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The medical term for shock
Who do we treat for shock?
2 causes of shock
- 1. cardiovascular (heart, vessels, blood)
- 2. noncardiovascular
A state of collapse and failure of the cardiovascular system in which blood circulation decreases and eventually ceases. Can be anything from a heart attack-allergic reaction.
Circulatory system has 3 components:
- 1. a working pump-HEART
- 2. a network of pipes-BLOOD VESSELS
- 3. an adequate amount of fluid-BLOOD
- *these 3 can be referred to as the PERFUSION TRIANGLE*
4 types of shock in cardiovascular
- 1. Cardiogenic shock
- 2. Hypovolemic shock/ Hemorrhagic shock
- 3. Neurogenic shock
- 4. Septic shock
Caused by inadequate function of the heart, or pump failure (heart attack, backup of blood into the lungs-pulmonary edema)
Loss of fluid or blood, insufficient VOLUME of blood; can be internal or external bleeding; can occur with severe thermal burns (loss of plasma or dehydration)
Spinal cord damage can injure the part of the nervous system that controls blood vessel size and muscle tone, this is example of what kind of shock
Victims who have severe backterial infections that produce toxins/poisons which cause widespread vessel dilation, combined with the loss of plasma through injured vessel walls (this shock is almost always a commplication of a serious illness, injury, or surgery, and anaphylaxis)
3 noncardiovascular causes of shock
- 1. Respiratory insufficiency
- 2. Anaphlactic shock/ Anaphylaxis
- 3. Psychogenic shock
Chest injury or airway obstruction that results in INSUFFICIENT OXYGEN in the blood can produce shock
Occurs when the immune system reacts violently to a sub to which it has already been sensitized; sever alergic reaction; signs of this kind of shock are distinct from other forms of shock.
Anaphylactic shock/ Anaphylaxis
Severe allergic reactions commonly follow exposure by one of the these:
- 1. Medications (penicillin, aspirin, sulfa drugs)
- 2. Food (shellfish, nuts, eggs)
- 3. Insect stings (honeybee, wasp, yellow jacket, hornet, fire ant)
- 4. Plant pollen
*Table 7-1* SIGNS AND SYMPTOMS OF ANAPHYLACTIC SHOCK (occur quickly!) (pg.82)
- SKIN*Flushing, itching, or burning, especially over the face and upper chest
- *Hives, which can spread over large areas of the body
- *Swelling, especially of the face, tongue, and lips
- *Bluish lips (cyanosis)
- CIRCULATORY SYSTEM*Weak pulse (you might be barely able to feel it)
- *Fainting and unresponsiveness
- RESPIRATORY SYSTEM*Sneezing or itching in the nostrils
- *Tightness in the chest, with a persistent, dry cough
- *Breathing difficulty
- *Secretions of fluid and mucus into the throat and lungs
- *Wheezing (forced expirations during breathing)
- *Breathing stops
A sudden nervous system reaction that produces a temporary vascular dilation, resulting in fainting, or syncope (causes can range from fear, bad news, or unpleasant sights)
*Table 7-2* PROGRESSION OF SHOCK (pg. 83)
- COMPENSATE(body can still function)SHOCK*Agitation
- *Feeling of impending doom (like you are about to die)
- *Altered mental status
- *Weak, rapid, or absent pulse
- *Clammy (pale, cool, moist) skin
- *Paleness, with cyanosis about the lips
- *Shallow, rapid breathing
- *Shortness of breath
- *Nausea or vomiting
- *Capillary refill longer than 2 secs in infants and children
- DECOMPENSATED(body can't function)SHOCK*Difficulty breathing
- *Ashen, mottle, or cyanotic skin
- *Dull eyes, dilated pupils
General care for shock
- 1. Protect yourself (gloves)
- 2. Monitor breathing
- 3. Control all obvious external bleeding
- 4. Treat for shock
- -Place the victim on their BACK (supine position)
- 5.-Raise legs 6-12 inches *DO NOT MOVE VICTIM WITH HEAD OR SPINE INJURIES*
- 6.-Splint any bone or joint injuries
- 7.-Keep the victim warm. (Prevent heat loss)
- 8. Handle the victim gently
- 9. Seek medical care.
- *study pg. 84!*
NEVER GIVE THE VICTIM ANYTHING TO EAT OR DRINK!!
How do you care for Anaphylaxis?
