Tue, 20 May 2008|
Mike McEvoy reviews the basics of controlling bleeding in a prehospital environment and talks new technology as well as old techniques that are coming back into favor.
But there. Today we're gonna talk about -- control. And I'm gonna review the conventional methods of bleeding control and talk about some old practices that are coming back into action. And some newer technologies that are available to help you control -- in a greenhouse one buyer. And you review some the basics of bleeding control just as a refresher. If our patient here was to have a serious laceration on his wrist the first thing that we would use to control would be direct pressure. And we'll do that with a dressing that's of sufficient size actually cover the wound. But not so large that it would continue to absorb blood without giving us an indication that -- continuing to come from the wound itself. -- chose a four by four dressing in this situation. -- will apply it directly over the wound surface. And just put them direct pressure on long. 90% of external bleeding is control with direct pressure along. If there won't continue to believe we know that by -- -- starting to saturate with blood. It's not necessary or really a smart idea to lift the dressing up to look at the -- because it removes clot and debris that is actually helping to control the bleeding. If the -- continues to saturate with glut. We got an additional dressing on to a and we can ask the patient to put pressure on -- wound to help to continue to direct pressure. Fifth open up -- -- bandage. Put that on it and our next step would be to elevate the wound above the level are still do that with our patient here. -- the bleeding were to continue at this point. We would apply pressure to a pressure point. And in this case the break -- artery -- upper arm would be the pressure point in a lower extremity when the final -- would be useful pressure point. There are some spots on the body such as head where there are no simple pressure points to use. If that was not to control the bleeding the next step would be to put pressure bandage over the long and we could do that using -- -- bot. Wrapping around the -- tying it or taking some cruel acts wrapping that around the world continuing to add bandages as the -- bullet. That said there are some new things that are coming back into fashion and one of those is -- use of a tourniquet. I want to talk about the use of a tourniquet a little bit and why that practice is now becoming popular again. The reason that's occurred is because of the experience of our military. Virtually 10% of battlefield deaths result from -- -- nation. That translates -- to 60%. Of preventable deaths of soldiers on the battlefield. As a consequence of that discovery the military has moved bleeding control -- the first priority and patient care. That means that prior to airway and prior to -- Control of serious external bleeding takes precedence. For the military the use of the tourniquet has become a mainstay. Of control of external hemorrhage in the battlefield. In our application and civilian world there are actually for situations. When a tourniquet. May be of use today -- -- responder. The first of those situations. Would be when there's a -- threat that causes external -- to take precedence over control of an airway. Application of a tourniquet indefinitely before any other steps of external bleeding. May slow the bleeding. And allow the provider to turn the management of airway in the patient. Returning to control the bleeding after the airway has been secured. The second situation where the tourniquet may be of use to -- provider in the field. Would be an extremity bleeding that's not controlled by conventional means the steps that we've just reviewed. Direct pressure elevation use of a pressure point and a pressure bandage when -- persists beyond that. Current -- may be -- helpful means of controlling the hemorrhage. The third indication for use of a tourniquet would be one limb. That's and trap is inaccessible to rescuers. And most of the time that would occur in a motor vehicle crash where extremities pinned underneath the dash or someplace where rescuers are unable to get to it. To apply direct pressure to do elevation or to use other means of controlling -- I could also be seen in industrial accidents where people are trapped and in machinery. The fourth indication. When it -- might be considered in a pre hospital use is in a mass casualty incidents. Where multiple patients with severe hemorrhage overwhelm the resources of the rescue. Tourniquet could be applied rapidly to all of the patients and then go back. To control bleeding on -- one by one fashion as the resource has become available. But those are four thoughts but the medical literature currently supports for use -- -- -- Let me talk a little bit and demonstrate to you how you would apply a tourniquet. The first way you might want consider applying it turn it as what's done in the operating room when tourniquet they -- used for control of bleeding in surgical field. And that's the use of blood pressure cuff. In our patient who has an extremity injury to his wrist. We could apply blood pressure cop -- arm. And -- the blood pressure cuff beyond what the patient systolic blood pressure is. And gain control the bleeding simply through used for the blood pressure -- In this situation we need to know what patients pressures -- inflate the cup until we got beyond that systolic pressure and leave that inflated at that point. And definitely would see some control the bleeding pistol to wear the cup is applied. More conventional application of a tourniquet would involves using either commercial tourniquet or taking a -- As you probably learned in your initial. And applying a robot in a fashion so that it's where it is about the size of of -- in diameter so that it doesn't cause injury to soft tissue. Wrapping that. Above the level of the injury. Somewhere in the range of one to two inches above where the bleeding has actually occurring. And then finding something that will tighten that device around the skin. Which oftentimes can be done with -- oppressors. And -- tie the device so that you can actually see. The use of the -- oppressors. What I've done -- Secure the -- oppressors and and not. Attached to the bandage. Now -- with. The depressed -- Until. The bandages tight enough. That the bleeding is controlled. Pistol to -- the tourniquet has been applied. To keep the -- to -- is in place. It's often necessary. To secure them with an additional wrap around the extremity so that they don't -- back. And loosen. Tourniquet on the -- them. The last topic I wanna talk about his use of human static agents to control -- the state -- the -- in the operating room has turned to. Bandages and chemicals that are able to induce -- right at the site of -- Those bandages and those chemicals are now available the pre hospital provider and even to consumers for use -- controlling bleeding. One such agent that is used by EMS providers is -- quick clot first response -- This is a gauze bandage that's impregnated. With components that induce clotting at the sight of -- Application -- -- -- static and it's such as the quick clot is done directly to the site where the bleeding as a current. It can be used at any point in the process of controlling external bleeding. From the initial application of the bandage all the way to the application -- -- -- What's necessary is for the band itself to be applied directly to this site of -- This is one instance where you would actually remove bandages that -- place prior to the application of the human static -- In this -- will remove the pressure bandage that's been applied. Expose the area that's actually believing. And place -- the static bandage on the wound itself. The rest of the principles continue to apply we would place other bandages on top of those apply direct pressure. -- -- -- -- -- Would use pressure a pressure point and we would apply a pressure -- In the static agents are probably going to become the stated -- are for pre hospital control of serious external hemorrhage just like they are. In the hospitals. I'm Mike -- thanks a lot.