9/10/2012. Chapter 44. Learning Objectives. Learning Objectives (Cont d) Bleeding

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1 Chapter 44 Bleeding 1 Learning Objectives Describe the etiology, history, and physical findings of external bleeding Predict hemorrhage on the basis of the patient s mechanism of injury Distinguish between controlled and uncontrolled hemorrhage 2 Learning Objectives (Cont d) Using patient history and physical examination findings, develop a treatment plan for the patient with external bleeding Distinguish between various techniques for hemorrhage control of open soft tissue injuries, including direct pressureand tourniquet application 3 1

2 Learning Objectives (Cont d) Distinguish between administration rate, amount of intravenous fluid for the patient with controlled hemorrhage, and the rate/amount for patient with uncontrolled hemorrhage Describe the etiology, history, and physical findings of internal bleeding 4 Learning Objectives (Cont d) Using the patient history and physical examination findings, develop a treatment plan for the patient with internal bleeding 5 Hemorrhage Massive, heavy bleeding Perfusion Circulation of blood through organ structure Critical to function of cells, tissues, organs, organ systems, body 6 2

3 Causes Solid organ injury Abdominal aortic aneurysm rupture Vascular injury Penetrating trauma Severe GI bleeding Ruptured liver or spleen Hemothorax Ruptured ectopic pregnancy Arteriovenous malformation 7 Causes Bleeding esophageal varices Pelvic fracture Femur fracture Bleeding peptic ulcer Placenta previa Abruptio placentae Scalp lacerations Intracranial hemorrhage 8 Observable blood loss Etiology Soft tissue trauma Penetrating trauma (stab wounds, GSW) Menstrual, miscarriage Upper and lower GI bleeding Nose, ear, or mouth bleeding causes Artery Venous bleeding 9 3

4 10 History MOI/NOI When bleeding began Amount of blood loss History of clotting disorders/anticoagulant use Herbal product use 11 Physical findings Signs depend on source, hole size in blood vessel, pressure within vessel Signs/symptoms Dizziness/lightheadedness Pale skin Increased heart rate Normal to low BP Narrow pulse pressure Normal or altered mental status, or unresponsiveness 12 4

5 Differential diagnosis Penetrating trauma Hemorrhagic shock GI tract diseases Hemorrhoids Gastric ulcers Esophageal varices Pregnancy complications Placenta previa Abruptio placentae 13 Therapeutic interventions Be alert for other injuries/conditions Manage life threats Remove necessary clothing ABCs, O 2, IV therapy Do not delay transport Check breath sounds Use isotonic crystalloid solution Large bore, short catheters (14-16 gauge) 14 Therapeutic interventions Maintain systolic BP of mm Hg In head trauma: >90 mm Hg Give 20 ml/kg fluid challenge Reevaluate Direct pressure Sterile dressings Pressure dressing Tourniquet Treat for shock 15 5

6 16 Skill 44-1: Hemorrhage Control Appropriate PPE Apply direct pressure Apply sterile dressing material over wound Assess for control of hemorrhage 17 Hemorrhage Bleeding from blood vessels or organs internally Etiology Trauma Soft-tissue injuries or fractures Rupture of blood vessels Common MOIs Falls Motorcycle crashes Pedestrian/bicycle impacts Automobile collisions 18 6

7 History MOI/NOI Abdominal pain with lightheadedness Alcohol abuse, liver disease, past GI bleeding Abdominal pain in females Ripping or tearing pain Worst headache of my life! 19 Signs/symptoms Anxiety, restlessness, combativeness, altered mental status Weakness, faintness, dizziness Rapid, shallow breathing Hypotension Rapid, weak pulse Pale, cool, clammy skin Narrowing pulse pressure Excessive thirst 20 Signs/symptoms Pain, tenderness, swelling, discoloration of suspected site of injury Bleeding from mouth, rectum, vagina, other opening Vomiting bright-red blood, dark coffee-ground colored blood Coughing up blood Sudden, severe headache Dark, tarry stools or bloody stools Tender, rigid, or distended abdomen 21 7

8 Differential diagnosis Solid organ injury Vascular injury Pelvic fractures Closed femur fracture Intestinal obstruction Aortic aneurysm rupture Hemothorax Ruptured ectopic pregnancy AV malformation Bleeding esophageal varices Peritonitis 22 Therapeutic interventions Manage life threats ABCs, high percentage O 2 Package patient, rapid transport Remove necessary clothing Pulse-oximetry/capnography ECG monitor, IV therapy Treat for shock Reassess frequently 23 Chapter Summary Internal and external hemorrhage can result from a variety of causes Adequate blood volume is critical to adequate perfusion Uncontrolled blood loss can quickly lead to hypovolemic shock and poor patient outcome 24 8

9 Chapter Summary (Cont d) Goal of treatment in a hemorrhaging patient is to stop the hemorrhage as quickly and efficiently as possible Patient should not be allowed to continue to bleed while ineffective methods of hemorrhage control are attempted 25 Questions? 26 9

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