[CN]CHAPTER 15



CHAPTER 15

Bleeding and Shock

Preparation and Resources Needed

Materials: Graph paper and various types of wound dressings used at your school.

Equipment: Stethoscopes and manual sphygmomanometers.

Personnel: EMS personnel to demonstrate how they control bleeding in the field, take blood pressure, treat for shock, and so on.

Recommended Time to Complete: Seven days (based on two class periods per day, 170 school days per year). More activities are available through the textbook, workbook, and instructor’s manual than can be fit into the recommended time. The instructor should select activities that best suit his or her own teaching situation and training program duration.

Key Terms

aorta The heart’s main artery, which carries nutrient-rich blood away from the heart to the body’s cells.

arteries Blood vessels that carry blood from the heart to all of the body’s organs and cells.

arterioles The smallest of the arteries.

atria (singular: atrium) The upper chambers of the heart.

capillaries Microscopic blood vessels that connect arteries to veins.

cardiac conduction system The heart’s electrical system, consisting of specialized cells within heart muscle that carry electrical signals that regulate the pumping of the heart.

cardiorespiratory system The body system that includes the functions of the heart, blood vessels, circulation, and exchange of gases between the blood and the atmosphere.

coronary arteries The heart’s own system of blood vessels.

diastolic The lowest pressure in the heart; relates to ventricular relaxation.

gauze dressing A woven, flexible, absorbent cloth applied to a wound.

occlusive dressing A petroleum-based dressing with a thin plastic film, designed to keep air and moisture from entering or escaping a wound.

plasma The yellowish, liquid part of blood.

platelets Tiny cell fragments in blood that aid in clotting.

pulmonary artery The artery that connects the heart to the lungs.

pulse pressure The difference between the diastolic and systolic pressures in the heart.

pulse The rhythmical beating of the heart.

septum The wall separating the left and right sides of the heart.

shock A potentially fatal physiological reaction usually characterized by significant drop in blood pressure, reduced blood circulation, and inadequate blood flow to the tissues; may occur in response to several conditions, including illness, injury, hemorrhage, and dehydration.

standard precautions Infection control guidelines designed to protect workers from exposure to disease spread by contact with blood or other bodily fluids.

systolic The highest pressure in the heart; correlates to ventricular contraction.

target heart rate The percentage of the maximum heart rate that is safe to reach during exercise.

veins Blood vessels that carry blood back to the heart.

ventricles The lower chambers of the heart.

venules The smallest of the veins.

Lecture Outline

I. The Cardiorespiratory System

a. Includes functions of the heart, blood vessels, circulation, and gas exchange between the blood and atmosphere

i. Heart pumps blood through the body through pathways (e.g., arteries, veins, and capillaries)

. Blood is enriched with oxygen when it passes through lungs

. As oxygen enters the bloodstream, carbon dioxide leaves it (i.e., respiration)

Key Concept

The cardiorespiratory system is the body system responsible for providing oxygen and nutrients to all of the body’s cells, as well as ridding the body of the waste products of metabolism.

II. The Circulatory System

a. Course taken by blood through arteries, capillaries, and veins, and back to the heart

ii. Blood transports dissolved materials (e.g., oxygen, carbon dioxide, nutrients, waste) throughout the body

b. The heart

i. Two major circulations

. Each has its own pump

. Both pumps are incorporated into the heart

Key Concept

The right side of the heart pumps blood through the lungs, where it picks up oxygen to be delivered to the cells of the body. The left side of the heart pumps blood to all other parts of the body, delivering oxygen-rich blood to the cells and picking up waste products to be delivered to the lungs and kidneys for removal.

c. Heart structure

i. Primarily a shell with four inner chambers

d. Blood

i. Only tissue that flows throughout the body

ii. Carries oxygen and nutrients to all body parts

iii. Transports waste products back to the lungs, kidneys, and liver for disposal

e. Plasma

i. River in which blood cells travel

ii. Makes up 55 percent of blood's total volume

iii. Also carries nutrients, waste products, antibodies, clotting proteins, chemical messengers, and proteins

f. Red blood cells

i. Highly specialized cells

ii. “Stripped” of everything that might get in the way of transporting oxygen

g. Hemoglobin

i. Picks up oxygen in areas where it is abundant and releases it in tissues where oxygen is low

h. White blood cells

i. Five kinds: neutrophils, monocytes, lymphocytes, eosinophils, and basophils

i. Platelets

i. Release agents to help initiate clotting and protect integrity of the vasculature

j. Blood vessels

i. Hollow tubes, running throughout the body, through which blood circulates

ii. Types:

. Arteries

. Arterioles

. Veins

. Venules

. Capillaries

Key Concept

The structures that make up the circulatory system are the heart, blood, and blood vessels.

