Course Library

Bleeding

Information Covered:

1. Pathophysiology
   1. Type of Traumatic Bleeding
      1. Internal
      2. External
      3. Arterial
         1. Bright red bleeding “spurting”
         2. Difficult to control, due to size of vessels, volume of blood, and pressure that blood is pushed through arteries
         3. As blood pressure drops, amount of spurting blood drops
      4. Venous
         1. Darker red blood can vary from slow to severe stream, depending on size of vein
         2. Can be difficult to control, but easier to control than arterial bleeds
         3. Bleeding can be profuse and life-threatening
      5. Capillary – blood oozes from wound
         1. Usually easy to control or stop without intervention
         2. Clots spontaneously
   2. Severity – Related to
      1. Volume of blood loss
      2. Rate of blood loss
      3. Age and pre-existing health of patient
   3. Physiological Response to Bleeding
      1. Clotting and clotting disorders
      2. Factors that affect clotting
         1. Movement of injured area
         2. Body temperature
         3. Medications
         4. Removal of bandages
      3. Localized vasoconstriction
2. General Assessment
   1. Mechanism of Injury
   2. Primary Survey
      1. Identify and manage life threats related to bleeding
      2. Mental status
   3. Physical Exam
      1. Blood pressure is not a reliable indicator of early shock
      2. Lung sounds
      3. Peripheral perfusion
      4. Skin parameters
   4. History – Pre-Existing Illnesses
   5. Pediatric Considerations
      1. Vital sign variations
      2. Total fluid volume less than adults
   6. Geriatric Considerations
3. Management Strategies
   1. Body Substance Isolation
   2. Airway  Patency – May be obstructed if unconscious
   3. Oxygenation and Ventilation
      1. Pulse oximetry
      2. Apply oxygen
   4. Internal and External Bleeding Control
      1. External bleeding
         1. Direct pressure
            1. application of even pressure to an open injury that includes the area just proximal and distal to the injury
            2. using a gloved hand and dressings, the wound is covered and firm pressure applied until bleeding is controlled
            3. usually effective in capillary and minor venous bleeding
            4. in cases of heavier bleeding or major wounds, multiple dressings may be necessary; do not remove existing dressings but apply additional dressings on top of existing dressings in cases of continuing hemorrhage
         2. Splints
            1. soft
            2. rigid
            3. traction splint
            4. pressure splints
         3. Tourniquet – if severe bleeding is not controlled by direct pressure
         4. Signs and symptoms – bleeding may not slow after much blood loss
            1. some patients may be quiet and calm due to excessive blood loss
            2. the amount of blood at the scene does not always estimating the amount of blood loss by the size of a blood pool or the amount on clothing is not accurate
            3. assess for signs and symptoms of shock
      2. Internal bleeding
         1. Definition/description
            1. any bleeding in a cavity or space inside the body.
            2. internal bleeding can be severe and life threatening.
            3. may initially go undetected without proper assessment (mechanism of injury, signs, and symptoms)
         2. Signs and symptoms
            1. guarding, tenderness, deformity, discoloration of the affected area
            2. coughing up blood, blood in urine, rectal bleeding
            3. abdominal tenderness, guarding, rigidity, distention
            4. bleeding from a body orifice.
            5. signs of shock
   5. Stabilize Body Temperature
   6. Psychological Support
   7. Transport Considerations
      1. Trauma center
      2. Aeromedical transport
      3. ALS mutual aid

Content Creator: Josh Renolds
CAPCE Course Number: 20-EMTP-F3-2103
NJ Course Number: 141099
Total CE Hours: 1
Level: Basic
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.