Bleeding Control and Shock Care

Scene Safety

- Where is what caused the injury?

- What BSI is needed (face shield, gloves, gown)?

- Determine MOI for internal bleeding or shock

Arteries

- Bright red blood

- Spurting, pulsating blood

Veins

- Darker red blood

- Flowing blood

Capillary

- Medium red blood

- Oozing blood

Severity of Bleeding

- Volume lost (>15% leads to shock)

- Rate of bleeding

- Patients health

- Age and size

Adult and Pediatric Blood

- 70 mL/kg

- 80 mL/ kg

Estimating Blood Loss

- Do not try and measure volume lost

- Assess patient for shock

Signs of Shock

- Decreased blood pressure

- Rapid, weak pulse

- Cool, clammy, and pale or grey skin

- Changes in mental status

Dressing

- Sterile gauze placed directly on injury site

- Helps control bleeding and prevents additional contamination of wound

- Small sized, abdominal pad, large multi-trauma dressing, occlusive dressing

Bandaging

- Non-sterile material used to wrap around or over a sterile dressing to maintain pressure

- Not placed directly on wound

- Rolled gauze (Kerlix), triangular bandage (kravat), tape

Occlusive Dressing

Forms an airtight seal with Vaseline (hard to tape things on)

Combat Gauze

- Hemostatic dressing used to rapidly control severe, life-threatening, arterial and venous bleeding (activate clotting factor 12)

- If on blood thinners, doesn't work as fast

Chitosan

- Hemostatic gauze that can be used with blood thinners

- Helps platelets aggregate and get fibrin in

Methods for External Hemorrhage Control

- Direct pressure, elevation, tourniquet

Direct Pressure

- Apply pressure through a sterile dressing

- Additional dressing may be stacked if injury bleeds through

Elevation

- Elevate the extremity (continue with direct pressure)

- Be careful of other injuries (fractures) that might be present (may need to apply splint)

Tourniquet

- Controls hemorrhage by constricting blood flow to extremities

- Use prepared tourniquet, wide bandage, or BP cuff

- Write TK with the time the tourniquet was applied on forehead (can be left for 8-10 hours)

Ammputation

- Clean gross contaminants and wrap in dry sterile dressing

- Place in plastic bag and put on a chemical cold pack

- Hold amputate tooth by crown and place is sterile water

Impaled Object

- Do not remove object

- Stabilize object with bulky dressing/rolled bandages

- If object impaled patient's cheek, remove it

Shock Control

- Airway (position, manual techniques, suction, adjuncts)

- Breathing (high flow O2 with NRBM, assist ventilation)

- Circulation (hemorrhage control, stabilize fractures)

- Keep patient warm

CAT Tourniquet

- Insert bleeding extremity into tourniquet and pull the CAT tail with the other hand until tightly secured high above area of bleeding

- Secure the tourniquet with velcro then by twisting the rod until bleeding stops (will be painful)

- Secure the rod and write time of placement

- If need be, add additional tourniquet

Compartment Syndrome

- Swelling in a confined space that produces dangerous pressure

- May cut off blood flow or damage sensitive tissue.