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Mechanical advantage on pressure points

Discussion in 'First Aid Station' started by Weko, Feb 16, 2016.

  1. Weko

    Weko Loaded Pockets

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    I was reading a blog and the writer mentioned that he includes mini tennis balls for use in the case of severe bleeding. In particular the balls are used to provide a mechanical advantage when pressing on the pressure points. First time I read this particular bit and on the surface seems to make sense. Can anyone think of any reasons for or against this idea?
     
  2. Ian McDevitt

    Ian McDevitt Loaded Pockets

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    Yea. Think about it. Sooooo, he carries the tennis ball around in his pocket? Really?.....find out more about the author of the article. Find out if he actually works in the real world doing EMS or ? See if he can tell you the actual cases in which he successfully used them. Then you can tell him the military has been advising thousands of troops to just grab a proper sized rock off the ground if you REALLY need to, which you won't.
     
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  3. VinnyP
    • In Omnia Paratus

    VinnyP Loaded Pockets

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    From the current Pre Hospital Trauma Life Support guidelines.

    "elevation of an extremity and compression on a pressure point proximal to the injured site are not proven methods of hemorrhage control and are not endorsed by PHTLS"

    These can stop a bleed in the short term which is why they look like a good idea, but they stop you dealing with the problem or any other problem including calling for help, they are hard to maintain and you can't maintain them and move the patient. You usually only get one good clot and if when you release it (As happens in most cases), it blows that clot it makes matters much worse. There are some junctional type tourniquets that have two small balls that you can use in this way but that is different from manual pressure on one.
     
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  4. thekapow

    thekapow EDC Junkie!!!!!

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    1+ This, in fact i want to quote this again.

    I also recomend reading the great JEMS article "New External Hemorrhage Control Evidence-Based Guideline"

    This is an evidence based protocol.
    [​IMG]
     
    Last edited by thekapow, Feb 17, 2016
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  5. RAMBOCAT

    RAMBOCAT Loaded Pockets

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    +1 for thekapow.....
     
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  6. Timlugia

    Timlugia Loaded Pockets

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    Just a sidenote, there are approved junctional and aortic tourniquets on the market now, but they are rarely carried by civilian or traditional EMS due to price (300-500) and complexity of use.
    So hemostatic agent is still the best option for most providers. (or if not available, use traditional gauze rolls)
     
  7. 343KD

    343KD Loaded Pockets

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    Not a fan of carrying mini tennis balls.
    An option that kind of makes sense is the Olaes bandage, that includes a small plastic cup as part of the bandage. The cup can be used to apply increased pressure to a wound.
     
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  8. polak187

    polak187 Loaded Pockets

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    Many EMS services are taking pressure point out of their bleeding control protocols. New and revised guides go for: direct pressure, elevation and tq followed by the second tq if needed.

    Now if the author wants to carry tennis balls around fine but I think this might be another case of some Mickey Mouse nonsense.


    Sent from my iPhone using Tapatalk
     
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  9. Timlugia

    Timlugia Loaded Pockets

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    Despite pressure point is no longer recommended as standard procedure for bleeding control, it can still be used at the first contact with casualty while TQ/hemostatic/gauze being prepared.
    In TCCC they taught put a knee on proximal side of casualty's limb to slow down bleeding while you get TQ out of trauma kit.
     
  10. polak187

    polak187 Loaded Pockets

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    They told you that for real? Were there any contraindications to "the knee placement" ?


    Sent from my iPhone using Tapatalk
     
  11. Timlugia

    Timlugia Loaded Pockets

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    It's widely taught among military instructors, I first heard it during Army CLS class about 7 years ago, and again during my both civilian PHTLS and TCCC last year.
    It's also mentioned in the current version of Tactical Paramedic textbook published by North American Rescue, pg24.

    It' is pressure point method indeed, but not used in the traditional sense as a definitive way to control bleeding, instead used just a few seconds until TQ is applied.
     
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  12. polak187

    polak187 Loaded Pockets

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    How would that work if you had blast injury to the lower leg with possible upper shaft femur fracture that you don't know about because of MOI? Your pressure point is femoral artery in that case and you are kneeling down on the thigh possibly severing that artery rendering the tq useless.


    Sent from my iPhone using Tapatalk
     
  13. Mudinyeri

    Mudinyeri Loaded Pockets

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    I've always been taught direct pressure, direct pressure with a dressing, TQ, hemostatic agent as the four basic steps in that order ... much like the flow chart in thekapow 's post. I can see where an object might aid in applying direct pressure or pressure with a dressing. Most people don't understand the amount of pressure that needs to be applied. A mechanical device could assist in focusing the pressure but I've never seen it taught.
     
  14. Timlugia

    Timlugia Loaded Pockets

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    In the unlikely situation you described,
    if placing fist or knee first before TQ would worsen a fracture, then apply a tourniquet would also likely have same result, isn't it?
     
  15. thekapow

    thekapow EDC Junkie!!!!!

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    you forgot this:
    Elevation has been removed from every guideline I have seen since 2010, where it was removed from most textbooks including PHTLS 6. There is no evidence what so ever that it has any positive effect on traumatic bleeding.


    Also from the 2011 IFRC international guidelines

     
    Last edited by thekapow, May 1, 2016
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  16. badphishRN

    badphishRN Empty Pockets

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    in my experience, direct pressure is king, you can take a knotted cravat over wound with bandage to provide extra pressure to wound.
     
  17. thekapow

    thekapow EDC Junkie!!!!!

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    I have been looking through the TCCC guidelines :censored: well as phtls, but i cant find the knee anywhere in the literature, do you have a source? The skill sheet for CAT and SOFFT modul published by NAEMT and instructor guides dosent mention it anywhere as far as I can see. But it sounds interresting - if littereature exists
     
  18. Timlugia

    Timlugia Loaded Pockets

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    True, it's not in PHTLS material itself, since it's only a temporal measure. But it is certainly taught in military, including PJs.
    The only literature I have at the hand is "Tactical Paramedic: Certification and Practical Application by IAMED" (ISBN 13:978-0990356103)
    I am sure that some military medics posted it on youtube, I will try to find it later.
     
  19. Joelski

    Joelski Loaded Pockets

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    DIRECT PRESSURE > + Hemostatic gauze > Tourniquet.

    The pressure point is where you place DIRECT PRESSURE. Doesn't matter if you use a knee, both hands, or a flying saucer, arterial pressure points over bony prominences are out, as is elevation.

    Standard of care since 2008.
     
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  20. VinnyP
    • In Omnia Paratus

    VinnyP Loaded Pockets

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    I never heard of a knee on the thigh in nearly 30 years even when indirect pressure was going on. I can't see how it would make much difference, it's unlikely to compress the artery very much. It's not in current NAEMT TCCC, or CMT. TCCC do teach knees fists etc. but for DIRECT pressure which might be a good idea especially for a bleed actually in the inguinal crease, which is where the indirect pressure point used to be.