Talk to me about pressure point bleeding control...

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attnondeck

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1: pressure (understood)
2: elevate (understood)
3: pressure points (understand the concept, but where and how is it done)
4:tourniquet (yup.... self explanatory)


just looking for some info on number 3. thanks
 
1: pressure (understood)
2: elevate (understood)
3: pressure points (understand the concept, but where and how is it done)
4:tourniquet (yup.... self explanatory)
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https://www.nremt.org/nremt/downloads/bleedingcontrolshock.pdf

Although I also learned it this way, it is no longer in practice.

The NREMT removed pressure points from their skills test. Studies have shown its more beneficial to just go straight to tourniquets.

If you understand the concept it's pretty self explanatory. Find the arterial pressure point above the injury and apply pressure, thus occluding or slowing blood flow enough to allow the clotting cascade to begin.

The brachial and femoral arteries were the go to's in most situations.
 
Just remember... What the NREMT says, and what is actually done aren't usually the same. If granny has a skin tear from a slip and fall, and direct pressure doesn't solve the problem because she's on blood thinners, you don't have to jump to a tourniquet. Be smart.
 
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HotelCo said:
Just remember... What the NREMT says, and what is actually done aren't usually the same. If granny has a skin tear from a slip and fall, and direct pressure doesn't solve the problem because she's on blood thinners, you don't have to jump to a tourniquet. Be smart.
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I don't think pressure points are going to work here either though. I never saw pressure points be effective for more than a couple if seconds. As far as a tourniquet goes, either it's egxangunating hemorrhage or it's not, the type of wound doesn't matter. It doesn't matter if it's a papercut, if there's sufficient blood loss it will get a tourniquet.

One thing to remember is a B/P cuff is a much gentler and more controllable tourniquet than the gee whiz tactical stuff.
 
usalsfyre said:
either it's egxangunating hemorrhage or it's not, the type of wound doesn't matter.
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I would say that in most cases it is not.

I have noticed that my definition of "a lot" of blood has changed considerably over the years.

An amount it takes to be life threatening is very often more than what it looks like.

That doesn't even begin to touch on the type of bleeding.

I would like to point out that in the EMS curriculum, in first responder texts they refer to 2 types of bleeding, "bleeding you can see and bleeding you can't see." In the paramedic level texts they don't bother to increase the level of understanding, but simply change the words to "external bleeding and internal bleeding."

With this (sarcastic) advanced knowledge, (end sarcasm) they are expecting people to determine what is life threatening or not and what to do about it.

Then many paramedic classes don't have clinical rotations in surgery or major trauma centers, so many students have no idea what life threatening bleeding might look like any more than some guy on the street.

(Except for the two dudes, who know a considerable amount about dealing out injuries :) )
 
Veneficus said:
I would say that in most cases it is not.

I have noticed that my definition of "a lot" of blood has changed considerably over the years.
Click to expand...

One of my favorite exercises is to take 6 liters of theatrical blood and pour it out on the floor. People are usually shocked at how much it actually is. Granted it doesn't take anywhere near what amounts to your entire blood volume to be life threatening, but it usually causes people to drastically alter their perception.
 
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usalsfyre said:
One of my favorite exercises is to take 6 liters of theatrical blood and pour it out on the floor. People are usually shocked at how much it actually is. Granted it doesn't take anywhere near what amounts to your entire blood volume to be life threatening, but it usually causes people to drastically alter their perception.
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I never thought about doing that in an educational setting, that is a great idea!

Maybe I'll just get a butcher to save me abot 3 units of animal blood though.
 
usalsfyre said:
One of my favorite exercises is to take 6 liters of theatrical blood and pour it out on the floor. People are usually shocked at how much it actually is. Granted it doesn't take anywhere near what amounts to your entire blood volume to be life threatening, but it usually causes people to drastically alter their perception.
Click to expand...

I am calling a few instructors to suggest this. Even if you use a simple 3 liter bottle you are talking half the volume and things are going to be very interesting.
 
Clotting cascade? Ha! You know every second person is on coumadin for their AF and every other person is on aspirin as part of their post infarct regime :D

Man a lot of people seem to be sick these days ....

It takes a considerable amount of pressure to actually make the "pressure point" theory work and if we think about it, its much easier to apply a tourniquet
 
MrBrown said:
Clotting cascade? Ha! You know every second person is on coumadin for their AF and every other person is on aspirin as part of their post infarct regime :D
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Platelet disorders and clotting cascade disorders are not the same :)
 
usalsfyre said:
One of my favorite exercises is to take 6 liters of theatrical blood and pour it out on the floor. People are usually shocked at how much it actually is. Granted it doesn't take anywhere near what amounts to your entire blood volume to be life threatening, but it usually causes people to drastically alter their perception.
Click to expand...

