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HEMORRHAGE CONTROL

HEMORRHAGE CONTROL. RIFLES LIFESAVERS. Introduction. Review types of injuries Review Tactical Combat Casualty Care Evaluate and control bleeding Take home message: HEMORRHAGE CONTROL SAVES LIVES. Facts and Tips. Blood volume of the adult human body Approximately 5 to 6 liters

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HEMORRHAGE CONTROL

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  1. HEMORRHAGE CONTROL RIFLES LIFESAVERS

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

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

  4. Sources of Bleeding • 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 Control Bleeding

  5. External Bleeding Control Bleeding

  6. Types of External Bleeding • Lacerations • Abrasions • Puncture wounds • Amputations • Avulsions Control Bleeding

  7. Laceration Control Bleeding

  8. Abrasion Control Bleeding

  9. Puncture Wound Control Bleeding

  10. Amputations Control Bleeding

  11. Avulsion Control Bleeding

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

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

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

  15. Internal Bleeding Control Bleeding

  16. Injured Internal Organs Control Bleeding

  17. Internal Bleeding • 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 Control Bleeding

  18. CARE UNDER FIRE • “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 tohemorrhage from extremities Control Bleeding

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

  20. TACTICAL FIELD CARE • 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 Control Bleeding

  21. STOP THE BLEEDING ! • 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 Control Bleeding

  22. Pressure Points • 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 ( Control Bleeding

  23. Important Pressure Points • Brachial • Femoral ( Control Bleeding

  24. Brachial Pressure Point • 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 Control Bleeding

  25. Brachial Pressure Point Control Bleeding

  26. Brachial Pressure Point Control Bleeding

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

  28. Splints • 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 Control Bleeding

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

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

  31. Combat Application Tourniquet WINDLASS OMNI TAPE BAND WINDLASS STRAP Control Bleeding

  32. Tourniquet Application • Place tourniquet between the heart and wound • Wrap tourniquet around extremity • Tighten UNTIL BLEEDING STOPS Control Bleeding

  33. Tourniquet Application Control Bleeding

  34. Tourniquet Self-Application Control Bleeding

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

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

  37. Summary • 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 Control Bleeding

  38. Questions? Control Bleeding

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