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Hemostasis / Controlling External Bleeding

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by

Jessica Blake

on 10 May 2015

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Transcript of Hemostasis / Controlling External Bleeding

62
ECG
bpm
Questions?

Blood Supply
Average adult: 7-8% of
total body weight (5-6L)

Babies: wt. based.

* A loss of 1L poses a risk
for death (exsanguination).
* Place direct pressure over wound (except for open fractures) by putting a clean pad over the wound and pressing firmly... approximately 6 minutes.

* Scalp wounds may require continuous direct pressure for 30 to 60 minutes.
Hemorrhage / Bleeding Control
* Direct Pressure

* Pressure Dressing

* Tourniquet

* Hemostatic Agents


References
Doyle GS, Taillac PP. Tourniquets: A review of current use with proposals for expanded pre-hospital use. Prehosp Emerg Care. 2008 Apr-June; 12(2): 241-56.

Prehospital Trauma Life Support, 7th ed. Mosby, Inc. 2011

Della-Gustina, D., Ingebretsen, R. (2013) Advanced Wilderness Life Support. Utah School of Medicine, Salt Lake City. p. 24-25

Wakai A, Winter D C, Street J T. et al Pneumatic tourniquets in extremity surgery. J Am Acad Orthop Surg 2001. 9345–351.351

Kragh JF Jr, et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. The Journal of Trauma Injury, Infection, and Critical Care. 2008;64(2 suppl):S38;discussion:S49.


First Line of Action: DIRECT PRESSURE
Hemostasis / Controlling External Bleeding
112
ECG
bpm
If after 6- 10 minutes the
wound is continuing to bleed,
add additional pressure and dressing over the bottom
dressing.
Take a heavy gauze or elastic bandage and maintain compression by the wrapping the limb firmly but not cutting off circulation.

Consider elevation of extremity if you are able.


Second Line of Action:
PRESSURE IMMOBILIZATION BANDAGE
145
ECG
bpm
Indications
Hemorrhage from an extremity that cannot be controlled by direct pressure or a pressure bandage.

Used for
life-threatening
extremity
hemorrhage.

Used only for limb wounds.
Third Line of Action: TOURNIQUET
Types of Bleed
* Arterial.

* Venous.

* Capillary.
Types of Bleed
* Arterial.

* Venous.

* Capillary.
Direct pressure controls
bleeding for most wounds.
Bleeding that
requires a tourniquet...
Improvised
Tourniquet
At least 2 inches wide.

Rigid object. A stick that is strong enough to tighten the tourniquet and be secured.

Material that will secure the rigid object once the tourniquet is tightened.
Improvised Tourniquet
Application
2-3 inches above the wound.

Multiple bleeding sites - closest to the heart.

Should be tight enough to stop bleeding.

Should never be placed on a joint (knee or elbow) or over an impaled object.

Extremity should be exposed.

Document application time. Write on
patient!
Application

Only a physician providing definitive care should completely remove a tourniquet that has been placed for more than 2 hours.
Leave tourniquet in plain sight.
Write a "T" on the casualty's forehead and
the time applied & relay to provider
assuming care.
Instruct patient to
inform every provider
that they come in
contact with about
its place and location.
Tourniquet?
Tourniquet?
Apply hemostatic agent to other massive bleeds
When the bleeding is in the site where a tourniquet cannot be applied (e.g. groin area), apply hemostatic agents.





2.
Attempt direct pressure to control bleeding for a minimum of 2 minutes. If you are unable to control the bleed, apply hemostatic agent directly to the source of bleeding.

3.
With fingertip pressure and a 4 x 4 gauze, compress the wound and hemostatic agent for at least 2 minutes. Failure to apply direct pressure to the source of the bleeding may delay or prevent the cessation of bleeding.


4.
Leaving the 4 x 4 in place, evaluate for cessation of bleeding. If bleeding has stopped, dress the wound as appropriate.

5.
If bleeding continues, remove the 4 x 4 or trauma dressing and reapply the hemostatic agent and 4 x 4 dressing. Confirm that direct pressure is being placed on the source of bleeding.





Tourniquet?
When & Where?
When bleeding is uncontrollable with direct pressure or when tourniquets cannot be used.

Attempt direct pressure to control bleeding for a minimum of 2 minutes. If unable to control bleed, apply hemostatic agent directly to the source of bleeding
How?
With fingertip pressure, apply hemostatic gauze.

Compress the wound for 2 minutes.

Failure to apply direct pressure to the source of bleeding may delay or prevent the cessation of bleeding.
Then what?
Leaving the hemostatic gauze in place, evaluate for cessation of bleeding, if bleeding has stopped, dress the wound as appropriate.
What if?
If bleeding continues, remove the 4x4 hemostatic gauze and reapply the hemostatic agent. Confirm direct pressure is being placed on the source of bleeding.
Application & Soak Through
Hemostatic Agents
PHTLS, 2011; ITLS, 2013
Life Threatening Conditions


I - airway + breathing
II - bleeding
III- circulation
AIRWAY
Most common obstruction: tongue
BLEEDING
Control Severe Bleeding
CIRCULATION
Ensure adequate circulation... shock treatment.
head/tilt
chin/lift
RESTORE BREATHING
Brain cells start to die after 4 minutes without oxygen.
jaw thrust
Full transcript