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

[micosabeh]

Well for me, first I control it by direct pressure (gloves), elevate, add gauze/pad then using splint then tourniquet as last option then treat for shock.. for some who asking why for treat for shock meaning the amount of blood that loss during the management of bleeding is already enough to knock-out the patient that is why treating for shock is done after doing tourniquet..

Using pressure points perhaps, not applicable, for me, to use as one of the control bleeding due to invasion of privacy

 

[sredish]

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 ??

a lot of the textbooks still teach this, they haven't been updated but the instructor has the responsibility to update the student. what they have all said is correct. direct pressure then if unmanageable, straight to TQ.

 

[Niccigsu]

This comes straight out of the AEMT book:
1.Apply direct pressure over the wound. Elevate the injury above the level of the heart if no fracture is suspected.
2. Apply a pressure dressing.
3. If direct pressure with a pressure dressing does not control bleeding, apply a tourniquet above the level of the bleeding.

 

[Fish]

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 ??

Apply pressure
Apply Gause
Apply more
Turniqut

 

[JPINFV]

Wait... all bleeding stops... eventually.

 

[DesertMedic66]

Everywhere teaches it differently. I know some places that teach cold packs to stop bleeding.

I like and use: direct pressure with gauze, then more gauze, then elevation, pressure point, pressure bandage (usually a BP cuff works well) and then the tourniquet.

 

[SanDiegoEmt7]

In the context of the discussion I thought it was assumed we were all talking about hypovolemic/hemorrhagic shock.

Right? On a question about bleeding control that's what one would expect.

But someone's always gotta get on the soapbox. Either way the first aider isn't going to be able to figure out the difference and doesn't have the tools to treat anything accept, spurting red stuff.

 

[Shishkabob]

Funny story. A patient sliced his cephalic vein open. Fire arrives, sees blood, freaks out, puts on gauze. Blood continues. Fire freaks out more, slaps on 3 separate TQs. Blood continues. Fire totally loses it and packs on the quikclot bandages. Blood continues.

We arrive, pull out a BP cuff, get odd looks (Stupid Paramedics wanting a blood pressure while the patient bleeds? HA!), slap on BP cuff, pump up, and... voila! No more bleeding.

 

[JPINFV]

Fornicating veins, how do they work?

 

[mycrofft]

NRretty well covered.

Quote above:
"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?"
Ans: GO faster.

Pragmatic answer: Do the official stuff. If you fail to get bleeding to stop, you are usually not pressing hard enough. If you do not have a tourniquet and pressure still won't stop it, a pressure point is a last ditch but it ties you in place and is so hard to do properly that it rarely works anyway. A tourniquet may be your ticket, but, if applied too loosely, will accelerate bleeding through collateral circulation and due to venous/arterial pressure differential. Elevation of the injury works for things like nosebleed and minor cut finger; ice will help a really minor booboo but will also reduce swelling and reduce pain; elevating legs to counter shock is too minor and enough elevation would push the viscera into the diaphragm since the pt is upside down and draining like a stuck pig. (The leg up deal is an old last-ditch thing and like a resisted Valsalva maneuver good for fainting/syncope).
If you slapped on a combine dressing like most "ABD" 's/5X9's, you can hasten clotting by slapping on a regular gauze pad first; the combine dressing is designed to absorb, so the blood/clot is in the dressing and not on the wound unless you have put-on beaucoup pressure.

 

[NYMedic828]

Here in NY it has changed to direct pressure, pressure dressing, tourniquet.

We used to be of the mindset that once we put on a tourniquet the pt is going to lose the limb distal to it. This turned out to be entirely untrue as a limb can go from 5-12 hours without blood supply depending upon what text you read.

It is more important to maintain a sufficient hemodynamic by controlling a major bleed than the possible extended loss of a limb that more than likely can be repurfused by time of surgery.

 

[Sandog]

Here in NY it has changed to direct pressure, pressure dressing, tourniquet.

We used to be of the mindset that once we put on a tourniquet the pt is going to lose the limb distal to it. This turned out to be entirely untrue as a limb can go from 5-12 hours without blood supply depending upon what text you read.

It is more important to maintain a sufficient hemodynamic by controlling a major bleed than the possible extended loss of a limb that more than likely can be repurfused by time of surgery.

I think the original fear of a tourniquet (Tk) was necrosis (cell death) due to massive acidosis buildup and release of acid throughout the body when Tk removed, but with the use of alkaline injections prior to removal, this is no longer a concern.

 

[NYMedic828]

I think the original fear of a tourniquet (Tk) was necrosis (cell death) due to massive acidosis buildup and release of acid throughout the body when Tk removed, but with the use of alkaline injections prior to removal, this is no longer a concern.

The "Rescue Medics" here in NYC actually have sub protocols that allow them to give sodium bicarbonate to victims with crush syndrome for an extended period while being extricated.

 

[mycrofft]

Tourniquets (TK's) cost limbs because improvised and older commercial ones were too narrow and crush tissue circumferentially. However,as they say, "life or limb"...
True urban legend: broken bottle fight in a bar, guy has neck cut. Another drunk takes off his belt and tries to make a tourniquet. Because it was a leather belt and holes were too near the tip, he failed with the TK, but succeeded in putting lots of pressure on the bleeder, and the guy lived. (related by Omaha firefighter, 1979).

 

[Veneficus]

You mean its not:

1. epi soaked gauze
2. epi injection
3. Bovie
4. preformed metal clamp
5. sutures
6. make a flap
7. cut the offender out


Damn... No wonder I can't pass NREMT-B :unsure:

 

[mycrofft]

1. Find the source of bleeding by touch (it's dark and raining),
2. Jam your finger into the hole.

 

[Tigger]

You mean its not:

1. epi soaked gauze
2. epi injection
3. Bovie
4. preformed metal clamp
5. sutures
6. make a flap
7. cut the offender out


Damn... No wonder I can't pass NREMT-B :unsure:

Mmmm love me some blanching with my hockey players.

 

[mycrofft]

Be like an old timer fighter, put ALUIM on it. (Hydrated potassium aluminum sulphate).

Two years ago every other reply would have been about clotting chemicals OTHER than the common stypic pencil (alum).

 

[Veneficus]

Be like an old timer fighter, put ALUIM on it. (Hydrated potassium aluminum sulphate).

Two years ago every other reply would have been about clotting chemicals OTHER than the common stypic pencil (alum).

I thought stypic pencils were only used by barbers?

There is always a new gadget or technological device that is going to allow medics to save the world.

Unfortunately none of those things ever seems to be a book that details most of that overpriced crap is just a waste of money.

 

[TLettuce]

Funny story. A patient sliced his cephalic vein open. Fire arrives, sees blood, freaks out, puts on gauze. Blood continues. Fire freaks out more, slaps on 3 separate TQs. Blood continues. Fire totally loses it and packs on the quikclot bandages. Blood continues.

We arrive, pull out a BP cuff, get odd looks (Stupid Paramedics wanting a blood pressure while the patient bleeds? HA!), slap on BP cuff, pump up, and... voila! No more bleeding.

BP cuffs... definitely one of the more under-appreciated tools on the rig.