University:
Northwest College
Course:
VN 220 | Medical/ Surgical
Academic year:

2023
Views:

344

Pages:

1
Author:

Yesenia M.

Hemorrhage Hemorrhage that results in reduction of circulating blood volume is a main cause of shock . minor bleeding (usually venous) stops spontaneously unless the pt has a bleeding d/o or has been taking anticoagulant agents. Internal hemorrhage can hide in many anatomic spaces and compartments , resulting in shock w/out external evidence of hemorrhage. (internal spaces include retroperitoneum, pelvis, chest, and thighs) s/s shock: cool, moist skin, decreased BP, increased HR, delayed capillary refill, decreasing urine volume. Pts who hemorrhage are at risk for cardiac arrest caused by hypovolemia w secondary anoxia. MANAGEMENT Fluid replacement: loss of circulating blood results in a fluid vol deficit and decreased cardiac output . Fluid replacement important to maintain circulation. 2 large gauge IVS inserted to provide fluid replacement. PRBCS are infused where there is a massive blood loss which may also necessitate transfusion of other blood components including platelets and clotting factors. (infusion rate is based off the severity of the blood loss and the clinical manifestations of hypovolemia. Blood transfusions that involve transfusing several units of blood products should be given via a warmer when possible bc admin of large amounts of blood that has been refrigerated has a core cooling effect that can lead to cardiac arrest and coagulopathy. CONTROL OF EXTERNAL HEMORRHAGE: If a pt is bleeding out externally (from a wound) , they need a rapid physical assessment to identify the area that is bleding. APPLY FIRM DIRECT PRESSURE OVER THE BLEEDING AREA. Most bleeding can be stopped or controlled w pressure- uncontrolled bleeding can lead to DEATH. Tourniquet applied when bleeding cannot be controlled- always apply it PROXIMAL to the wound and tie it tight to control arterial blood flow. The time of tourniquet application and removal should be documented. CONTROL OF INTERNAL HEMORRHAGE: If pt has no external s/s of bleeding but has other s/s such as tachycardia, falling BP, thirst, apprehension, cool and moist skin, delayed cap refill, suspect INTERNAL HEMORRHAGE. PRBCS, plasma, platelets are usually given as tx. ABGS are also obtained for baseline and to determine the amt of fluid replacement that the pt can tol Keep pt in SUPINE position and monitor closely