My instructor did a very similar exercise the other day in lab. He had different items that he soaked in "blood". He used a tampon, t-shirt, trauma pad, jeans, a maxi pad and a couple of other items. We had to estimate the amount of blood each one held. Estimates ranged from 15ml-1000ml. Turns out it was fairly difficult to determine the amount of blood in each (point of the demonstration) and each item had 60ml of blood.
 
Clotting cascade? Ha! You know every second person is on coumadin for their AF and every other person is on aspirin as part of their post infarct regime
Click to expand...

Let's not forget about my favorites: liver cirrhosis(alcoholism) and vitamin deficiencies(poor diet/antibiotics) ;)

It takes a considerable amount of pressure to actually make the "pressure point" theory work and if we think about it, its much easier to apply a tourniquet
Click to expand...

Too true.

Man a lot of people seem to be sick these days ....
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:wacko:
 
so what im seeing is that its rarely used and a tourniquet is just a better option? thanks for all the replies guys
 
It's not that it's rarely used, it's that it's rarely applied effectively, and even if you do manage to stop flow through that particular artery, there will likely be some collateral circulation that will still allow for some blood flow. A tourniquet is a lot easier, and once applied, you have several HOURS before there's irreversible damage from the tourniquet.
 
Out of order as usual

Not to undermine your learning (I presume this is in re. a class?), but some comments:
1. ELEVATION: watch to see this officially labelled "ineffective". ARC teaches laypersons it is. I've seen it work on extremites and nosebleeds...or was letting them fall dependent the error, versus elevation being the effective intervention?
2. PRESSURE POINTS: hurt like heck, often ineffective for a number of reasons, but if you don't have a TK handy, or while you're waiting for teh Boy Scout to spin his neckerchief , it might buy you time. Laypersons rarely do them right at all.
3. TK's and PRESSURE POINTS: if you are going to "shut down an artery", make 'em work; if you are only causing venous congestion by failing to close the artery but still closing the vein, the rate of bleeding increases due to the entire tributary (downstream of an open artery and normally drained by the vein you're holding closed) vessel bed to pressurize; ask any phlebotomist.

MANY, many bleeds on extremities are controlled by fast, adequate pressure which is HELD in place and titrated to effect.
PS: Ever notice in training classes that no one ever has a significant bleed from the head, the torso, the groin, or the face?
 
mycrofft said:
Not to undermine your learning (I presume this is in re. a class?), but some comments:
1. ELEVATION: watch to see this officially labelled "ineffective". ARC teaches laypersons it is. I've seen it work on extremites and nosebleeds...or was letting them fall dependent the error, versus elevation being the effective intervention?
2. PRESSURE POINTS: hurt like heck, often ineffective for a number of reasons, but if you don't have a TK handy, or while you're waiting for teh Boy Scout to spin his neckerchief , it might buy you time. Laypersons rarely do them right at all.
3. TK's and PRESSURE POINTS: if you are going to "shut down an artery", make 'em work; if you are only causing venous congestion by failing to close the artery but still closing the vein, the rate of bleeding increases due to the entire tributary (downstream of an open artery and normally drained by the vein you're holding closed) vessel bed to pressurize; ask any phlebotomist.

MANY, many bleeds on extremities are controlled by fast, adequate pressure which is HELD in place and titrated to effect.
PS: Ever notice in training classes that no one ever has a significant bleed from the head, the torso, the groin, or the face?
Click to expand...
Direct Pressure on the wound works wonders! If that doesn't work, TK.
 
mycrofft said:

PS: Ever notice in training classes that no one ever has a significant bleed from the head, the torso, the groin, or the face?
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Yeah, and the patient is never laying face down either.

This morning however, I had a patient who had avulsed a portion of her nose (with resultant 500ml or so estimated blood loss) after falling off the toilet through a glass shower door, and was still laying on her face on arrival. D@mn real life...:D
 
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So how did you stop the bleeding?

Everything I think of looks like something from an 1880's patent medicine ad for snoring relief.
 
attnondeck said:
1: pressure (understood)
2: elevate (understood)
3: pressure points (understand the concept, but where and how is it done)
4:tourniquet (yup.... self explanatory)


just looking for some info on number 3. thanks
Click to expand...

My personal practice is more like:
1. Pressure/pack the wound.
2. If it's still bleeding, push harder/make sure I'm pushing in the right spot.
Note: If they are still bleeding and I'm not using my entire body weight, then it's never a matter of "sufficient pressure". More than once, I've ridden to the hospital kneeling on someone's groin. A couple of those times it was actually medically indicated.
3. Tourniquet. The tourniquet would have been proactively placed but not tightened while I was making sure I was pushing hard enough.
 
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