Control of External Bleeding

Question 1

External hemorrhage

Answer 1

• is identified and controlled during the primary survey
• Hemorrhage is the predominant cause of preventable death after injury
• Occult or hidden blood loss often occurs in the chest, abdomen, retroperitoneum, pelvis, and long bones

Question 2

Methods used in prehospital environment to control bleeding

Answer 2

• Direct pressure
• Elevation
• Immobilization
• Torniquet

Question 3

Direct Pressure

Answer 3

Application of pressure over a bleeding wound slows blood flowing into the damaged vessels, allowing the platelets to seal the vascular wall

• Always attempt to assess distal circulation before and after the applciation of direct pressure.
  Adjust the dressing as needed in case of complication (e.g loss of distal pulse, diminished sensation, change in skin colour and or/temperature distal to the dressing)

Question 4

Elevation

Answer 4

In cases of venous bleeding, elevating the extremity above the level of the heart can substantially slow the rate of bleeding.
This measure alone will NOT control bleeding but it may be helpful in conjunction with other measures.

Care should be taken as to not exacerbate other injs

Question 5

Immobilization

Answer 5

Movement promotes blood flow in an extremity.

When the extremity is also injured, motion may disrupt the clotting process and lacerate more blood vessels

Question 6

Tourniquet

Answer 6

• is useful if a pt is bleeding severely from a partial or complete amputation - and other methods of bleeding control have proved ineffective

Question 7

Tourniquet - negatives

Answer 7

• application can have complications including damage to the nerves and blood vessels. and when in place for an extended period of time, loss of the distal extremity

A tourniquet applied too loosely, by contrast may increase bleeding if it occludes venous return without hampering arterial inflow.

Question 8

Tourniquet - steps

Answer 8

1. During your scene size up or Rapid Trauma Survey identify massive extremity bleeding caused by avulsions. amputations, or lacerations.
2. Make one attempt w/ direct pressure for active arterial bleeding. For more diffuse slower bleeding make 2 attempts to secure bleeding before going to the tourniquet may be acceptable. - If in doubt contact CliniCALL
3. Ideally, position the tourniquet 2-5cm above the injury. If the bleed is on the upper arm or leg, position the tourniquet as high on the limb as possible. Avoid application over joints
4. The tourniquet should be applied directly to skin to prevent slipping. All clothing should be removed
5. Ensure the tourniquet is secured through the buckle. the Velcro is secured and the winidlass bar is secured w/ windlass strap
6. Note time of application; do not cover as it may obscure ongoing bleeding; reassess frequently to ensure bleeding remain controlled and has not restarted