# General impression



## Ediron (Dec 11, 2009)

If you find a victim bleeding profusely, would you immediately apply direct pressure since it is said to be life threatning, or would you start with ABC's??
this question also applies to other life threatning emergencies (hypothermia, hyperthermia,etc.)

and what is the difference between Ischemia & Hypoxia ???


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## Lifeguards For Life (Dec 11, 2009)

Ediron said:


> If you find a victim bleeding profusely, would you immediately apply direct pressure since it is said to be life threatning, or would you start with ABC's??
> this question also applies to other life threatning emergencies (hypothermia, hyperthermia,etc.)
> 
> and what is the difference between Ischemia & Hypoxia ???



Ischemia is insufficient blood flow to provide adequate oxygenation. This, in turn, leads to tissue hypoxia (reduced oxygen) or anoxia (absence of oxygen). Ischemia always results in hypoxia; however, hypoxia can occur without ischemia if, for example, arterial hypoxia occurs.

check the airway first. the initial assessment's goal is to discover what is goint to kill your patient fastest. While the bleeding needs to be adressed quickly, respiratory arrest is more imminently fatal.


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## nomofica (Dec 11, 2009)

If it's a deadly bleed and it was a 2-rescuer intervention I'd delegate my buddy to control the bleeding, while I did my ABCs and a rapid assessment for any other possible injuries.


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## Ediron (Dec 11, 2009)

Ok so your saying to go with ABC's first , even though the victim is bleeding so much that its leading to shock??

Im takinig the national soon, any advice.

-Thank you


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## Lifeguards For Life (Dec 11, 2009)

Ediron said:


> Ok so your saying to go with ABC's first , even though the victim is bleeding so much that its leading to shock??
> 
> Im takinig the national soon, any advice.
> 
> -Thank you


the national is not really testing your critical thinking skills. the goal is just to certify that you have met the minimum proficiency standards to work in the field. attached is a list of the exam coordinators documents, put out by the NREMT. The national test does not really throw you any curve balls, just follow the orders listed in these sheets. 
good luck

http://www.nremt.org/nremt/about/exam_coord_man.asp#BSkillSheets


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## Lifeguards For Life (Dec 11, 2009)

In the patient assessmnet/managment- trauma sheet they want you to assess for adequate breathing and initiate the appropriate O2 therapy before you begin to assess or control any bleeding. for testing puropses

http://www.nremt.org/nremt/about/exam_coord_man.asp#BSkillSheets

hope this helps


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## Dominion (Dec 12, 2009)

As far as I remember when I did my EMT class I was always told that before ABC's if there is a life threatening bleed to control that first.  Maybe the sheets have changed


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## redcrossemt (Dec 12, 2009)

Bleeding a part of the circulation assessment/management in the initial assessment.

A (airway) and B (breathing) come before C (circulation).


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## exodus (Dec 12, 2009)

Bleeding is in your C.


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## EMSLaw (Dec 12, 2009)

Bleeding is part of circulation, yes, but if the patient is spurting blood all over the place, you want to control that immediately.  The patient will bleed out faster than they will suffocate.  

And incidentally, if the patient is spurting arterial blood hither and yon, you know they have a heartbeat.


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## rhan101277 (Dec 12, 2009)

EMSLaw said:


> Bleeding is part of circulation, yes, but if the patient is spurting blood all over the place, you want to control that immediately.  The patient will bleed out faster than they will suffocate.
> 
> And incidentally, if the patient is spurting arterial blood hither and yon, you know they have a heartbeat.



If they have an arterial bleed and you don't get there soon, they will be dead anyhow.  Especially if they are unconcious and have no way of knowing what is going on.  All ambulances have (2) people, I would have my partner control bleeding while I controlled airway.


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## redcrossemt (Dec 12, 2009)

rhan101277 said:


> If they have an arterial bleed and you don't get there soon, they will be dead anyhow.  Especially if they are unconcious and have no way of knowing what is going on.  All ambulances have (2) people, I would have my partner control bleeding while I controlled airway.



If you are in class or doing the NREMT and don't have a partner readily available, do it with "C"...

If this is real life, do as above.


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## Dominion (Dec 12, 2009)

redcrossemt said:


> If you are in class or doing the NREMT and don't have a partner readily available, do it with "C"...
> 
> If this is real life, do as above.



I feel pretty sure that in the trauma skill sheets controlling life threatening injuries comes before ABC....posting this then going to look.

Edit:
Ok on our state sheets it says "Assess/Manage Immediate Life Threats" before ABC.  This is not NREMT sheets though.


