Soft tissue

Question 1

Consider

Answer 1

underlying injuries to deep structures (e.g. nerves, vessels, bones);

Question 2

if Wound is located on an extremity

Answer 2

i. apply well-aimed, direct digital pressure at the site of bleeding,

ii. apply 2 pressure dressing and if those fail

iii. apply a tourniquet, if tourniquet fails to stop bleeding completely or cannot be used for any reason then apply a second tourniquet, and/or,

iiii. pack the wound with hemostatic dressing if appropriate and available or
standard gauze if contraindicated or unavailable, maintain pressure and secure with a pressure dressing;

Question 3

if the wound is located in a junctional location (e.g. head, shoulders, armpit, neck,
pelvis, groin),

Answer 3

i. apply well-aimed, direct digital pressure at the site of bleeding,

ii. pack the wound with a hemostatic dressing if appropriate and available or standard gauze if contraindicated or unavailable, maintain pressure and secure
with a pressure dressing;

Question 4

if the wound is located in the hollow spaces of the skull, chest or abdomen

Answer 4

i. apply manual pressure with a flat palm and a hemostatic dressing where
available and appropriate or standard gauze if cannot use hemostatic dressing,

ii. do not pack dressings of any kind into the hollow spaces of the skull, chest or
abdomen,

iii. do not insert fingers into the hollow space of the skull, chest or abdomen;

Question 5

Application of well-aimed direct pressure

Answer 5

• Expose the wound cavity
• Attempt to visualize the source of bleeding inside the wound cavity
• Clear away blood, debris to better visualize source
• Be firm and aggressive in applying pressure; be prepared for local tissue destruction as
  a result of applying pressure and packing
• Apply pressure as accurately, directly, firmly and with as small a surface area as
  possible

Question 6

Use of a tourniquet

Answer 6

• Tourniquets work best when placed over large muscle mass (e.g. thigh, upper arm
  muscles)
• Tourniquets work poorly when placed on joints (e.g. knee, elbow) or twinned long
  bones (e.g. radius/ulna, tibia/fibula)
• if a tourniquet is applied to stop uncontrollable extremity hemorrhage, it should not be
  removed in the pre-hospital setting
• The time of tourniquet application must be documented and communicated to the receiving facility at transfer of care
• In situations such as multi-casualty incidents (MCI), the time of tourniquet application
  must be listed on the patient and tourniquet
• Do not cover the tourniquet once in place
• If a single tourniquet fails, a second may be used. If a second fails, move immediately to use of pressure and hemostatic dressings

Question 7

Use of hemostatic dressings

Answer 7

• Maintain pressure on bleeding site continuously while packing junctional or extremity
  wounds
• Ensure wound cavity is completely filled with densely packed dressing material