Trauma - Bleeding Control Flashcards
Where is the appropriate location to place this tourniquet?
Number 1 is correct. You want to place the tourniquet two inches proximal to the wound to effectively cut off blood supply to stop the bleeding. Tourniquets are used to occlude an artery to prevent blood from reaching the wound and to treat arterial bleeds.
When is the use of a tourniquet indicated?
A tourniquet is indicated if bleeding is not controlled by direct pressure either with holding direct pressure or using a pressure dressing.
What are the three steps to applying a tourniquet?
- Select a site that is roughly 2 inches proximal to the wound.
- Place a commercially available tourniquet or roughly 4 inch wide flat material over the artery to be compressed.
- If fashioning a tourniquet place a pad or rolled up gauze over the artery to be compressed.
- Then wrap the material around the extremity and pad twice and tie a half knot over the pad.
- Place a windlass on the half knot and tie a square knot. (a stick, pen, or another similar type of object can be used)
- Tighten the windlass of the commercial or fashioned tourniquet by twisting until the bleeding stops and then secure the windlass in position.
- Note the time of the tourniquet application and secure it to the patient. (this can be a piece of tape or written on the patient in permanent marker)
How would you apply a pressure dressing to the neck, groin, or axilla?
You can apply pressure to these areas using wound packing. There are commercial wound packing materials available but rolls of gauze can be used to pack a wound to apply pressure to the bleeding area.
After the wound is packed you apply a dressing to the outside to hold the packing in place.
How do you manage bleeding of chest wounds and what are the possible complications?
In a bleeding chest wound, it is important to place an occlusive pressure dressing to prevent further risk of pneumothorax or an air embolism. With chest wounds, the patient is at risk of developing a pneumothorax.
It is important to address the patient’s airway and ensure that they continue to have adequate ventilation. The patient may also develop a pericardial effusion that can lead to cardiac tamponade.
How do you manage bleeding of abdominal wounds and what are the possible complications?
You can apply pressure dressings to abdominal wounds as well. There are some commercial dressings available that may make it easier to apply and maintain pressure to the wound but they are not necessary. If there is significant bleeding present that requires a pressure dressing the patient may also have a significant injury or bleeding to internal organs or blood vessels that we are unable to see. It is important to closely monitor your patient for a drop in blood pressure or change in mentation even if the bleeding appears controlled.
For a wound on the forearm or calf that requires a tourniquet, is it still effective to place tourniquet 2 inches above the wound?
Due to the presence of the radius and ulna in the forearm and the tibia and fibula in the calf, the vessels may run between the two bones and not be compressible by a tourniquet. If a tourniquet is applied and the bleeding continues you may need to place a tourniquet above the joint to effectively occlude the artery.
Name 6 types of dressings and their uses
- Sterile - used when infection is a concern such as burns.
- Non-Sterile - used when infection is not a concern such as most bleeds.
- Occlusive- does not allow air to pass, used on the chest and over large vessels where there is concern that air may be sucked in due to negative pressure leading to air embolisms or pneumothorax.
- Non-Occlusive- used when there is not a concern for embolism or pneumothorax, allows air through, used for most dressings.
- Adherent - these dressings adhere to the wound and sometimes contain hemostatic agents to control bleeding.
- Non-Adherent - these dressing do not adhere to wounds and are often used after a wound is closed to prevent further damage due to exudate leaking from the wounds.
In what order would you treat these wounds if you were on a multi patient scene. A 32 year old female with an am amputated right hand with spurting bright red bleeding, a 29 year old male with large scalp laceration that is oozing dark blood, a 2 year old female with an abrasion to her right forearm with no obvious bleeding and a 10 year old male with a laceration to the left medial thigh that is bleeding briskly and bright red?
You would start with the 32-year-old female as she is at most risk from hemorrhaging from her amputation.
You then would treat the 10-year-old male as he is bleeding briskly and we know that the femoral artery and vein run along the medial thigh and this is likely arterial.
We would then treat the 29-year-old male as he is oozing and likely has a venous bleed, lastly, we would treat the 2-year-old female as she has an abrasion that is not actively bleeding. Always work from the most life-threatening to the least life-threatening even if the wound looks more dramatic.
