Circulation Management of shock Assessment of shock and control of external haemorrhage

The ability to assess a patient for the presence of shock is essential at all levels of the health care system. The only resources required for this function are a clock or watch with second hand, a stethoscope and blood pressure (BP) cuff, and the relevant training. Training should include visual/manual assessment of circulation, including pulse, venous filling and skin temperature. If no other resources are available at the level in question, it is anticipated that shock would usually constitute grounds for referral to the next highest level of the system.

Control of external haemorrhage through manual pressure and through the application of a pressure dressing is essential at all levels of the health care system. The only resources required are training and sufficient gauze bandages. These should be sterile whenever possible. Given the limited facilities for sterilization at most basic facilities, clean bandages should be considered essential at this level. Sterile bandages are considered essential at all hospital levels. Training regarding indications for the use of arterial tourniquets in extreme situations, as well as understanding the potential complications and the need for removal under controlled circumstances within several hours, is essential at all levels. Splinting of fractured extremities as a means of decreasing internal haemorrhage is essential at all levels.

More advanced, externally applied haemorrhage control measures include wrapping for potential pelvic fractures and deep interfascial packing for complicated wounds, such as landmine and machete wounds. These are deemed desirable at the basic level and essential at all hospital levels.

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