Immediately call 9-1-1. Use epi pen (epinephrine auto-injector) or benedryl
How much blood does an adult have and how much can they lose before going into shock?
- Adult has 5-6 quarts (10-12 pints)
- *dangerous amount is 1quart in an adult and a child can only lose 1 pint.
3 Types of bleeding; according to the type of blood vessel that is damaged.
- 1. Arterial bleeding
- 2. Venous bleeding
- 3. Capillary bleeding
Refers to a large amount of bleeding in a short time
The most serious type of bleeding because a large amount of blood can be lost in a very short period of time; less likely to clot bc blood can clot only when it is flowing slowly; dangerous and difficult to control
Blood from a vein flows steadily or gushes; bleeding from the veins
The most common type of bleeding, blood oozes from the capillaries; usually not serious and can be controlled easily; will usually clot and stop by itself
Two ways the body naturally responds to bleeding
- 1. Blood vessel spasm
- 2. Clotting (platelets in blood form clots)
Care for external bleeding
- 1. Protect yourself
- 2. Expose the wound
- 3. Place a sterile gauze pad or a clean cloth such as a handkerchief, washcloth, or towel over the entire wound and apply direct pressure with your fingers or the palm of your hand. hold for 5 min *DIRECT PRESSURE stops most bleeding.
- 4. If bleeding from an extremity (arms or legs) elevate and apply pressure
- 5. To free you to attend to other injuries or victims, use a pressure bandage to hold the dressing on the wound. (Use a roller gauze bandage)
- 6. If the bleeding continues, apply pressure at a pressure point to slow the flow of blood as you continue putting direct pressure over the wound.
- 7. If direct pressure can't be applied due to protruding bone or object, make a doughnut shaped pad to control bleeding.
- *DO NOT APPLY TURNICATES!!*
Signs of internal bleeding:
- *Bright red blood from the mouth or rectum or blood in the urine
- *Nonmenstrual vaginal bleeding
- *Vomited blood; may be bright, dark red, or look like coffee grounds
- *Black, foul-smelling, tarry stools
- *Pain, tenderness, bruising, or swelling
- *Broken ribs, bruises over the lower chest, or a rigid abdomen
Care for Internal bleeding
- 1. Monitor breathing
- 2. Expect vomiting
- 3. Treat for shock
- 4. Treat suspected internal bleeding in an extremity by applying a splint
- 5. Seek immediate medical care
For internal bleeding
- R -Rest
- I -Ice
- C -Compress the area with elastic bandage
- E -Elevate the injured extremity
The top layer of the skin is removed, with little or no blood loss; tend to be painful bc the nerve endings often go along with the skin
Cut skin with jagged, irregular edges; usually caused by a forceful tearing away of skin tissue
Ten to have smooth edges and resemble a surgical or paper cut; the amount of bleeding has to do with the depth, the location, and the size of the wound
Are usually deep, narrow wounds in the skin and underlying organs such as a stab wound from a nail or knife; the entrance is usually small, and the risk of infection is high
A piece of skin is torn loose and is hanging from the body or completely removed; can bleed heavily; if the flap is still attached, lay it flat and realign it into its normal position; often involve ears, fingers, and hands
Involves the cutting or tearing off of a body part, such as a finger, toe, hand, foot, arm, or leg
Care for open wounds
- 1. Protect yourself (gloves)
- 2. Expose the wound (move clothing)
- 3. Control the bleeding by using direct pressure. If direct pressure doesn't resolve it elevate and use pressure points.
What usually restarts the bleeding bc it disturbs the clot?
Cleaning a wound
- 1. Scrub your hands with soap and warm water
- 2. Expose the wound
- 3. Clean the wound
- -For a SHALLOW wound---> Wash inside the wound with soap and warm water. Flush the wound with water. (Run water directly into the wound
- -For a wound with high risk of INFECTION---->Seek medical care for wound cleaning.
- 4. Remove small objects not flushed out with sterile tweezers
- 5. If bleeding restarts, apply direct pressure over the wound
Types of wounds that have a high potential for infection:
- *Bite wounds
- *Very dirty, contaminated wounds
- *Crushing, ragged wounds
- *Wounds over injured bone, joint, or tendon
- *Puncture wounds
- **Bacteria thrives in dark, warm, and moist areas**
Covering a wound for a small wound
- 1. Cover it with antibiotic
- 2. Cover the wound with a STERILE DRESSING.