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## bunkie (Dec 13, 2009)

Dominion said:


> I feel pretty sure that in the trauma skill sheets controlling life threatening injuries comes before ABC....posting this then going to look.
> 
> Edit:
> Ok on our state sheets it says "Assess/Manage Immediate Life Threats" before ABC.  This is not NREMT sheets though.



I'm going to +1 you on this one. We had "life threats" in our scene size up. And management of them came before the ABC's.


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## NomadicMedic (Dec 13, 2009)

The NREMT testing station is nowhere near real life... *If you want to pass the station, do it in the order that's listen on the SKILL SHEET.
*
And on the skill sheet, "assess and control major bleeding" follows "apply appropriate 02 therapy." 

Good luck.


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## Dominion (Dec 14, 2009)

n7lxi said:


> The NREMT testing station is nowhere near real life... *If you want to pass the station, do it in the order that's listen on the SKILL SHEET.
> *
> And on the skill sheet, "assess and control major bleeding" follows "apply appropriate 02 therapy."
> 
> Good luck.



Make sure the state you test in doesn't have their own sheets.  The one I referenced is a Kentucky sheet and if a proctor is feeling froggy they will fail you not doing it.


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## R.O.P. (Dec 14, 2009)

bunkie said:


> I'm going to +1 you on this one. We had "life threats" in our scene size up. And management of them came before the ABC's.



+ another 1
If you see a spurting artery, penetrating chest wound, etc., deal with that IMMEDIATELY upon pt. contact!  This can be as fast and simple as just putting a (gloved- it had better be gloved) hand onto the wound to seal it right then and there. It it an autofail if you do not!  Then say, "Now my partner will apply an occlusive dressing to the wound" or "Now my partner will apply direct pressure to control the bleeding". Then ABC's, while you are still managing the wound.


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## daedalus (Dec 14, 2009)

For testing purposes the airway is always first. In real life you are going to get a firefighter or partner on the bleed ASAP. No use getting air in the lungs if there is no blood the pick up new O2 and drop off CO2..


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## emstchr (Dec 14, 2009)

I agree that active life threatening bleeding needs to be addressed immediately.  A and B won't be of much benefit if there is no blood left to oxygenate.

For testing purposes, however, your best answer would be to direct your partner to control the bleeding as you assess airway.  NREMT testing does allow "ghost" partners.


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## Dominion (Dec 14, 2009)

daedalus said:


> For testing purposes the airway is always first. In real life you are going to get a firefighter or partner on the bleed ASAP. No use getting air in the lungs if there is no blood the pick up new O2 and drop off CO2..



STILL, check your sheets.  In Kentucky IT DOES NOT come after ABC's.  If you get a tester who says "Your patient has a GSW to the upper chest blah blahblah." and you don't say something to the effect of placing a gloved hand or having a partner control bleeding, you can/will be failed.  When in doubt, check.

Edit: Further, you can always direct a phantom partner to manage it.  I've yet to meet an EMT proctor who would fail you for having a partner do something such as covering wounds, managing broken bones.  When I do trauma and you are doing the sheet, I will say something to the effect of "I note the injury, does it currently appear life threatning?" No. "Ok I will note and move on, if available I will have a partner manage the splint"...as long as you note the injury, treat it, and remember it in your report or when it comes time to do other interventions.


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## Ediron (Dec 16, 2009)

thanx for the help everyone


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## Jeffrey_169 (Jan 11, 2010)

Ediron said:


> If you find a victim bleeding profusely, would you immediately apply direct pressure since it is said to be life threatning, or would you start with ABC's??
> this question also applies to other life threatning emergencies (hypothermia, hyperthermia,etc.)
> 
> and what is the difference between Ischemia & Hypoxia ???



If the airway is clear, the pt. is breathing, and the patient is "bleeding profusely", i.e. posing a significant threat to life/ limb I would try to control it immediately as this poses the most significant threat at this point. If the patient is not breathing then this is your primary concern. If there is two people, even if one is a bystander, have them try to control hemorrhage and you work on the ABC's.


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## Jeffrey_169 (Jan 11, 2010)

Ediron said:


> If you find a victim bleeding profusely, would you immediately apply direct pressure since it is said to be life threatning, or would you start with ABC's??
> this question also applies to other life threatning emergencies (hypothermia, hyperthermia,etc.)
> 
> and what is the difference between Ischemia & Hypoxia ???



If the airway is clear, the pt. is breathing, and the patient is "bleeding profusely", i.e. posing a significant threat to life/ limb I would try to control it immediately as this poses the most significant threat at this point. If the patient is not breathing then this is your primary concern. If there is two people, even if one is a bystander, have them try to control hemorrhage and you work on the ABC's.


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