Hunter
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Child safety locks for known elopement risk bakeracts.
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the 100% directionless thread
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Wheel
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I may need a Facebook vacation. First, I hate Harlem shake videos. Second, there is a friend of mine that insists on posting "this study shows that marijuana is good for your brain! (Study that stated that marijuana has properties that are neuroprotective in subjects who were binge drinkers) I dare say that's not exactly what that means.
adamjh3
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Wheel
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Thank you. This officially made my night.
EpiEMS
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I bet that was entertaining to try and get to stop bleeding.
adamjh3
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Probably the only time I'll ever be quicker on the draw than him.
This little gem made my night
"Ma'am, what do you normally take for your pain?"
"Delorean"
"... Dilaudid?"
"No, I'm pretty sure it's Delorean"
DesertMedic66
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Seems when I went down to part time status my profile for our CE website (300+ free CE hours) got deleted so now I can't take any classes on there. Ooh and I still haven't received my W2 form for taxes. Looks like I'm going to be making a couple of calls to HR tomorrow.
Yeah...
Direct pressure didn't work. Combat style tourniquet holding direct pressure didn't work. Finally a pressure infusion bag with the arm slid in it did.
katgrl2003
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I had a similar run on Christmas day. They ended up having to put a few stitches in the graft.
katgrl2003
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Holy crap, way sick is an understatement. We tried a tourniquet and direct pressure, luckily the hospital was about 3 miles away. It took forever to get all the blood cleaned up.
Clare
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Dialysis shunts bleed .... a lot
We had a guy about a year ago, bleeding profusely, called for backup, just before back up arrived the patient had a cardiac arrest, resuscitation was unsuccessful.
Because they are small (only a couple cm) the best way to stop bleeding is to use very firm, very direct pressure over the shunt, use a balled up combine dressing or a gauze pad; push hard wish several fingers or the heel of your hand.
I think it has something to do with basic physics, hell I don't know physics is evil, but something about pressure distribution; in the past I always thought you wrapped a dressing around it then put another one ontop and re-bandaged but apparently that just distributes the pressure over a larger area so it is less effective hence we are told the most effective way is very, very firm, very, very direct pressure.
I am mixed on tourniquets; I've never used one, but I have seen them used, and the two times I have is not when I would use them myself and they are probably overused.
I know something was published somewhere from the Clinical Standards Unit about stopping bleeding, I will have a look and see if I can find it.
Clare
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Here we go, from the Clinical Standards Unit ...
The lesson - stopping external bleeding
• Arterial bleeding usually requires very firm and very direct pressure (using a hand, or fingers directly over the bleeding point), as shown in photo on the previous page where a lacerated carotid artery is being directly compressed, or it requires a tourniquet to be applied proximal to the bleeding at a tight enough pressure that it stops arterial flow.
• Arterial bleeding is often not adequately controlled by applying bandages (even tight ones) – particularly if there is a flat dressing or towel underneath that has been placed across a large area.
• Flat dressings or towels underneath bandages distribute the pressure across a large surface area – reducing the amount of direct pressure applied to the actual bleeding point.
• If a bandage is being applied for control of significant bleeding a dressing must be placed underneath in such a way that it provides pressure directly over the site of bleeding – this almost always means that the dressing needs to be tightly folded or ‘balled up’ and placed directly over the point of bleeding.
• If bleeding continues despite applying pressure then applying more dressings on top will usually not fix the problem – all this will do is to reduce the amount of pressure applied to the actual point of bleeding. In this situation - take the dressing off, see where the most bleeding is coming from and apply very firm and direct pressure over this area. If this does not control the bleeding then a tourniquet may be required.
• Dialysis fistulas can bleed a lot. They are under arterial pressure and are only just below the skin. They usually bleed because they are infected or because they have been lacerated.
• Varicose veins can bleed a lot. They need immediate elevation of the foot to above the heart (this reduces venous pressure considerably) in combination with firm direct pressure – often a finger or two is all that is required.