- 3. If a wound bleeds after a dressing has been applied and the dressing becomes stuck, leave it on as long as the wound is healing.
- 4. If a dressing becomes wet or dirty, change it.
_____ is applied over a wound to control bleeding and prevent contamination, should be STERILE. ______ holds the dressing in place.
ANY WOUND CAN BECOME INFECTED!!
The signs and symptoms of infection include:
- *Swelling and redness around the wound
- *A sensation of warmth
- *Throbbing pain
- *Pus discharge
- *Swelling of lymph nodes
- *One or more red streaks leading from the wound toward the heart
Factors that increase the likelihood for wound infection include:
- *Dirty and foreign material left in the wound
- *Ragged or crushed tissue
- *Injury to an underlying bone, joint, or tendon
- *Bite wounds (human or animal)
- *Hand and foot wounds
- *Puncture wounds or other wounds that cannot drain
- *Keeping the area clean
- *Soaking the wound in warm water or applying warm, wet packs
- *Elevating the infected portion of the body
- *Applying antibiotic ointment
- *Changing the dressings daily
- *Seeking medical help if the infection persists or becomes worse
Caused by a toxin produced by a bacterium & another name for this; Shot recommended once ever 10 years
Tetanus (Lockjaw-bc the tightening of the jaw muscles)
How long should you go to sufficiently maintain immunity
booster shot every 5-10 years
The guidelines for tetanus immunization boosters are:
- *Anyone with a wound who has never been immunized against tetanus should be given a tetanus vaccine and booster immediately
- *A victim who was once immunized but has not received a tetanus booster within the last 10 years should receive a booster
- *A victim with a dirty wound who has not had a booster within the past 5 years should receive a booster.
- *Tetanus immunization shots must be given within 72 hours of the injury to be effective
3 types of amputations
- 1. Guillotine amputations
- 2. Crushing amputations
- 3. Degloving
A clean-cut, complete detachment; ex a finger cut off with an arm severed with a power tool
Occurs when an extremity separates by being crushed or mashed off, such as when a hand is caught in a roller machine
Is when the skin is peeled off, much as you would take off a glove
Care for amputation
- 1. Control the bleeding with direct pressure and elevate the extremity. apply a dry dressing or bulky cloths.
- 2. Treat the victim for shock
- 3. Recover the amputated part, take it to the hospital
- 4. To care for the amputated body part
- -Do not clean the amputated portion
- -Wrap the amputated part with dry, sterile gauze or other clean cloth
- -Put the wrapped amputated part in a plastic bag or other waterproof container
- -Place the bag or container with the wrapped part on a bed of ice. Keep the amputated part cool, but do not freeze
- 5. Seek medical care immediately
NEVER REMOVE AN IMPALED OBJECT EXCEPT THROUGH THE CHEEK!!
COVER THE UNINJURED EYE AND NEVER REMOVE AN IMPALED OBJECT FROM THE EYE!
A ____ covers an open wound, it touches the wound
A dressing should be:
- *Larger than the wound
- *Thick, soft, and compressible so pressure is evenly distributed over the wound
- *Lint free
The purposes of using a dressing are to:
- *Control bleeding
- *Prevent infection and contamination
- *Absorb blood and wound drainage
- *Protect the wound from further injury
Types of dressings
- *Gauze pads
- *Adhesive strips
- *Trauma dressings
Types of bandages
- *Roller bandages
- *Self-adhering, conforming bandages
- *Gauze rollers
- *Elastic roller bandages
- *Triangular bandages
- *Adhesive tape
A triangular bandage folds into a ____
- Cravat (spiral method, figure eight method)
- Do ABOVE and UNDER the joint
70% of all burn injuries occur where; most victims are injured as a result of their own actions
in the home
The highest-risk age groups for burn injuries
children younger than 5 & adults older than 55
Burns can be classified as:
- 1. Thermal (heat)
- 2. Chemical
- 3. Electrical
Are caused by flames/ contact with hot objects
Thermal (heat) burns
A wide range of chemical agents can cause tissue damage and death on contact with the skin; will continue to damage until completely removed. 3 types.