III. The Heart’s Conduction System

a. Cardiac conduction system

iii. Made up of specialized cells within heart muscle tissue

. Carries electrical signals to muscle cells throughout the heart

. Signals trigger muscles to contract and pump blood throughout the body

k. Blood pressure

i. Systolic

. Highest pressure

. Corresponds to ventricle contraction

ii. Diastolic

. Lowest pressure

. Represents ventricle relaxation

l. Pulse pressure

i. Difference between systolic and diastolic

m. Pulse

i. Rhythmical beating of the heart

n. Target heart rate

i. Range of percentages of maximum heart rate safe to reach during exercise

IV. Body Substance Isolation

a. Protective equipment includes:

ii. Sterile gloves

iii. Protective eyewear

iv. Surgical mask

V. OSHA Guidelines for Infectious Disease Control

a. Centers for Disease Control and Prevention

v. Monitors outbreaks of infections

vi. Advises on how to handle and control disease spread

o. Standard precautions

i. Infection-control guidelines

ii. Designed to protect workers from exposure to diseases spread by blood and bodily fluids

Key Concept

Standard precautions were developed to prevent contact with the blood of patients who may have infections that can be spread through bodily fluids and blood. All patients should be assumed to be infectious for bloodborne diseases.

VI. Wound Care

a. Principles:

iii. Irrigate wound with clean, cool water

iv. Gently wash with mild soap (superficial cuts)

v. All foreign particles must be removed or infection will result

. Minor cuts and abrasions should be washed, dried with a sterile gauze sponge, treated with a first-aid cream, and covered with a sterile bandage

p. Proper bandaging and dressing of a wound ensures proper healing and infection control

q. Two primary types of dressings:

i. Gauze

ii. Occlusive

VII. Bleeding

a. Three basic types of bleeding

Key Concept

There are three basic types of bleeding: arterial, venous, and capillary. Arterial bleeding can be severe. Venous bleeding is often less severe than arterial bleeding, but can often be profuse. Capillary bleeding is slow and can increase the risk of infection.

VIII. Shock

a. Circulation system fails to send blood to all parts of the body

r. Main types:

i. Hemorrhagic shock

. Loss of blood from an injury

Key Concept

Shock is a precursor to death. When the body is in a shock state, certain areas are deprived of oxygen. This could result in damage to those parts of the body and, if prolonged and untreated, could result in death.

ii. Respiratory shock

. Lungs are unable to supply enough oxygen to blood

iii. Neurogenic shock

. Loss of vascular control by the nervous system

iv. Cardiogenic shock

. Inadequate functioning of the heart

v. Metabolic shock

. Severe loss of bodily fluids

vi. Anaphylactic shock

. Severe allergic reaction

vii. Septic shock

. Life-threatening reaction to a severe infection

viii. Psychogenic shock

. Physiological response to fear, stress, or emotional crisis that causes the person to faint

s. Signs and symptoms include:

i. Restlessness and anxiety, weak and rapid pulse, cold and clammy skin, profuse sweating, pale face or cyanotic (blue) around the mouth, shallow respirations, dull eyes with dilated pupils, thirst, nausea and vomiting, blood pressure that falls gradually and steadily, and loss of consciousness

t. General care and treatment

i. Critical for the victim’s well-being

ii. Follow general guidelines

iii. Goal is to keep the victim from getting worse

. Proper care, and reassuring the victim, will help meet this objective

IX. Conclusion

a. The cardiorespiratory system is responsible for the function of the heart, blood vessels, circulation, and breathing

u. Anyone working with athletes must take preventive measures for protection against bloodborne pathogens and other diseases

v. There are three basic types of bleeding: arterial, venous, and capillary

i. All types require immediate care to prevent shock and infection

Lesson Plans and Teaching Strategies

Follow the lecture outline to present material to students, using a variety of teaching strategies described in the Instructional Strategies, such as modified lecture and cooperative/collaborative learning.

If blood pressure wasn’t dealt with in a previous chapter, this is the time to discuss blood pressure and how the sphygmomanometer works (what it does to the blood vessels of the arm and where the sounds heard through the stethoscope originate). If done before, this would be a good opportunity to review blood pressure. Have students get their own blood pressure taken every day for a week or two, compute an average, graph the individual readings, and then compare their results.

Practice taking pulse readings, using different pulse points. Have the students try to determine if one pulse point is better than another, or if there is a difference from one person’s pulse point to another.

Answers to Student Exercises

Textbook Review Questions

1. The circulatory system is responsible for transporting oxygen (picked up in the lungs) and nutrients (from the digestive tract) to the cells of the body, and for transporting carbon dioxide and other waste products to the lungs and kidneys for removal.

