Soooo you THINK you know your steps to control bleeding !!!!!

[dannios3]

When I was in school which was about half a year ago they taught us that to control bleeding you had to

1. Apply direct pressure over the wound, with dressing
2. If bleeding continues, apply more dressing
3. If it continues, elevate
4. If it doesn't stop use the nearest pressure point
5. Finally if bleeding proceeds use a tourniquet

However recently I heard that the steps have changed?!?!

Does anyone know ??

 

[JPINFV]

I believe that the "official" steps removed elevate and pressure point.

 

[vquintessence]

Where does ice fit into the equation?

But if you want a real neat & effecive trick for bleeding control: just stop the heart before going through any of those steps.

 

[jjesusfreak01]

Where does ice fit into the equation?

But if you want a real neat & effecive trick for bleeding control: just stop the heart before going through any of those steps.

Can a reverse cardioversion be done? Shock the heart at just the right part of the rhythm so that it goes into vfib. Then control bleeding and shock again.

 

[Adz]

I heard they are now:

Direct pressure with dressing

Pressure dressing

Elevation

Tourniquet

Treat for shock if necessary

EDIT

So you basically remove the pressure point step, going straight to tourniquet.

 

[18G]

Both elevation and pressure points were found not to be very effective which is why they were deemphasized. Direct pressure and tourniquet use are the primary methods for bleeding control. Of course you can use elevation... nothing say's that you can't.

The tourniquet is effectively your pressure point.

 

[DesertMedic66]

According to national testing it's just: direct pressure. If bleeding continues tourinquet. (sorry for bad spelling). And treat for shock.

 

[Melclin]

Treat for shock if necessary

What does that involve exactly?

 

[DesertMedic66]

For EMT-B it just involves elevate feet, blanket, and high flow O2.

 

[dannios3]

so acording to what the most of the guys said the only thing that changed was that they took out elevate and pressure point...

 

[18G]

My definition of "treat for shock"....

- Provide warmth (since decreased temp decreases clotting ability).

- Oxygen to increase pO2 to drive diffusion since oxygen carrying capacity may be decreased from loss of RBC's.

- Keep patient calm as to reduce the metabolic demands of the already stressed body (decreased O2 consumption in a calm person).

- Maintain perfusion with IV fluids to prevent acidosis and maintain oxygen delivery to the tissues - (blood clots poorly with low pH - yes, I know large volumes of NSS can actually cause acidosis).

- Can try leg elevation if not contraindicated.

- Ultimately in traumatic shock with external hemorrhage... STOP THE BLEEDING.

 

[Shishkabob]

If you're testing for NR, it's direct pressure followed by TQ. No in between... if pressure can't stop it you don't fool around with anything else but TQs.

It's been that way since January-ish 09.

 

[dannios3]

If you're testing for NR, it's direct pressure followed by TQ. No in between... if pressure can't stop it you don't fool around with anything else but TQs.

It's been that way since January-ish 08.

yeah i was wondering for the NR i didnt want to make a mistake..

 

[DesertMedic66]

And pressure dressing. It used to be: direct pressure, elevate, pressure point, pressure dressing, tourniquet, treat for shock. But now national just wants direct pressure, tourniquet, treat for shock.

 

[Melclin]

Right.

My definition of "treat for shock"....

- Provide warmth (since decreased temp decreases clotting ability).

- Oxygen to increase pO2 to drive diffusion since oxygen carrying capacity may be decreased from loss of RBC's.

- Keep patient calm as to reduce the metabolic demands of the already stressed body (decreased O2 consumption in a calm person).

- Maintain perfusion with IV fluids to prevent acidosis and maintain oxygen delivery to the tissues - (blood clots poorly with low pH - yes, I know large volumes of NSS can actually cause acidosis).

- Can try leg elevation if not contraindicated.

- Ultimately in traumatic shock with external hemorrhage... STOP THE BLEEDING.

You guys don't divide shock into say... hypovolaemic, cardiogenic, distributive and obstructive and then go from there? "Treat for shock" sounds like something out of our volly first aid 'curriculum'. "He got an awful fright so we treated for shock", "She fell down and flight of stairs and looks like death, so we treated for shock". Weird.

 

[DesertMedic66]

For paramedic I would say yeah you have to know what kind of shock. But for just EMT-B it's just "treat for shock". Our textbooks didn't talk about the different types of shock. It just said the usual signs and vital signs for shock and then how to treat it.

 

[Adz]

You guys don't divide shock into say... hypovolaemic, cardiogenic, distributive and obstructive and then go from there? "Treat for shock" sounds like something out of our volly first aid 'curriculum'. "He got an awful fright so we treated for shock", "She fell down and flight of stairs and looks like death, so we treated for shock". Weird.

When I'm reviewing the call to further educate myself, but it doesn't matter on scene because it doesn't change my treatment options as an EMT-B.

 

[JPINFV]

You guys don't divide shock into say... hypovolaemic, cardiogenic, distributive and obstructive and then go from there? "Treat for shock" sounds like something out of our volly first aid 'curriculum'. "He got an awful fright so we treated for shock", "She fell down and flight of stairs and looks like death, so we treated for shock". Weird.

For someone who doesn't carry a monitor, can't start an IV, and is limited essentially to oxygen and oral glucose (some places allow albuterol), what exactly are you expecting an EMT to do for cardiogenic, distributive, or obstructive shock?

 

[Melclin]

For someone who doesn't carry a monitor, can't start an IV, and is limited essentially to oxygen and oral glucose (some places allow albuterol), what exactly are you expecting an EMT to do for cardiogenic, distributive, or obstructive shock?

I don't really care to start an argument about EMT education and scope and so forth, I was just surprised to hear that sort of first aid terminology pop up and thought it might mean something else when used by actual healthcare providers. I don't really see knowing the types of shock as being advancing your education. I see it as the foundation... In the sense that it hadn't really occurred to me that it could be reduced to a simpler concept and still be correct. I suppose 'correct' is a relative term.

It seems also that the idea has made its way through to the P level as well. Building on advanced first aid rather than just starting from scratch with the real story seems sort of counter productive to me.

 

[JPINFV]

To be fair, they were at a minimum mentioned, and not much more, during my EMT training, but, yea... not really emphasised.