CIRCULATION: HAEMORRAGHIC SHOCK

Assess the circulation

Signs of hypoperfusion

-   Confusion, lethargy or agitation
-   Pallor or cold extremities
-   Weak or absent radial and femoral pulses
-   Weak or absent radial and femoral pulses
-   Tachycardia
-   Hypotension

Examine the abdomen for tenderness or guarding Carefully assess pelvic stability

Large volumes of blood may be hidden in thoracic, abdominal and pelvic cavities, or from femoral shaft fractures.

To decrease bleeding: Apply pressure to external wounds Apply splint to possible femur fracture Apply pelvic binder to possible pelvic fracture

If patients is pregnant, she should not be on her back, put her on her left side.

Send blood for type and crossmatch

CIRCULATION

Obtain two large bore IV catheters

If systolic BP <90 mmHg or pulse >110 bpm

• Give 500 ml bolus of Ringer’s Lactate or NS
• Keep patient warm
• Reassess vitals
• If still hypotensive after 2L of crystalloids, transfuse blood

STOP THE BLEEDING

Apply direct pressure to the wound, then put on compression dressing. Apply only enough pressure to stop the bleeding.

ONLY if bleeding is life-threatening and cannot be controlled, apply a tourniquet. Use a blood pressure cuff or wide elastic band over padded skin. Transfer urgently!

DISABILITY or DAMAGE

Checking for neurological damage: vital part of primary survey Abbreviated neurological examination:

-   ALERT
-   VERBAL - responsive to verbal stimulus
-   PAIN - responsive to painful stimulus
-   UNRESPONSIVE

GLASGOW COMA SCORE (GCS)

Total Score = Eye + Verbal + Motor Scores

GLASGOW COMA SCORE

Eyes +Verbal + Motor Scores = GCS
  - Severe head injury: GCS 8 or less
  - Moderate head injury: GCS 9-12
    - Mild head injury: GCS 13-15

GCS is to be repeated and recorded frequently. It is the best way to determine deterioration