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Bleeding

Discussion in 'First Aid Station' started by RAMBOCAT, May 28, 2016.

  1. RAMBOCAT

    RAMBOCAT Loaded Pockets

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    What say you on temporarily closing a small nick in a reachable artery with a hemostat. Just until transport.
     
  2. Westerdutch

    Westerdutch Loaded Pockets

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    Dont. Medical personnel has training with these things for a reason, metal pliers will win from anything soft in the human body every single time so you are likely to do more damage than good.
     
  3. RAMBOCAT

    RAMBOCAT Loaded Pockets

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    So in the middle of the wilderness do nothing ? Assuming the artery is located where you can't use a tourniquet(like traumatic amputation of the arm at the shoulder) and can't stop the bleeding with direct pressure.
     
  4. Swe_Nurse

    Swe_Nurse Loaded Pockets

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    In such cases the answer to "should I do X?" is always yes.

    Besides, in that scenario it is hardly the "small nick" that you describe in the OP. So I have to agree with Westerdutch, in the case of a small nick you're likely to do more damage than good.
     
  5. Westerdutch

    Westerdutch Loaded Pockets

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    Traumatic amputation is way beyond what any single hemostat or basic first aid kit can handle. Even a small arterial bleed i would recommend highly against blindly digging your way around into the wound trying to clamp anything down (you wil not see anything as its bloody in there) and also don't ever use a tourniquet unless you know how to do so.

    In your 'in the middle of wilderness' scenario i personally just would take off a piece of clothing (use the cleanest cotton you have available), fumble it up in a nice ball and firmly press it up against the wound. Don't try to constrict blood-flow to the wounded body part with ropes or belts, instead just keep pressure on the wound itself to reduce the bleeding. Its fine to wrap something up over the dressed wound but just do so to make keeping pressure on it easier if you ave to move or something.

    If you plan to go into the wildernis planning on doing dangerous things without any sort of access to medical assistance or medical services i recommend you take a couple first aid classes.
     
  6. Easyrunning

    Easyrunning Loaded Pockets

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    Actually, tourniquets are the new standard of care for extreme peripheral bleeding. They can be in place for up to 6 hours without loosing the limb. In a wilderness traumatic amputation, a tourniquet would be perfect. Quick Clot stuffed into a severe bleed followed by a pressure bandage such as an Israeli bandage would also be a good option on a severe bleed before going to a tourniquet if you expect to be longer than 6 hours from definitive care. But never skip the tourniquet if you can use one and can't stop the bleeding any other way. Life over limb. Remember. . . All bleeding stops . . Eventually.
     
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  7. RAMBOCAT

    RAMBOCAT Loaded Pockets

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    I apologize for the "small nick" comment, but was using the amputation to counter the "metal pliers will always win" comment. Again, no disrespect was meant. Sorry.
     
  8. VinnyP
    • In Omnia Paratus

    VinnyP Loaded Pockets

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    I would think it's highly unlikely you would be closing it you would be clamping it which is pretty specialised. If you can see the small nick (You wont be able to but if you can reach it) then I would have thought Hemostatic gauze is a much better idea. Traumatic amputation at the shoulder is a bit beyond a small nick.
     
  9. Burncycle

    Burncycle Loaded Pockets

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    I get what you're asking... if you can reach in and grab it, why not bring hemostats and clamp it? (I assume you're not talking about poking around blindly in a wound with hemostats)

    I suppose that can work, but for bleeding that severe you're not going to be able to see much, and if you've got hemostats sticking in there trying to clamp an artery then you're not holding direct pressure on the wound like you should be.

    Along similar lines, if an artery is severed (say a penetrating knife wound happened to just catch it and bisect it) at a location where a tourniquet isn't indicated (ie, where an extremity meets the body) and in this hypothetical scenario it retracts and he's essentially bleeding out internally, well then why can't you widen the wound with your pocket knife enough to reach in and maybe find and stop it, when the patient is basically dead anyway if you don't, even if it's a long shot? Well, because you'd be operating out of your scope, and breaking the "first, do no harm" rule (ie, don't cut on the patient and make things worse in order to gain access)

    Stuff the wound with gauze (pack it) so that hopefully your direct pressure on the outside visible part would be enough to also apply pressure to the deeper bleeding vessels and pray help gets there fast.

    For an interesting wilderness first responder type scenario, google "reunion bike crash" and watch the video. Guy flips over the handlebars of a bicycle, at bicycle speeds, and tears his femoral. Very lucky to have survived, and the outcome could have been much worse. Neck injuries are also bad news.
     
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  10. Westerdutch

    Westerdutch Loaded Pockets

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    Really? Huh sounds I need a refresh course myself. I learned that you should only apply a tourniquet if losing the limb is the least bad thing that can happen (aka under direct threat of death).

    But even then, you need to know what you are doing as there are some absolute do's and don'ts when it comes to applying a tourniquet. I would never recommend anyone without any medical know-how to just bring one to have just in case as he might actually use it to treat a small to medium wound.
     
  11. Swe_Nurse

    Swe_Nurse Loaded Pockets

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    It used to be, then the US went into the middle east and lessons learned there (among other areas) changed that. We learned that rapid application of tourniquets save lives and have few drawbacks. It is the first and the primary tool to control catastrophic bleeding in the extremities. So yes, I would recommend a refresher course or read up on some of the recent studies.
    There are far fewer "do's and dont's" than you'd think, even fewer are absolutes. One used to be "always above the knee/elbow joint", this doesn't hold true anymore but is rather "usually above the knee/elbow joint". Another one was "loosen the tourniquet every X minutes", this has changed to "do not touch that tourniquet unless you're tightening it".