• Do not waste time at the scene waiting for backup; load and treat en-route; that is, move towards hospital as soon as possible. All practice levels from Ambulance Officer up have tourniquets in their delegated scope of practice and control of bleeding is an ordinary intervention that my be performed by all personnel. IV access and fluid resuscitation is a very low priority pales into insignificance when compared to time to get the patient to a hospital, particularly if they are very shocked. If transport time is going to be extended and back up is close then it is acceptable to wait a few minutes for back up to arrive.
The lesson - stopping external bleeding
• Arterial bleeding usually requires very firm and very direct pressure (using a hand, or fingers directly over the bleeding point), as shown in photo on the previous page where a lacerated carotid artery is being directly compressed, or it requires a tourniquet to be applied proximal to the bleeding at a tight enough pressure that it stops arterial flow.
• Arterial bleeding is often not adequately controlled by applying bandages (even tight ones) – particularly if there is a flat dressing or towel underneath that has been placed across a large area.
• Flat dressings or towels underneath bandages distribute the pressure across a large surface area – reducing the amount of direct pressure applied to the actual bleeding point.
• If a bandage is being applied for control of significant bleeding a dressing must be placed underneath in such a way that it provides pressure directly over the site of bleeding – this almost always means that the dressing needs to be tightly folded or ‘balled up’ and placed directly over the point of bleeding.
• If bleeding continues despite applying pressure then applying more dressings on top will usually not fix the problem – all this will do is to reduce the amount of pressure applied to the actual point of bleeding. In this situation - take the dressing off, see where the most bleeding is coming from and apply very firm and direct pressure over this area. If this does not control the bleeding then a tourniquet may be required.
• Dialysis fistulas can bleed a lot. They are under arterial pressure and are only just below the skin. They usually bleed because they are infected or because they have been lacerated.
• Varicose veins can bleed a lot. They need immediate elevation of the foot to above the heart (this reduces venous pressure considerably) in combination with firm direct pressure – often a finger or two is all that is required.
• Do not waste time at the scene waiting for backup; load and treat en-route; that is, move towards hospital as soon as possible. All practice levels from Ambulance Officer up have tourniquets in their delegated scope of practice and control of bleeding is an ordinary intervention that my be performed by all personnel. IV access and fluid resuscitation is a very low priority pales into insignificance when compared to time to get the patient to a hospital, particularly if they are very shocked. If transport time is going to be extended and back up is close then it is acceptable to wait a few minutes for back up to arrive.
RocketMedic
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The opposite actually, Clare, tourniquets here are way underused. Why mess around with direct pressure for a major extremity bleed when you can tourniquets it? Most people are still afraid of them. Iraq and Afghanistan have proven that tourniquets are not automatic amputations, do not generally cause damage, and a4e rarely contraindicated. If you might need one, you probably do.
Clare
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Depends what you are dealing with; most bleeding can be controlled with very firm, very direct pressure (see the above points from CSU) however for life threatening haemmorhage that cannot be controlled, by all means, use a tourniquet.
The situations I have seen them used is in patients where the CAT has been slapped into somebodys limb when bleeding has been controlled but it has just bled a lot so it "looks bad"
katgrl2003
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That's pretty much what we did, in addition to the tourniquet. I had to hold the radio for my medic because she had both hands holding pressure.
I agree with Rocketmedic. This is the first time I have used a tourniquet. There have been times in the past I probably could have used them, but I didn't think it was necessary. I think they are very underutilized.
Clare
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You raise a great point; an early RT call to the hospital for this sort of thing is a great idea; especially if you are transporting to a hospital where they do not have a 24 hour surgical service (i.e. the Registrar is on-call); or at any rate even if they do; place an RT call early so they can get the surgical service up and about, and down to resus to meet you.
I guess you could put very, very firm pressure with a small balled up combine dressing or a couple of 4x4s and bandage them very, very tightly in place to free up a hand? ... never tried it.
Very firm pressure, load and transport without delaying waiting for backup or trying to get IV access and fluids (unless you can do all three (pressure, transport and cannulation/infusion simultaneously) and place an early R40 to the hospital.
But you perhaps see more penetrating trauma with life threatening haemmorhage than we?
I'll see if I can get some feedback on our use of tourniquets from CSU
Hey, I'd love to go back in time to prevent some painful episodes I've had too. I think I'd prefer to do it this way though
