HEMORRHAGE HEMORRHAGE CONTROLCONTROL

RIFLES LIFESAVERSRIFLES LIFESAVERS

Core SkillsCore Skills Control BleedingControl Bleeding 22

IntroductionIntroduction

Review types of injuriesReview types of injuries Review Tactical Combat Casualty Review Tactical Combat Casualty

CareCare Evaluate and control bleedingEvaluate and control bleeding Take home message:Take home message:

HEMORRHAGE CONTROL SAVES HEMORRHAGE CONTROL SAVES LIVESLIVES

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Facts and TipsFacts and Tips Blood volume of the adult human bodyBlood volume of the adult human body

Approximately 5 to 6 litersApproximately 5 to 6 liters Loss of as little as 2 pints may cause Loss of as little as 2 pints may cause

shockshock Field blood pressures, when palpable pulse Field blood pressures, when palpable pulse

is appreciatedis appreciated Carotid: SBP>60 mmHgCarotid: SBP>60 mmHg Femoral: SBP>70 mmHgFemoral: SBP>70 mmHg Radial: SBP>80 mmHgRadial: SBP>80 mmHg

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Sources of BleedingSources of Bleeding ArterialArterial

- Rapid, profuse and pulsating- Rapid, profuse and pulsating

- Bright red in color- Bright red in color VenousVenous

- Steady flow, nonpulsating- Steady flow, nonpulsating

- Dark red or maroon in color- Dark red or maroon in color CapillaryCapillary

- Slow and oozing- Slow and oozing

- Often clots spontaneously, not dangerous- Often clots spontaneously, not dangerous

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External BleedingExternal Bleeding

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Types of External BleedingTypes of External Bleeding

Lacerations Lacerations Abrasions Abrasions Puncture woundsPuncture wounds AmputationsAmputations AvulsionsAvulsions

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LacerationLaceration

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AbrasionAbrasion

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Puncture WoundPuncture Wound

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AmputationsAmputations

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AvulsionAvulsion

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Internal BleedingInternal Bleeding

Can occur with blunt or penetrating Can occur with blunt or penetrating

traumatrauma Suspicion based on mechanism of injurySuspicion based on mechanism of injury

FallsFalls

Blast injuriesBlast injuries

Penetrating traumaPenetrating trauma

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Causes of Internal BleedingCauses of Internal Bleeding

Blunt TraumaBlunt Trauma Auto vs. Auto vs.

pedestrianpedestrian Motor vehicle Motor vehicle

accidentsaccidents FallsFalls Blast injuriesBlast injuries Etc.Etc.

Penetrating Penetrating injuriesinjuries Gunshot woundsGunshot wounds Stab woundsStab wounds Shrapnel woundsShrapnel wounds

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Internal BleedingInternal Bleeding

Signs and SymptomsSigns and Symptoms Pain, tenderness, swelling, Pain, tenderness, swelling,

discoloration at injury sitediscoloration at injury site Bleeding from any body orifice Bleeding from any body orifice Vomiting blood Vomiting blood Tender, rigid, or distended abdomenTender, rigid, or distended abdomen

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Internal Bleeding Internal Bleeding

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Injured Internal OrgansInjured Internal Organs

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Internal BleedingInternal Bleeding

Can result in rapid progression to Can result in rapid progression to hypovolemic shock and deathhypovolemic shock and death

IV fluids may buy timeIV fluids may buy time The scalpel is the cure: The rapidly The scalpel is the cure: The rapidly

spiraling patient requires surgical spiraling patient requires surgical interventionintervention

Immediate evacuationImmediate evacuation

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CARE UNDER FIRECARE UNDER FIRE

““The best medicine on any battlefield is The best medicine on any battlefield is fire superiority”fire superiority”

Control of hemorrhage is essential since Control of hemorrhage is essential since injury to a major vessel can result in injury to a major vessel can result in hypovolemic shock in a short time framehypovolemic shock in a short time frame

2/3 of all preventable combat deaths are 2/3 of all preventable combat deaths are due todue to hemorrhage from extremitieshemorrhage from extremities

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CARE UNDER FIRECARE UNDER FIRE

Prompt use of tourniquets to Prompt use of tourniquets to stop stop the bleedingthe bleeding may be life saving may be life saving

Various types of tourniquets existVarious types of tourniquets exist Combat application tourniquet (CAT)Combat application tourniquet (CAT) TherabandTheraband Cloth and stickCloth and stick

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TACTICAL FIELD CARETACTICAL FIELD CARE

Evaluation begins with ABCs with Evaluation begins with ABCs with attention to prioritiesattention to priorities

Any bleeding site not previously Any bleeding site not previously controlled should be addressedcontrolled should be addressed

Significant bleeding should be Significant bleeding should be controlled using a tourniquetcontrolled using a tourniquet

