Catastrophic haemorrhage

Question 1

What is a ocmpressible haemorrhage?

Answer 1

One that is responsive to truncal tourniquets e.g. limbs

Question 2

What is a non-compressable haemorrhage?

Answer 2

Generally occurs as bleeding into internl body cavities or wounds at truncal junctions to the limbs

Question 3

How would you manage a haemorrhage?

Answer 3

Following order

1. Compression bandages and Elevation
2. Apply prepared bandages/gauze/swabs containing mucoadhesive agents
3. Apply direct pressure for 3 minutes
4. If uncontrolled, apply arterial tourniquet

Question 4

When would you apply a tourniquet immediately (before applying dressings)?

Answer 4

If there is catastophic haemorrhage

Question 5

If you did not have a tourniquet available, what could you use as an alternative method of tourniquation?

Answer 5

Windlass technique:

1. Dressing and bandage applied to wound
2. Second bandage placed over top of the wound
3. Pen placed under second bandage and rotated until tight

Question 6

What are side effects to tourniquet use?

Answer 6

• Pain
• Nerve palsy
• Arterial insufficiency
• Vascular spasm
• Limb shortening
• Plaque fracture

Question 7

What is the general limit set for the length of time a tourniquet can be left on?

Answer 7

2 hours

Question 8

What can happen if a tourniquet is applied for more than 2 hours?

Answer 8

• Permanent nerve injury
• Muscle injury
  
  • Contractures
  • Rhabdomyolysis
  • Compartment syndrome

Question 9

What can cause failure of a tourniquet?

Answer 9

Insufficient pressure - e.g. clothing obstructing tourniquet

Question 10

Why can a poorly applied tourniquet increase blood loss?

Answer 10

Causes venous pooling due to occlusion of the venous system, which adds to the bleeding

Question 11

If someone had a catastrophic haemorrhage from a chest wound, how would you manage this?

Answer 11

Apply a chest dressing - cant apply tourniquet

Question 12

If someone had a catastrophic haemorrhage from a wound to the head, neck or torso, how would you manage it?

Answer 12

Can’t apply tourniquet

1. Apply direct pressure
2. If bleeding not controlled - pack with haemostatic gauze

Question 13

If someone had a catastrophic haemorrhage from a limb, how would you approach managing it?

Answer 13

1. Apply truncal tourniquet above bleeding site
2. If bleeding not controlled - Apply second tourniquet above first

Question 14

What approach would you use for packing a wound?

Answer 14

1. Apply direct pressure to the wound
2. Insert haemostatic gauze
3. Apply pressure through fresh dressing

Question 15

What is important to do once you have appliued a tourniquet?

Answer 15

Note the time it was applied