2. About 8,000 gallons of blood that pass through the heart daily.

3. Plasma is the liquid portion of blood, making up slightly more than one-half of its volume. It carries dissolved materials such as nutrients, wastes, hormones, and antibodies throughout the body to various destinations.

4. Arteries carry blood away from the heart; veins carry blood toward the heart. Artery walls are also more muscular than those of veins. Many veins have internal valves, which are not present in arteries.

5. Sterile gloves, usually made of latex, protect against possible infections from blood or other body fluids. Protective glasses are good protection if there is a chance of blood or other bodily fluids getting into the eyes of the health care provider. A surgical mask should be worn if there is a danger of infectious disease spreading from the athlete to training staff.

6. Most gloves are made of latex, but those who are allergic can use nonlatex synthetic gloves.

7. Eyewear should provide adequate protection against the hazards for which they were designed, be reasonably comfortable, fit securely without interfering with movement or vision, be capable of being disinfected and cleaned, be durable, and fit over, or incorporate, prescription eyewear.

8. Infection control guidelines are designed to protect workers from exposure to diseases spread by blood and certain bodily fluids.

9. Wash hands before and after all patient and specimen contact, treat all blood as potentially infectious, treat all linen soiled with blood or body secretions as potentially infectious, wear gloves if contact with blood and bodily fluids is possible, place used syringes immediately in nearby impermeable containers, do not recap or manipulate needles in any way, wear protective eyewear and a mask if splatter with blood or body fluids is possible, and wear a mask if there is risk of infection by TB or other respiratory organisms.

10. Gauze is a cotton material, whereas occlusive dressings, impregnated with petroleum gel or covered with a thin plastic film, are designed to prevent air and moisture from escaping the wound.

11. Select the proper size and material, have the athlete remove items like watches and bracelets that would interfere with bandaging, never reuse a dressing or bandage and always use sterile material, the bandage should be snug but not too tight, and leave fingers and toes exposed (if possible) so circulation can be checked.

12. Capillary bleeding is more of a slow oozing of blood from the body; venous bleeding flows steadily; and arterial bleeding spurts according to the pulse.

13. Shock occurs when the circulatory system fails to send blood to all parts of the body, depriving some areas of oxygen resulting in damage to limbs, lungs, heart, and brain, which could cause death.

14. Hemorrhagic shock is the loss of blood from an injury. Respiratory shock occurs when the lungs cannot supply enough oxygen to the blood. Neurogenic shock is the loss of vascular control by the nervous system. Cardiogenic shock is caused by inadequate functioning of the heart. Metabolic shock occurs when there is a severe loss of bodily fluids. Anaphylactic shock is caused by a severe allergic reaction. Septic shock is caused by a severe infection. Psychogenic shock is a physiological response to fear, stress, or emotional crisis, causing a person to faint.

15. Signs of shock include restlessness, anxiety, weak and rapid pulse, cold and clammy skin, profuse sweating, a pale face becoming cayanotic around the mouth, shallow respiration, eyes dull with dilated pupils, thirst, nausea, vomiting, blood pressure falling gradually and steadily, and loss of consciousness.

16. Maintain a clear airway, control all bleeding, elevate extremities, splint fractures and elevate if well stabilized, avoid rough and excessive handling, prevent loss of heat with a blanket above and below the athlete if possible, keep victim in a supine position, withhold food and drink, record vital signs, reassure victim, and activate EMS.

Workbook Vocabulary Review

Matching

1. F

2. A

3. K

4. L

5. D

6. H

7. I

8. R

9. W

10. J

11. M

12. X

13. S

14. N

15. G

16. B

17. P

18. Q

19. T

20. U

21. V

22. E

23. C

24. O

Workbook Quiz

1. A

2. B

3. C

4. D

5. A

6. B

7. D

8. C

9. B

10. C

Critical Thinking

1. The cardiorespiratory system includes the functions of the heart, blood vessels, circulation, and gas exchange between the blood and the atmosphere. The heart is responsible for pumping blood throughout the body through a complex system of pathways. The circulatory system is the course taken by blood through arteries, capillaries, and veins, and back to the heart. The cardiac conduction system, made up of specialized cells within the heart muscle tissue, carries electrical signals, in a properly timed sequence, to muscle cells throughout the heart. These signals trigger the muscles to contract and thereby pump blood throughout the body. When the heart pumps blood into the arteries, the surge of blood filling the vessels creates pressure against the vessel walls; this is blood pressure. Blood pressure is measured in two aspects: the systolic and diastolic. Pulse pressure, a figure derived from blood pressure, is the difference between the systolic and diastolic pressures.

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