Lecture 9A: Hemorrhage Flashcards
What are the S/S of capillary bleeding and how would you treat them?
S/s: ooze, risk of infection
tx: disinfect, dressing, bandage
What are the S/S of venous bleeding and how would you treat them?
s/s: profuse, dark, risk shock
tx: direct pressure, more pressure/dressing, bandage, O2, shock prevention
What are the S/S of arterial bleeding?
s/s: spurting, bright red, risk shock
What are the important factors in successful control of bleeding?
apply pressure firmly and for a long time
How long does it take for a dangerous bleed to lead to exsanguination?
1-2 minutes
When is a tourniquet indicated?
if attempt at direct pressure/ pressure dressing fails to control emergent hemorrhage within 10seconds
TRUE or FALSE. A tourniquet can be removed by anyone after it has been applied.
FALSE. DO NOT REMOVE a tourniquet before the person is seen in an ER. There has been no cases of amputations with tourniquet placed <2h
Should wounds of the chest, abdomen or pelvis be packed?
they should not be packed because bleeding from these wounds is generally from a very deep source that can’t be reached from the outside. Should be performed at the discretion of local medical direction.
Why shouldn’t neck wounds be packed?
they aren’t generally packed because of the risk for airway compromise
What should you do in an urban setting?
Extremity packed (if no extremity tourniquet available)
junctional area packed (if no junctional tourniquet)
Back packed (outside of cavity)
What should you do in a wilderness/rural setting?
if a tourniquet is initially placed on an extremity wound, it may later be replaced with a pressure dressing or with packing, which may be more comfortable for the patient and provide for a moderate amount of distal circulation
Should transport be delayed for extensive packing and repacking of the wound?
No
Epinephrine gel is contraindicated for what?
fingers, toes, penis, nose
What is monsell’s solution?
a coagulant used to assist with minor bleed management
What is Urgent QR?
hydrophilic polymer + K salt
apply to wound creates hematrix scab
What is ActCel?
cellulose gauze converts to glucose gel upon contact with blood, controlling bleed fast acting for minor bleeds
What are some management considerations for epistaxis?
MOI?
Trauma related?
Affected structures?
Cervical or TBI?
Profuse uncontrolled bleeding?
Anterior vs Posterior bleed?
What are the management steps for epistaxis?
remain calm
initially pinch soft area of nose
place a gauze under bleeding nostril to limit contagion
sit upright, to keep the head above heart level
Lean forward slightly to prevent blood entering the throat
ideally have any blood leaks contained in a bin in front of athlete
bleeding should stop within 15 minutes
initially avoid placing gauze or tampon or other in nose (unless minor and RTP)
When should you do an emergency referral for a nose bleed?
if bleeding has not stopped after 20min and/or overall condition of athlete has not improved, an ambulance/further care is needed
if blood is felt or tasted in throat even if bleeding has stopped
if nosebleed occurs after an injury with symptoms: dizziness, fever, fainting, vomiting
more blood than usual
bleeding interferes with breathing
if possible that bleeding is linked to a medical condition or medication use
