Interactive Ready for Review: Interactivities

is the circulation of blood in adequate amounts to meet each cell's current needs for oxygen, nutrients, and waste removal.

, or shock, occurs when the cardiovascular system fails to provide adequate perfusion.

Both internal and external bleeding can cause shock. You must know how to recognize and control both.

In the order of preference, the seven methods for controlling bleeding are direct local pressure and elevation, pressure dressings, application of pressure to pressure points, splints, air splints, PASG, and tourniquets.

Do not remove a until a physician has evaluated the patient's condition; instead, apply additional dressings as needed. If bleeding continues, locate and apply pressure to the appropriate pressure point.

Stabilizing a serious fracture has a high priority in the control of bleeding.

Use a PASG to prevent or minimize shock only when there is massive soft-tissue bleeding of the lower extremities that cannot be otherwise controlled, or bleeding associated with fractures of the pelvis and bilateral femurs. Always follow local protocols and consult medical control for advice regarding the PASG.

Use a only as a last resort, typically with amputations.

You should assess and promptly transport any patient who may have internal bleeding, particularly if the mechanism of injury is severe and has affected the abdomen, the chest, or both.

Signs of bleeding include hematemesis, melena, hemoptysis, broken ribs, bruised chest, distended abdomen, and referred pain.

Signs of shock that suggest internal bleeding include change in mental status, pallor, weakness and dizziness, tachycardia, thirst, nausea and vomiting, and shallow, rapid breathing.

If you suspect that a patient is bleeding internally, maintain the airway, administer 100% supplemental oxygen and be prepared to assist ventilation, keep the patient still and warm, apply a splint to any affected extremity, monitor vital signs at least every 5 minutes, and, in nontrauma patients, elevate the legs.

(hypoperfusion) is the collapse and failure of the cardiovascular system in which blood circulation slows and eventually ceases.

Perfusion requires a cardiovascular system with all three parts (the pump, container, and fluid) working, but it also requires a functioning respiratory system.

The signs and symptoms of shock are caused by the actions of the and of hormones (catecholamines) responding to the need for additional perfusion.

Signs of shock include agitation or anxiety; a weak, rapid pulse; clammy skin; air hunger; nausea or vomiting; slow capillary refill in children and infants; and marked thirst.

Signs of shock include labored or irregular breathing, ashen or cyanotic skin, thready or absent peripheral pulses, dilated pupils, poor urinary output, and, finally, a falling blood pressure. By the time you detect a drop in blood pressure, shock is well developed.

Expect shock in cases of massive internal or external bleeding, multiple severe fractures, abdominal or chest injury, spinal injury, severe infection, massive myocardial infarction, and anaphylaxis.

Treat patients with shock by:

opening and maintaining the airway

providing 100% oxygen and, if necessary, assisting ventilations

controlling all obvious external bleeding

conserving body heat with blankets

properly positioning the patient

IV fluid replacement

transporting promptly