Trauma and Bleeding Control Notes

Bleeding Control

• Direct Pressure:

  • First action: Apply gloved hand with direct pressure.
  • If bleeding isn't controlled, proceed to tourniquet.
  • If direct pressure controls bleeding: Apply 4x4s, wrap tightly with cling.
  • Never remove 4x4s due to clot disruption.
  • Add more 4x4s if bleeding soaks through.

• Tourniquets:

  • Apply tourniquet two inches above wound.
  • Tighten until bleeding stops; significant pain indicates proper application.
  • Secure the windlass and record the time of application.
  • If initial tourniquet fails, apply a second tourniquet above the first, instead of removing it.
  • Various types of tourniquets exist (CAT, military-grade with steel).

• Homemade Tourniquet:

  • Use a smaller cloth, wrap it two inches above the wound, tighten it, use a windlass (pen, stick), and twist until the bleeding stops.
  • Secure the windlass to maintain pressure.

• Scalp Wounds:

  • The scalp is vascular; head wounds bleed heavily but are often easily controlled due to small blood vessels.

• Important Considerations:

  • Never place a tourniquet on a joint.
  • Always record the time of tourniquet application for medical personnel.
  • Tourniquets cut off or severely hamper blood supply to the limb.

Sucking Chest Wounds

• Pathophysiology:

  • Penetrating chest wounds disrupt the sealed chest cavity, causing a tension pneumothorax.
  • Air enters the chest cavity through the wound instead of the lungs, potentially collapsing the lung.

• Initial Management:

  • Immediately cover the wound with a gloved hand.

• Occlusive Dressing:

  • Apply an occlusive dressing (airtight material) to seal the wound.
  • Have the patient exhale forcefully before applying the dressing.
  • Tape all four sides to create a seal.

• Commercial Chest Seals:

  • Adhesive chest seals are available; apply over the wound.
  • If breathing becomes difficult, create a flutter valve by opening a corner during exhalation.
  • Chest seals can be used on any thoracic cavity wound, including back wounds.

• Additional Considerations:

  • Always check for exit wounds and seal them as well.
  • Control bleeding before applying the seal.
  • Be aware of potential shock; manage cold, clammy, sweaty skin.

Neck Wounds

• Risk:

  • Neck wounds pose a risk of air entering the circulatory system.

• Initial Management:

  • Immediately cover the wound with a gloved hand.

• Occlusive Dressing Application:

  • Apply an occlusive dressing followed by 4x4s.
  • Use a figure-eight wrapping technique under the arm to secure pressure without wrapping directly around the neck.

• C-Spine Injury Considerations:

  • Address airway concerns first.
  • C-collars and backboards are not always necessary unless neurological deficits are present.

Eye Injuries

• General Approach:

  • Protect the injured eye with a doughnut-shaped gauze pad.
  • Cover both eyes to prevent movement of the injured eye.
  • Secure with wrapping, avoiding direct pressure on the eye.

• Impaled Objects:

  • Stabilize the object with padding.
  • Create a donut around the base of the object

• Special Considerations:

  • For cheek impalements obstructing the airway, the object can be removed.
  • Retain the impaled object for hospital evaluation if possible.
  • Prioritize life-threatening conditions (e.g., airway obstruction, major bleeding) over eye injuries unless in the cheek.

Additional Information

• Hemostatic Dressings:
  • Gauze soaked in a chemical to promote clotting. Useful when bleeding cannot be controlled by other means.
  • Expensive and not always practically used.
• Tourniquet Alternatives
  • Belts or P2s can slow but often cannot stop the bleeding without additional assistance.
• Arterial vs. Vein Bleeds
  • Arterial bleeds are much more forceful and harder to stop than steady-flow vein bleeds.