Initiate IV fluidsInitiate IV fluids Prepare for evacuationPrepare for evacuation

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STOP THE BLEEDING !STOP THE BLEEDING ! Apply direct pressure with gauze or Israeli Apply direct pressure with gauze or Israeli

dressingdressing Elevate the extremity above the heartElevate the extremity above the heart Apply additional dressings if wound Apply additional dressings if wound

continues to bleedcontinues to bleed Apply pressure to appropriate pressure Apply pressure to appropriate pressure

point if continues to bleedpoint if continues to bleed Immobilize injured extremity with a splintImmobilize injured extremity with a splint Apply tourniquet if continues to bleedApply tourniquet if continues to bleed Initiate IV fluids and treatment for shock Initiate IV fluids and treatment for shock

as neededas needed

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Pressure PointsPressure Points

May be helpful with severe bleeding May be helpful with severe bleeding as an adjunctas an adjunct

Apply when bleeding not controlled Apply when bleeding not controlled by direct pressure and elevation by direct pressure and elevation

Apply pressure to appropriate Apply pressure to appropriate pressure pointpressure point

(

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Important Pressure PointsImportant Pressure Points

BrachialBrachial

FemoralFemoral

(

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Brachial Pressure PointBrachial Pressure Point

Located in upper arm above the Located in upper arm above the elbow in the groove between elbow in the groove between musclesmuscles

Apply pressure to the inside of the Apply pressure to the inside of the arm over the bone using the fingers arm over the bone using the fingers or thumbor thumb

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Brachial Pressure PointBrachial Pressure Point

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Brachial Pressure Point Brachial Pressure Point

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Femoral Pressure PointFemoral Pressure Point

To control severe To control severe bleeding of thigh bleeding of thigh and lower legand lower leg

Located at front, Located at front, center part of center part of crease crease in the the groingroin

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SplintsSplints

Immobilization of the injured Immobilization of the injured extremity is one of the best ways to extremity is one of the best ways to stop bleedingstop bleeding

Broken bone fragments may lacerate Broken bone fragments may lacerate blood vesselsblood vessels

Muscular activity will increase rate of Muscular activity will increase rate of blood flowblood flow

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TourniquetsTourniquets

Early use of a tourniquet in Early use of a tourniquet in the setting of forceful the setting of forceful arterial bleeding, such as arterial bleeding, such as an amputation, may be an amputation, may be life-savinglife-saving

STOP THE BLEEDING!STOP THE BLEEDING!

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TourniquetsTourniquets

Use a commercial tourniquet, such as the Use a commercial tourniquet, such as the Combat Application Tourniquet, if Combat Application Tourniquet, if availableavailable

If not available, then use..If not available, then use.. CravatCravat BeltBelt RopeRope Strap from LBEStrap from LBE Any available materialAny available material

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Combat Application Combat Application TourniquetTourniquet

WINDLASS

OMNI TAPE BANDWINDLASS STRAP

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Tourniquet ApplicationTourniquet Application

Place tourniquet between Place tourniquet between the heart and woundthe heart and wound

Wrap tourniquet around Wrap tourniquet around extremity extremity

Tighten Tighten UNTIL BLEEDING UNTIL BLEEDING STOPSSTOPS

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Tourniquet ApplicationTourniquet Application

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Tourniquet Self-ApplicationTourniquet Self-Application

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Tourniquet EtiquetteTourniquet Etiquette

Never cover a tourniquet with Never cover a tourniquet with another dressing, etc.another dressing, etc.

Write “T” on the casualty's Write “T” on the casualty's forehead with pen or bloodforehead with pen or blood

Never loosen or remove a Never loosen or remove a tourniquet once placedtourniquet once placed

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AmputationAmputation

First,First, STOP THE BLEEDING! STOP THE BLEEDING! Use direct pressure, Israeli dressing, Use direct pressure, Israeli dressing,

or tourniquet as necessaryor tourniquet as necessary Apply dressing to cover end of the Apply dressing to cover end of the

stumpstump Blood vessels may collapse, retract Blood vessels may collapse, retract

or curl closed and limit bleedingor curl closed and limit bleeding

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SummarySummary

Care Under FireCare Under Fire: Stop significant bleeding : Stop significant bleeding with tourniquet while returning firewith tourniquet while returning fire

Tactical Field CareTactical Field Care: ABCs with attention : ABCs with attention to stopping significant bleedingto stopping significant bleeding

Evacuation CareEvacuation Care: Treat shock with IV : Treat shock with IV fluids, rapid evacuation to surgical assetsfluids, rapid evacuation to surgical assets

This knowledge will save lives in Iraq, This knowledge will save lives in Iraq, maybe your ownmaybe your own

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Questions?Questions?