HEMORRHAGE CONTROL RIFLES LIFESAVERS Core Skills Control Bleeding

Introduction n n Review types of injuries Review Tactical Combat Casualty Care Evaluate and control bleeding Take home message: HEMORRHAGE CONTROL SAVES LIVES Core Skills Control Bleeding 2

Facts and Tips n n Blood volume of the adult human body n Approximately 5 to 6 liters n Loss of as little as 2 pints may cause shock Field blood pressures, when palpable pulse is appreciated n Carotid: SBP>60 mm. Hg n Femoral: SBP>70 mm. Hg n Radial: SBP>80 mm. Hg Core Skills Control Bleeding 3

Sources of Bleeding n n n Arterial - Rapid, profuse and pulsating - Bright red in color Venous - Steady flow, nonpulsating - Dark red or maroon in color Capillary - Slow and oozing - Often clots spontaneously, not dangerous Core Skills Control Bleeding 4

External Bleeding Core Skills Control Bleeding 5

Types of External Bleeding n Lacerations n Abrasions n Puncture wounds n Amputations n Avulsions Core Skills Control Bleeding 6

Laceration Core Skills Control Bleeding 7

Abrasion Core Skills Control Bleeding 8

Puncture Wound Core Skills Control Bleeding 9

Amputations Core Skills Control Bleeding 10

Avulsion Core Skills Control Bleeding 11

Internal Bleeding n Can occur with blunt or penetrating trauma n Suspicion based on mechanism of injury n Falls n Blast injuries n Penetrating trauma Core Skills Control Bleeding 12

Causes of Internal Bleeding n Blunt Trauma n Auto vs. pedestrian n Motor vehicle accidents n Falls n Blast injuries n Etc. Core Skills n Penetrating injuries Gunshot wounds n Stab wounds n Shrapnel wounds n Control Bleeding 13

Internal Bleeding n Signs and Symptoms n Pain, tenderness, swelling, discoloration at injury site n Bleeding from any body orifice n Vomiting blood n Tender, rigid, or distended abdomen Core Skills Control Bleeding 14

Internal Bleeding Core Skills Control Bleeding 15

Injured Internal Organs Core Skills Control Bleeding 16

Internal Bleeding n n Can result in rapid progression to hypovolemic shock and death IV fluids may buy time The scalpel is the cure: The rapidly spiraling patient requires surgical intervention Immediate evacuation Core Skills Control Bleeding 17

CARE UNDER FIRE n n n “The best medicine on any battlefield is fire superiority” Control of hemorrhage is essential since injury to a major vessel can result in hypovolemic shock in a short time frame 2/3 of all preventable combat deaths are due to hemorrhage from extremities Core Skills Control Bleeding 18

CARE UNDER FIRE n n Prompt use of tourniquets to stop bleeding may be life saving Various types of tourniquets exist the Combat application tourniquet (CAT) n Theraband n Cloth and stick n Core Skills Control Bleeding 19

TACTICAL FIELD CARE n n n Evaluation begins with ABCs with attention to priorities Any bleeding site not previously controlled should be addressed Significant bleeding should be controlled using a tourniquet Initiate IV fluids Prepare for evacuation Core Skills Control Bleeding 20

STOP THE BLEEDING ! n n n n Apply direct pressure with gauze or Israeli dressing Elevate the extremity above the heart Apply additional dressings if wound continues to bleed Apply pressure to appropriate pressure point if continues to bleed Immobilize injured extremity with a splint Apply tourniquet if continues to bleed Initiate IV fluids and treatment for shock as needed Core Skills Control Bleeding 21

Pressure Points n ( n n May be helpful with severe bleeding as an adjunct Apply when bleeding not controlled by direct pressure and elevation Apply pressure to appropriate pressure point Core Skills Control Bleeding 22

Important Pressure Points n Brachial n Femoral ( Core Skills Control Bleeding 23

Brachial Pressure Point n n Located in upper arm above the elbow in the groove between muscles Apply pressure to the inside of the arm over the bone using the fingers or thumb Core Skills Control Bleeding 24

Brachial Pressure Point Core Skills Control Bleeding 25

Brachial Pressure Point Core Skills Control Bleeding 26

Femoral Pressure Point n n To control severe bleeding of thigh and lower leg Located at front, center part of crease in the groin Core Skills Control Bleeding 27

Splints n n n Immobilization of the injured extremity is one of the best ways to stop bleeding Broken bone fragments may lacerate blood vessels Muscular activity will increase rate of blood flow Core Skills Control Bleeding 28

Tourniquets n Early use of a tourniquet in the setting of forceful arterial bleeding, such as an amputation, may be life-saving n STOP THE BLEEDING! Core Skills Control Bleeding 29

Tourniquets n n Use a commercial tourniquet, such as the Combat Application Tourniquet, if available If not available, then use. . n n n Cravat Belt Rope Strap from LBE Any available material Core Skills Control Bleeding 30

Combat Application Tourniquet WINDLASS OMNI TAPE BAND Core Skills WINDLASS STRAP Control Bleeding 31

Tourniquet Application n Place tourniquet between the heart and wound n Wrap tourniquet around extremity n Tighten UNTIL BLEEDING STOPS Core Skills Control Bleeding 32

Tourniquet Application Core Skills Control Bleeding 33

Tourniquet Self-Application Core Skills Control Bleeding 34

Tourniquet Etiquette Never cover a tourniquet with another dressing, etc. n Write “T” on the casualty's forehead with pen or blood n Never loosen or remove a tourniquet once placed n Core Skills Control Bleeding 35

Amputation First, STOP THE BLEEDING! n Use direct pressure, Israeli dressing, or tourniquet as necessary n Apply dressing to cover end of the stump n Blood vessels may collapse, retract or curl closed and limit bleeding n Core Skills Control Bleeding 36

Summary n n Care Under Fire: Stop significant bleeding with tourniquet while returning fire Tactical Field Care: ABCs with attention to stopping significant bleeding Evacuation Care: Treat shock with IV fluids, rapid evacuation to surgical assets This knowledge will save lives in Iraq, maybe your own Core Skills Control Bleeding 37

Questions? Core Skills Control Bleeding 38