Bleeding and Shock

1. Identification
BLS Treatment
ALS Assistance
Chapin Area Rescue Squad/February 2013/B. McCormick EMT-P

2. What is Shock
• Shock, also called Hypoprefusion, is a state that leads to inadequate
cellular oxygenation to meet metabolic needs.
• As the cells of the body go without oxygen they attempt to compensate
and will eventually die if not oxygenated.
• There are several causes of shock, with trauma being one of the largest
contributors we will see in the field.
• A full patient assessment is still required, even if shock is
suspected, paying careful attention to the ABCs.
• Since shock is a state of decreased oxygen in the blood, application of
oxygen is the initial and primary treatment for BLS providers.

3. Types of Shock
• Since Shock is a failure of the cardiovascular system to deliver oxygen, we
can identify three main types:
• Pump Failure- Heart cannot pump enough blood
• Pipe Failure- Capillaries dilate (expand) up to 4 times normal
• Fluid Loss- Bleeding, Dehydration, or other problem decreases amount of blood
• Technical terms for these types of shock are: Cardiogenic, Distributive
and Hypovolemic. A fourth, Obstructive, is a physical blocking of blood
flow, seen in neonates, and without removal can lead to death.
• Hypovolemic Shock is the most common for trauma patients
• Cardiogenic Shocks is most commonly seen as a myocardial infarction, or
heat attack.
• Distributive Shock is most commonly seen as anaphylaxis.

4. Shock Recognition
• The identification and recognition of shock is the most important step of
the treatment of shock.
• In addition to vital sign changes, mental status changes are a major
identifier of shock.

5. BLS Care
• If you suspect your patient is in shock, and ALS has not been
dispatched, call of paramedic care immediately.
• A baseline set of vitas is of paramount importance to trend the patients
condition
• Application of high concentration of Oxygen via NRB or assist ventilations
via BVM
• Maintain the patient's ABCs
• Position the patient in the trendelenburg position of no trauma
• Treat the cause if possible (anaphylaxis-EpiPen)
• Keep the patient warm
• Rapidly transport to appropriate facility

6. ****PATIENT DIFFERNCES****
• Shock has three major stages: Compensating, Decompensating and
Irreversible.
• Adults will move through all three stages giving providers time to assess
what stage the patient is in.
• Children will compensate for a longer period of time and
plateau, dropping from compensating to irreversible in a very short
period of time.
• Due to this rapid decline, EMS providers must always assume a child
could be in compensated shock and treat appropriately.

7. Types of Bleeding
• Bleeding can be internal or external, and both can be life threatening.
• Surgeons are the only ones that can effectively treat life threatening
internal bleeding, so reduction of on scene times is the EMTs greatest
treatment.
• External Bleeding is broken into three major types:
• Arterial
• Venous
• Capillary

8. Bleeding Control
• Direct Pressure is the number one treatment for controlling external
blood loss
• Application of a ‘pressure dressing’ is simply a dressing with a bandage
used to hold it in place
• Never remove a blood soaked bandage or dressing. Just add to it.
• Elevation of the limb or positioning will assist with bleeding control.
• Ice or Cold packs and Pressure Points can also be used to assist.
• Tourniquets can be used to control life threatening
bleeding not controlled by another method.
• Mark the time the tourniquet is put in place on the
patients limb.

9. Assisting ALS
• For major bleeding and shock, paramedic care is essential.
• Loading the patient and obtaining vitals every 5 minutes will be the main
duties for the BLS crew. The patient should already be on oxygen and
maintenance of the ABCs is crucial.
• ALS will place the patient on the cardiac monitor, if not done by CARS
members already.
• Assistance with IVs will be at the discretion of
the paramedic treating.
• Direct Pressure for external bleeding will
continue through transport, and may require
multiple people to assist with treating the
patient.

10. Conclusion
• Shock and Bleeding are major life threats that all levels must be able to
recognize
• Oxygen, positioning, warming and ensuring ABCs will be the EMTs
primary treatment for shock
• Bleeding can be both internal and external, use of MOI will assist with
internal bleeding assessment
• Methods to control external bleeding include: Direct
Pressure, Elevation, Pressure Points, Cold Packs, and Tourniquets.
• iPad training manuals are in each rig, and can
be emailed upon request.