trauma

Introduction

  • Discussion on commercial pressure dressings (e.g., ACE bandage, Israeli bandages).

  • Importance of pressure in controlling bleeding.

Understanding Tourniquets

  • Definition of a Tourniquet: A device that applies pressure to a limb to control bleeding, particularly in emergencies.

  • Placement Options:

    • High and tight above the injury.

    • Two inches proximal to the injury.

  • Joint Considerations:

    • Tourniquets should not be placed over joints as there is no bone to compress against.

Mechanism of Action

  • Goal of Tourniquet Application: To stop distal blood flow by compressing arteries.

    • Arteries: Vessels that carry blood away from the heart to the extremities.

    • Control of Bleeding:

    • Necessity to overcome internal vessel pressure, particularly systolic blood pressure (e.g., if systolic is 120, tourniquet must exceed this pressure).

    • Comparison between arterial and venous bleeding:

      • Arterial bleeding: Bright red, under pressure, potentially life-threatening.

      • Venous bleeding: Dark red, slower flow, can also be dangerous if significant.

Application Techniques

  • High and Tight Method:

    • Compresses artery against underlying bone, ideal for effective bleeding control.

    • In situations with no bone (e.g., joints like the knee), the tourniquet may not work effectively.

  • Placement Above Injury: Two inches above ensures effectiveness while minimizing potential for further injury.

  • Role of Clothing: Clothing can create space that reduces effectiveness. Removal or cutting away of clothing is necessary for proper application.

Critical Situations & Case Studies

  • Specific Case Example:

    • Incident on Memorial Day involving a car accident where the tourniquet faced challenges due to severe injury and absence of bone to compress.

  • Failure Factors:

    • Issues with applying tourniquets if they are placed over joints and not having solid bone to compress against.

  • Improvised Techniques: Junctional tourniquets for injuries where traditional tourniquet placement is not feasible.

Trauma Management

  • Control of External Bleeding is Vital:>

    • Major approaches include:

    • Tactical approach: Applying tourniquet high and tight.

    • Assessment of the type of injury: Understanding whether to leave a pre-existing tourniquet in place.

  • Protocol Guidelines:

    • Recommendations for placement two inches proximal for limb injuries to conserve extremity function and preserve complex joints.

Timeframes in Trauma

  • Critical Timeframes to Consider:

    • First Ten Minutes:

    • Critical for survival following severe trauma; brain damage possible.

    • First Hour:

    • Major risks from blood loss leading to decompensation and shock.

    • Twenty-Four Hours:

    • Risk of infection increases significantly if timely interventions are not performed.

Pathophysiology of Blood Loss

  • Physiological Responses to Bleeding:

    • Parasympathetic response: Fight or flight response initiated.

    • Understanding shock: Shock manifests through signs like pale, clammy skin and altered mental status.

  • Indicators of Perfusion Levels:

    • Key indicators are skin color/temperature and mental status.

Causes of Internal Bleeding

  • Signs of Internal Bleeding:

    • Bruising (known in EMS as ecchymosis).

    • Distended abdomen indicative of abdominal bleeding.

  • Recognition and Management:

    • Consideration for serious injuries resulting in protein loss, fluid shifts, and organ failure if untreated.

Special Considerations in Trauma Patients

  • Populations at Risk:

    • Elderly and those on blood thinners.

    • Pediatric patients: Smaller blood volume, rapid deterioration in the event of shock.

    • Hemophiliacs: Genetic predisposition to increased bleeding risks.

Advanced Considerations in Management

  • Homeostatic Mechanisms:

    • Body's natural feedback loops attempt to maintain equilibrium.

  • Chemical Mediators:

    • Catecholamines (e.g., epinephrine and norepinephrine) play roles in immediate responses to trauma.

Immediate and Long-Term Care Considerations

  • Post-Application Care:

    • Sterile dressings applied post-tourniquet to minimize infection risk.

    • Time frames for definitive care directly correlating with likelihood of survival and recovery.

Conclusion

  • Continuous Education and Awareness:

    • The importance of training in bleeding control and understanding physiological responses to trauma.

  • Call for Expertise:

    • A call to action for EMTs to master bleeding control techniques to enhance trauma patient outcomes effectively in emergent situations.