Class 6 (Initial Assessment with Circulatory System, Bleeding & Shock) Ch8 (Partial), Ch4 (Partial), Ch22 & Ch23Patient Assessment (Review)Initial AssessmentInitial Assessment: A-B-C TriadAnatomy of the Cardiovascular SystemThe Circulatory SystemThe HeartBlood Flow Through the HeartBlood VesselsMajor Arteries and VeinsCapillary SphinctersBloodPhysiology of the Circulatory System (1 of 2)Physiology of the Circulatory System (2 of 2)Perfusion (1 of 2)Perfusion (2 of 2)Perfusion TriangleSlide 18Assessing the PulseNormal Pulse Rates in Infants and ChildrenThe Significance of BleedingConditions With Possible Serious BleedingAssessing and Controlling External BleedingCharacteristics of BleedingBlood ClottingCirculationInterventionsControlling External BleedingDirect Pressure and ElevationPressure PointsLocation of Pressure PointsSplintsApplying a TourniquetTourniquet PrecautionsBleeding from the Nose, Ears, and MouthControlling a NosebleedBleeding from Skull FracturesInternal BleedingSigns and Symptoms of Internal Bleeding (1 of 2)Signs and Symptoms of Internal Bleeding (2 of 2)ShockSlide 42Signs of HypoperfusionProgression of ShockCompensated ShockDecompensated ShockIrreversible ShockWhen to Expect ShockCardiovascular Causes of Shock (1 of 4)Cardiovascular Causes of Shock (2 of 4)Perfusion and Neurogenic ShockCardiovascular Causes of Shock (3 of 4)Cardiovascular Causes of Shock (4 of 4)Noncardiovascular Causes of Shock (1 of 3)Noncardiovascular Causes of Shock (2 of 3)Noncardiovascular Causes of Shock (3 of 3)Emergency Medical Care (1 of 3)Emergency Medical Care (2 of 3)Emergency Medical Care (3 of 3)Treating Hypovolemic ShockTreating Cardiogenic ShockTreating Neurogenic ShockTreating Septic ShockTreating Respiratory InsufficiencyTreating Anaphylactic ShockTreating Psychogenic ShockAssessing PerfusionPriority PatientsTransport DecisionSlide 70Golden Hour-Platinum Ten MinutesClass 6 (Initial Assessment with Circulatory System, Bleeding & Shock)Ch8 (Partial), Ch4 (Partial), Ch22 & Ch23Patient Assessment (Review)•Scene size-up•Initial assessment•Focused history and physical exam–Vital signs–History•Detailed physical exam•Ongoing assessmentInitial Assessment•Develop a general impression.•Assess mental status.•Assess airway.•Assess the adequacy of breathing.•Assess circulation.•Identify patient priority.Initial Assessment: A-B-C Triad•Find & treat immediate threat to life–Lack of an airway–Ineffective breathing–Circulatory collapse•Bleeding•Shock•A B C all of equal importance–Starting with bleeding control (C) appropriate in an awake patientAABBCCAnatomy of theCardiovascular System•The cardiovascular system is responsible for supplying and maintaining adequate blood supply flow.•Consists of three parts:–Heart (pump)–Blood vessels (container)–Blood and body fluids (fluids)The Circulatory SystemThe HeartBlood Flow Through the HeartBlood Vessels•Arteries•Arterioles•Capillaries•Venules•VeinsMajor Arteries and Veins•Aorta•Pulmonary•Carotid•Femoral•Brachial•Radial•Superior vena cava•Inferior vena cava•PulmonaryCapillary Sphincters•Regulate the blood flow through the capillary beds.•Sphincters are under the control of the automatic nervous system.•Regulation of blood flow is determined by cellular need.Blood•Contains:–Red blood cells–White blood cells–Platelets–PlasmaPhysiology of theCirculatory System (1 of 2)•Pulse–The wave of blood through the arteries formed when the left ventricle contracts –Can be felt where an artery passes near the skin surface and over a bonePhysiology of theCirculatory System (2 of 2)•Blood pressure–Amount of force exerted against walls of arteries–Systole: Left ventricle contracts–Diastole: Left ventricle relaxes•Perfusion–Circulation of blood within an organ or tissue–If inadequate, the patient goes into shock.Perfusion (1 of 2)•Circulation within tissues in adequate amounts to meet the cells’ needs for oxygen, nutrients, and waste removal•Some tissues and organs need a constant supply of blood while others can survive on very little when at rest.Perfusion (2 of 2)•The heart demands a constant supply of blood.•The brain and spinal cord can survive for 4 to 6 minutes without perfusion.•The kidneys may survive 45 minutes.•The skeletal muscles may last 2 hours.Heart (Pump Function) Blood Vessels (Container Function)Blood (Content Function)Perfusion TriangleAssessing the Pulse•Presence•Rate•Rhythm•StrengthAge Range (beats/min)Infant: 1 month to 1 year 100 to 160Toddler: 1 to 3 years 90 to 150Preschool-age: 3 to 6 years 80 to 140School-age: 6 to 12 years 70 to 120Adolescent: 12 to 18 yearsAdults60 to 10060 to 100Normal Pulse Rates in Infants and ChildrenThe Significance of Bleeding•Hemorrhage = bleeding•The body will not tolerate an acute blood loss of greater than 20% of the blood volume.•In the typical adult, 20% is 1 liter or 2 pints.•Blood loss of 1 L can be dangerous in adults; in children, loss of 100-200 mL. is serious–A 1-year-old infant typically has 800 mL. A loss of 200 mL is significant.Conditions With Possible Serious Bleeding•Significant mechanism of injury•Poor general appearance of patient•Assessment reveals signs of shock•Significant amount of blood loss noted•Blood loss is rapid.•You cannot control external bleeding.Assessing and Controlling External Bleeding •Assess after clearing the airway and stabilizing breathing.•Look for blood flow or blood on floor/clothes.•Controlling bleeding–Direct pressure–Elevation–Pressure pointsCharacteristics of Bleeding•Arterial–Blood is bright red and spurts. •Venous–Blood is dark red and does not spurt.•Capillary–Blood oozes out and is controlled easily.Blood Clotting•Bleeding normally stops within 10 minutes.•Some medications interfere with clotting.•Some injuries will be unable to clot.•Patients with hemophilia lack clotting factors.Circulation•Quickly assess pulse rate and quality.•Determine skin condition, color, and temperature.•Control significant bleeding.•Treat for shock.Interventions•With significant bleeding, provide high-flow oxygen.•Control bleeding.•Using multiple methods to control bleeding usually works best.•Treat aggressively for shock.•Provide rapid transport.Controlling External Bleeding•Follow BSI precautions.•Ensure patient has an open airway and adequate breathing.•Provide oxygen if