    Using a tourniquet for "small or medium wounds" (extremity arterial bleed are neither) isn't much of a problem, but as with everything else one should know when to use and how to use whatever first aid supplies one carries.
     
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  12. thekapow

    thekapow EDC Junkie!!!!!

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    sounds like a situation where the ITClamp would be perfect. what's a small nick? 1 inch?


    [​IMG]
     
  13. Timlugia

    Timlugia Loaded Pockets

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    In my local protocol, we EMS can release TQ if it's deemed unnecessary, or an alternative hemorrhage control could be established during delayed situation.
    For layperson it is "do not release" under normal circumstance.

    The concept is "you could always use TQ first, then assess for other methods, but if you wait long before using TQ, it might be too late"
     
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  14. ffmedic245

    ffmedic245 Loaded Pockets

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    Contrary to popular belief, direct pressure WILL stop arterial bleeding. It just takes longer. Since the original question involved a small arterial "nick," I'd say that remains your first-line intervention.
     
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  15. Westerdutch

    Westerdutch Loaded Pockets

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    This is what i learned, but its very interesting to see that general recommendation on tourniquets has changed, ill def keep my eyes open on local public refresher classes. And that IT clamp looks like something that would be right at home in an ambulance or dedicated EMT bag but i never see myself needing and thus carrying something like that.
     
  16. ffmedic245

    ffmedic245 Loaded Pockets

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    The IT clamp is very cool. We got trained on them and should be getting them soon. You just gotta watch; because of the way it works it might be considered an invasive procedure in some places.
     
  17. VinnyP
    • In Omnia Paratus

    VinnyP Loaded Pockets

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    Slowly rolling out but limited uses TBH. Extremity major bleeds are still much better treated with a TQ if the site allows. They are only really good for incised wounds and no good for the big areas where a CAT type TQ can't help i.e. pelvis or torso. It's fiddly for junctional bleeds and of course it only seals the skin so the blood goes into the cavity, which at a junction is 2 cavities, so plenty of room to still bleed out.

    The big gap it fills is for neck wounds, it brings possible airway issues but one life threatening problem at a time so definitely it has it's place and it is dinky so easy to pack away, that animation doesn't really convey how compact it is.

    In order of bang for buck trauma equipment in my opinion it's still gloves, compression bandage, CAT (or similar), haemostatic gauze, AAT and then something like this, but at least we have something else in the tool box. I jump back and forth on the CAT/Bandage as well.
     
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  18. Iafrate

    Iafrate Empty Pockets

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    In my 30 years as a Paramedic, I never ran into hemorrhage that couldn't be controlled by elevation, direct pressure or pressure points. This includes a gunshot to the femoral triangle. I controlled it with big direct pressure but was unable to do anything else as that was my sole function. Both hands, kneeling similar to CPR and using all my weight. That said it was a one in a million circumstance. As to using hemostats for hemorrhage control, don't unless you're a surgeon and in the operating theater! Always revert to the basics, they've been around forever for a reason.
     
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  19. EMT_Carry

    EMT_Carry Empty Pockets

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    My own personal practice (because that's the joys of being an autonomous and professionally registered health professional, you get to appraise the evidence and guide your own practice rather than following lists someone else made!) for Catastrophic Haemorrhage is immediate pressure and elevation - preferably I'll get the patient to do it but if not a bystander or what other sets of hands are available whilst I apply either CELOX/IT Clamp or a Tourniquet depending if it's a limb injury or a junctional injury and I'd consider giving Inotropes, TXA and Fluids (sparingly) dependent on blood lost and the patients presentation.

    I agree full on direct pressure for a length of time does work, but it also ties my hands up, gets in the way of extrication, or worsens the injury beneath. An example would be a high leg amputation from a blast. TQ may or may not be applicable, there is a high mechanism for a pelvic fracture so throwing all of my weight onto it will potentially sever one of the many many important vessels that run through the pelvis causing a catastrophic bleed I can't compress and killing off my patient quicker. If I had nothing else, then direct pressure and lots of it for lots of time is what the patient would get as I'd be treating the known rather than the might happen - as it stands if I have the right kit to manage a Cat bleed then I'll utilise what is appropriate for the injury!

    The long and short of it is there are tools out there, how when and why you apply those tools will depend on your level of training and what you're carrying. Just do your best with what you have, don't be afraid to load the patient in a vehicle and drive very fast somewhere (too many Pre-Hospital Practitioners like to 'stay and play' when really the patient needs to be traveling to definitive care as soon as possible), always do what is best for your patient and always work within your scope of practice/competence and you won't go far wrong!


    (As for arterial cut downs and clamps, often a severed artery will spasm and retract inwards by upto a few inches so where the hole is with the blood coming out isn't necessarilywhere the artery you want to clamp is! you'd be better off controlling it with one of the many ways discussed already before attempting a cut down and clamp as in unskilled hands the patient is just loosing more blood)
     
  20. thekapow

    thekapow EDC Junkie!!!!!

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    so.. what effect does elevation have on bleeding/Catastrophic Haemorrhage according to your autonomous guides and self applied evidence?
     
    Last edited by thekapow, Jun 23, 2016