21. Hemorrhage/Lacerations - ABCD

Question 1

DANGEROUS Hemorrhage

Answer 1

Armpit
Coughing up (SERIOUS)
Groin
Neck
Postoperative oral-pharyngeal
Rectal (SERIOUS)
Vomiting (SERIOUS

Question 2

POSSIBLY DANGEROUS Hemorrhage

Answer 2

Abdomen
Arm, upper
Chest
Face
Leg, upper
Urinating (traumatic)
Vaginal (not pregnant)
Vaginal (post-partum)
Vomiting (MINOR)

Question 3

NOT DANGEROUS Hemorrhage

Answer 3

Ankle
Back
Buttock
Coughing up (MINOR)
Finger
Foot
Forearm
Hand
Leg, lower
Mouth (not vomiting/coughing)
Nose
Penis (external)
Rectal (MINOR)
Scalp
Toe
Urinating/Catheter (non-traumatic)
Wrist

Question 4

Hemorrhage through TUBES

Answer 4

Tube or hose (excluding urinary catheter or dialysis fistula) that is inserted into body cavity or organ to remove or add fluid or material. These include (but are not limited to) central lines, feeding tubes, pIC lines, chest tubes. Bleeding from a wound around an inserted tube should not be considered “hemorrhage through tubes”

Question 5

SERIOUS Hemorrhage

Answer 5

Uncontrolled bleeding (spurting or pouring) from any area, or anytime a caller reports “serious” bleeding

Question 6

MINOR Hemorrhage

Answer 6

Controlled or insignificant external bleeding from any area

Question 7

Problem Suffix

Answer 7

M: Medical
T: Trauma

Question 8

Medical

Answer 8

Illness or other biological malady

Question 9

Trauma

Answer 9

Physical injury or wound caused by an external force through accident or violence

Question 10

Rule 1

Answer 10

EMDs should not delay transport by sending paramedics if BLS unit at scene can transport immediately. En route rendezvous is preferable over any transport delay in serious trauma cases.

Question 11

Rule 2

Answer 11

Direct pressure on wound should be avoided in presence of visible fractured bone or foreign objects

Question 12

Rule 3

Answer 12

Hemorrhage through a dialysis fistula (artificial vessel used in dialysis) should not be considered ‘hemorrhage through tubes”. A hemorrhage dialysis fistula presents external bleeding should be controlled aggressively with direct pressure (Case Exist X-5)

Question 13

Rule 4

Answer 13

Hemorrhage from an enlarged vein, called a varicose vein, can become life-threatening if not promptly controlled. The size, volume, and pressure in these extended vessels can result in rapid blood loss. Bleeding should be controlled aggressively with direct pressure (Case Exit X-5)

Question 14

Rule 5

Answer 14

Abdominal and thoracic eviscerations should be handled on Protocol 27

Question 15

Rule 6

Answer 15

A complaint description of POSTPARTUM hemorrhage only should be handled on Protocol 21 (no complications with baby and placenta delivered)

Question 16

Axiom 1

Answer 16

Direct pressure will control most external bleeding and is the only control choice in dispatch environment

Question 17

Axiom 2

Answer 17

In most cases, external bleeding is not as serious as it appears. Bleeding is often over-treated to exclusion of location and treating more serious but less obvious injuries and problems. This often includes failure to perform simple airway maintenance.

Question 18

Axiom 3

Answer 18

It is sometimes harder to control bleeding in people who have bleeding disorders (i.e., hemophilia) or who take blood thinners (i.e. warfarin). In these people, MEDICAL bleeding warrants the upgraded BRAVO response, but MINOR traumatic bleeding should be elevated on case-by-case basis

Question 19

Axiom 4

Answer 19

Vomiting blood, coughing up blood, and vaginal or rectal bleeding are considered SERIOUS when bleeding is copious, profuse, flowing, or presenting in large clots. MINOR bleeding from these areas is best described as blood presenting with other bodily fluids.