- Chemical burns
- 1. acids
- 2. alkalis- produce deeper, more extensive burns than acids
- 3. organic compounds
The injury severity from contact with electric current depends on the type of current, the voltage, the area of the body exposed, and the duration of contact. can cause cardiac arrest (Ventricular fibrillation)
DETERMINE THE SIZE AND DEPTH OF THE THERMAL BURN!!
Affect the skin's OUTER layer (epidermis). Characteristics include rudeness, mild swelling, tenderness, and pain; healing occurs without scarring within a week.
1st degree burn SUPERFICIAL
Extend through the entire outer later and into the inner skin layer. blisters, swelling, weeping of fluids, and severe pain characterize these burns, which occur bc the capillary blood vessels in the dermis are damaged and give up fluid into surrounding tissues.
2nd degree burns PARTIAL-THICKNESS
Severe burns that penetrate all the skin layers into the underlying fat and muscle. the skin looks leathery, waxy, or perly gray and sometimes charred. dry appearance. victim feels no pain bc the nerve endings have been damaged or destroyed; usually involes skin graft
3rd degree burn FULL-THICKNESS
Seek medical care for all moderate and severe burns, as classified by the American Burn Association, or if any of the following conditions applies:
- *The victim has difficulty breathing
- *Other injuries exist
- *An electrical injury exists
- *The face, hands, feet, or genitals are burned
- *Child abuse is suspected
- *The surface are of a 2nd degree burn is greater than 20% of the body surface are
- *The burn is 3rd degree
Care of first degree burns
- 1. Immerse the burned area in cold water (10-45min)
- 2. Ibuprofen
- 3. Drink as much water as possible
- 4. Apply aloe vera gel
- 5. Elevate
Care of small 2nd degree burns (<20%surface area)
- 1-4 same as 1st degree
- 5. Cover the burn with a dry, nonsticking, sterile dressing or a clean cloth.
- 6. Seek medical care for 2nd degree burns covering more than 20% of the bsa in adults or 10% to 20% in children or elderly victims
Care for Large 2nd degree burns (>20% surface area)
- 1. Do not apply cold bc it could cause hypothermia
- 2. follow steps 2-3 for 1st degree.
- 3. Cover the burn with a dry, nonstick, sterile, or clean dressing
- 4. Care for shock
- 5. Seek medical care
Care for 3rd degree burns
- 1. Usually not necessary to apply cold to 3rd degree burns bc pain is absent.
- 2. Cover the burn with a dry, nonsticking, sterile dressing or a clean cloth
- 3. Treat the victim for shock by elevating the legs and keeping the victim warm
- 4. Seek medical care FOR ANY 3RD DEGREE BURN
NEVER APPLY COLD WATER TO BURNS GREAT THAN 20%!!
Care for chemical burns
- 1. Immediately remove the chemical by FLUSHING WITH FREE FLOWING WATER ON LOW PRESSURE the body portion with water. Brush dry powder chemicals from the skin before flushing bc powder chemicals could be activated by water.
- 2. Remove the victim's contaminated clothing and jewelry while flushing with water. Clothing can hold chemicals, allowing them to continue to burn as long as they are in contact with the skin.
- 3. Flush for 20 min or longer. Let the victim wash with a mild soap before a final rinse. Washing with large amounts of water dilutes the chemical concentration and washes it away.
- 4. Cover the burned area with a dry, sterile dressing or, for large areas, a clean lint free cloth, such as a pillowcase
- 5. If the chemical is in an eye, flood it for at least 20 min, using low pressure
- 6. Seek medical care immediately for all chemical burns
3 types of electrical injuries
- 1. thermal burn (flame)
- 2. arc burn (flash)
- 3. true electrical injury (contact)
Results when clothing or objects in direct contact with the skin are ignited by an electric current; caused by the flames produced by the electric current and not by the passage of the electric current or arc
Thermal burn (flame)
Occurs when electricity jumps, or arcs, from one spot to another and not from the passage of an electric current through the body; causes extensive superficial injuries
Arc burn (flash)
Happens when an electric current passes directly through the body; characterized by the entrance wound and an exit wound; the surface injury isnt the only concern may have cardiac arrest or internal burns and other injuries
True electrical injury (contact)
Care for electrical burns
- 1. Make sure the area is safe!
- 2. Monitor breathing and treat accordingly
- 3. If the victim fell, check for a spinal injury
- 4. Treat the victim for shock by elevating the legs 6-12 inches
- 5. Place blankets under and over the victim
- 6. Seek medical care immediately