circulation

stop further bleeding

assess signs of haemorrhagic shock

treat for shock

replace or convert tq if possible

evac asap

recheck mass haemorrhage

assess for pulse - check both sides for radial pulse, then move onto carotid. measure pulse rate

should be 60-80, below 50 is bradycardia, over 100 is tachycardia

check consistency and strength whilst measuring

no radial pulse - fluids

internal haemorrhage - blunt or penetrating trauma, leads to insufficient amount of circulating blood

s + s

  • pale, cold, clammy

  • rapid weak pulse

  • thirst

  • aggression and confusion

  • bruising

  • bleeding orifices

  • pain

  • weak pulse

lungs - coughing blood

stomach - vomiting blood

kidneys - urinating blood

large intestine - dark red or black, sticky tar like

blood on the floor four more - check for pools of blood around cas

  • chest - worsenflaps, at least flap. do worsen too if there is an injury

  • abdo - palpate. check for distension (firmness)

  • pelvis - check bruising, swelling, abnormalities, symmetry, one leg longer than the other, splayed feet, check for bodily fluids

  • long bones - bruising and swelling. can dress wounds if found, but can just leave until wounds

pelvic binder

  • not one size fits all

indications

  • scrotal bleeding

  • blast injury with amputation

application

  • align legs into neutral

  • apply lower down than greater trochanters - buckle to bush

  • two clicks, pull black towards you and orange away from you

  • bind feet

prevents further blood loss and reduces pain

improvised pelvic splint

  • tq and sam splint - more compact but needs making beforehand

  • same application as pelvic binder

kendrick traction device

  • administer pain relief first (fentanyl)

  • put on pelvic binder first

contraindications

  • knee joint disruption

  • fractured tib or fib (same limb)

  • ankle fracture or dislocation

  • amputation to affected limb

application

  • monitor sensation and circulation (pulse, cap refill)

  • green, yellow, red

  • apply to ankle first, then upper thigh

  • snap out traction pole, position so one section is past ankle

  • elastic around knee

  • belt around leg

  • green around ankle, yellow over pole, red tightens

  • check paed pulse

  • secure feet - figure eight

emergency bandage - bolster/bridge

  • two ffd/ecb either side, one wraps all the way round

  • keep site of open fracture untouched by bandage and make it visible that its an open fracture site

tq replacement

  • place deliberate tq closer to wound to save limb

indications

  • tq applied over clothing

  • tq applied too proximal

  • more than 2 hrs to surgery

application

  • expose injury to assess bleeding

  • place replacement tq directly onto skin

  • slowly release original tq over one min

  • assess to ensure distal pulse

  • loosen and slide off

  • record on atmist

should be converted within two hours if it can be controlled by other means

don’t take off if

  • 6 hrs on or more

  • cas in shock

  • amputated

  • tactical or medical considerations make transfer inadvisable

  • can’t closely monitor for re bleed

application

  • expose injury

  • apply celox

  • wait one min for strikethrough (shouldn’t strikethrough)

  • apply bandage

  • slowly take tq off over one min

  • annotate atmist