response: Stop bleeding by chemical means

(hemostasis)
Vascular reaction involves: Local vasoconstriction Formation of platelet plug Coagulation Growth of fibrous tissue into blood clot permanently closes and seals injured vessel
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 If

hemorrhage is severe, mechanisms may fail,

resulting in shock a condition in which widespread perfusion to the cells is inadequate to deliver oxygen ad nutrients to support vital organs and cellular function.

Stages of Shock
Stage 1: Compensatory
increased heart rate skin is cool and clammy bowel sounds are hypoactive urine output decreases normal BP mental status changes- confusion
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Stage 2: Progressive
hypotensive: systolic BP of less than 90 mm Hg or a decrease in

systolic BP of 40 mm Hg
Respirations are rapid and shallow Crackles are heard over the lung fields. The heart rate is rapid, sometimes exceeding 150 bpm lethargy increases

lose consciousness
Urinary output decreases ( less than 30 mL/h)
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Stage 3: Irreversible
The stage where in the organ damage is so severe that the patient does not respond to treatment and cannot survive. Despite treatment, BP remains low. Respiratory system failure prevents

adequate oxygenation and ventilation. Multiple organ

dysfunction progressing to complete organ failure has occurred, and death is imminent.

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Management:

> Fluid replacement which may include isotonic electrolyte

solutions (eg, lactated Ringers, normal saline

> Blood replacement, typed and cross-matched. Packed RBC are infused when there is massive blood loss.

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Control of External Bleeding

> Identify the area of hemorrhage. > Direct, firm pressure is applied over the bleeding area or the involved artery at a site that is proximal to the wound > Firm pressure dressing is applied > The injured part is elevated > If the injured area is an extremity, the extremity is

immobilized.
> A tourniquet is applied to an extremity only as a last resort
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Control of Internal Bleeding

> Packed RBC are administered at a rapid rate, and the patient is prepared for more definitive treatment (surgery, pharmacologic therapy).

> The patient is maintained in the supine position and monitored

closely until hemodynamic or circulatory parameters improve, or until he or she is transported to the operating room or intensive care unit.

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