Paed Haemorrhage

Question 1

Ways to control Haemorrhage

Answer 1

Dressing and bandages
CAT torniquet
QuikClot

Question 2

External Bleeding to Limb Indications

Answer 2

External Bleeding to Limb

Question 3

External Bleeding to Limb Contras

Answer 3

Nil

Question 4

External Bleeding to Limb Precautions

Answer 4

Nil

Question 5

External Bleeding to Limb Aims of Dressing

Answer 5

Elevate to control bleeding
Immobolise at rest in POC to trunk, sling or uninjured limb
Check to see if bleeding controlled

Question 6

CAT Indications

Answer 6

Uncontrolled haemorrhage from limb despite direct pressure

Multiple casualty scene where pt numbers dictate that simple haemorrhage control cannot occur and be individually applied

Question 7

CAT contras

Answer 7

Bleeding that can be controlled by basic first aid measures

Question 8

CAT precautions

Answer 8

• Do not apply the tourniquet over a wound or a joint
• Once applied the tourniquet must be visible – it cannot be covered by any clothing or other bandages
• This piece of equipment will be deployed in critical situations and requires regular practice to maintain
  familiarity and skill at quickly applying it whilst under stress
• The primary reason for failure of the CAT is excess slack in the strap when first applied*. Other reasons for
  sub-optimal results are too few turns of the windlass and failure to correctly work the strap-buckle
  mechanism.

Question 9

Where to place CAT

Answer 9

Approx 5-7cm proximal to site of bleeding - directly against skin and ensure band not twisted

Question 10

QuikClot Indications

Answer 10

Uncontrolled haemorrhage from a non-compressible wound site
Unable to control haemorrhage by other measures including direct pressure or Combat
Application Tourniquets

Question 11

QuikClot Contras

Answer 11

Ocular trauma

Question 12

QuikClot Precautions

Answer 12

Unable to make contact with point of bleeding

Question 13

How long do we hold pressure with QuikClot

Answer 13

3 mins

Question 14

What to record on QuikClot

Answer 14

How many used and what type

Question 15

Hemorrhagic Shock Patho

Answer 15

Hemorrhagic shock is due to the depletion of intravascular volume through blood loss to the point of being unable to match the tissues demand for oxygen.

The body compensates for volume loss by increasing heart rate and contractility, followed by baroreceptor activation resulting in sympathetic nervous system activation and peripheral vasoconstriction. Typically, there is a slight increase in the diastolic blood pressure with narrowing of the pulse pressure. As diastolic ventricular filling continues to decline and cardiac output decreases, systolic blood pressure drops.

Due to sympathetic nervous system activation, blood is diverted away from noncritical organs and tissues to preserve blood supply to vital organs such as the heart and brain. While prolonging heart and brain function, this also leads to other tissues being further deprived of oxygen causing more lactic acid production and worsening acidosis. This worsening acidosis along with hypoxemia, if left uncorrected, eventually causes the loss of peripheral vasoconstriction, worsening hemodynamic compromise, and death.