Talk to me about pressure point bleeding control...

we carry CATs and I have used them on serious limb injuries and I think they worked great, I liked it way more then using a triangle bandage and some improvised windlass. the combat tk was great, secure and completely occluded the artery
 
You original post asked for an explanation of the concept (where and how). The most common points are the common pulse points on long bones (femoral and brachial). The idea is that you pinch off the blood vessel by pressing it against a bone.

One problem is the amount of pressure it takes to actually accomplish this in many people. I don't believe most providers press hard enough (and pressure is often too "wide"...so the "pinching off" doesn't actually happen).

The other problem is that you tire out pretty darn quickly.


Since tourniquets don't have as many risks as previously thought, it's preferred you just stop the bleeding with one, than fumble around with pressure points. They're good to know. They can come in handy (as someone constructs/applies a tourniquet), but shouldn't be part of your routine bleeding control algorithm.


Direct pressure stops vast majority of bleeds. The best advice I can give of when to move on to a TQ is when you get the sense that direct pressure isn't helping. The direct pressure you have isn't significantly slowing the major bleed.

As far as elevation, I just blend that step with direct pressure. If I'm putting pressure on an extremity, I'm also elevating it if feasible. But it shouldn't be a step in itself (oh, bleeding is bad, let me now decide to elevate and wait to see if it helps, no didn't help, okay now I can tourniquet...as he continues to lose blood..).
 
TK risks...and quick and dirty OP pressure point note

In combat, and also under urban controlled circumstances, a proper tourniquet (not a piece of lamp cord) if properly applied and promptly delivered to definitive care, is not as injurious as we were told they were.

Why were we told this? Historically in real life, TK use has been with improvised cords, twisted with a windlass, often misplaced, often out in the sticks or the boonies (delayed transport), and were mis-applied, sometimes to pt's with injuries not calling for them. The resultant injuries and unnecessary use was a backlash against teaching or using TK's. Now we are swinging the other way, and are about to go past the point of approriate use and into the "DANGER, Will Robinson!" zone of free-for-all use.

To stop life threatening bleeding, or buy time when they are both bleeding and have other pressing injuries, use a proper TK properly. Usually, you can stop the bleeding by properly bandaging and compressing the site. A pressure point application can buy you the time for the TK, or slow bleeding where a TK or pressure dressing is not going to work (i.e., groin GSW with Hail Mary attempt to compress the descending aorta with your knee). In cases of delayed transport or long transport time, know your protocols, but generically realize that the pt will be experiencing injury from your TK, which was balanced by potential loss of life.

OP, pressure points: usually on flexor surface of joints, running next to a nerve usually ("painful and pulsating"). Don' try that aorta deal, it probably doesn't work.
 
The resultant injuries and unnecessary use was a backlash against teaching or using TK's.
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Actually if you read the article I posted, you'll see that the injuries attributed to tourniquets had nothing to do with their use directly, but with leaving people on the battlefield for extremely protracted periods of time (>12 hours, 18 hours, days, etc).

Actual serious complications of tourniquet use in the field are so rare as to be almost worthy of a case report in a medical journal.
 
Yes and no...I was not speaking only of battlefield. We're in agreement.

Civilians in the comfort of their own homes, bars, and turnpikes use belts, lamp cord, bailng wire, fan belts, etc., everything short of a chainsaw chain. THEN they stick a pencil in as a windlass twister and it snaps, or they use a tire iron and the TK acts like a cheesecutter. They also tend to place the TK right on the edge of the wound, or right on a joint, or, rarely, DISTAL to the wound.

Among the medical veterans of the Vietnam Conflict I served with and spoke to (interestingly, three were at Pleiku but at different time frames), they saw cruddy TK admin mostly due to not having the materials (applied by a buddy or just ran out of them) or insufficient opportunity (dustoff was leaving, under fire, or such), or the wound just didn't require a TK but it was applied for expedience or out of ignorance. Stuff happens under fire.

Great article, though!
 
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Yes and no...I was not speaking only of battlefield.
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Neither was I. The only major complication that comes from improvised tourniquets with any frequency is insufficient pressure to stop bleeding which is why they have been discouraged for some time now in favor of commercially available tourniquets.
 
Agreed

get it got it good.B)
 
While, I can't cite the frequency, one may also consider possible nerve damage as a complication, since that is one of the complications taught in phlebotomy when applying a tourniquet...and an arterial tourniquet would be much tighter than one used for venous blood draw (of course a proper tourniquet to stop bleeding would be wider than most venous tourniquets in order to reduce chance for tissue/nerve damage).
 
AnthonyM83 said:
While, I can't cite the frequency, one may also consider possible nerve damage as a complication, since that is one of the complications taught in phlebotomy when applying a tourniquet...and an arterial tourniquet would be much tighter than one used for venous blood draw (of course a proper tourniquet to stop bleeding would be wider than most venous tourniquets in order to reduce chance for tissue/nerve damage).
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Nerve and/or tissue damage mainly occurs after extended use. In most EMS situations the tourniquet will only be in place for a short amount of time.
 
crazycajun said:
Nerve and/or tissue damage mainly occurs after extended use. In most EMS situations the tourniquet will only be in place for a short amount of time.
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What he said.
 
they're about to take it out of the NJ basic curriculum though. Soon its just going to be direct pressure, and if that fails to control it, then tourniquet.
 
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