Bleeding Control

7/23/2019 Bleeding Control

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MSTC, FT LEWIS WAMSTC, FT LEWIS WA

Bleeding Control Bleeding Control

Lesson FiveLesson Five



OverviewOverview

►Review methods of controlling bleeding in aReview methods of controlling bleeding in a

tactical environmenttactical environment

►Hemorrhage is the leading cause ofHemorrhage is the leading cause ofpreventable death on the battlefieldpreventable death on the battlefield

►Hemorrhage control save livesHemorrhage control save lives

►New Hemostatic agentsNew Hemostatic agents



Extremity HemorrhageExtremity Hemorrhage

Control Control

Extremity Hemorrhage continues tobe the leading cause of preventable

death on the battleeld.



Extremity HemorrhageExtremity Hemorrhage

Control Control

Over 25deathsoccurred in!ietnam

secondary tohemorrhagefromextremity"ounds.

#hesecasualtieshad no otherin$uries.

#he tactical situation maynot allo" the time norsafety for conventional

methods of controlling the



Blood Blood

► Hemorrhage or bleeding:Hemorrhage or bleeding:

Escape of blood from capillaries, veins, and arteriesEscape of blood from capillaries, veins, and arteries

► Adult bodyAdult body::

Contains approximately to ! liters of bloodContains approximately to ! liters of blood

" pint of blood without harmful effects" pint of blood without harmful effects

# pints may cause shoc$ # pints may cause shoc$



External BleedingExternal Bleeding

► %ncision%ncision

► &aceration&aceration

► AbrasionAbrasion

► 'uncture wounds'uncture wounds

► AmputationAmputation



LacerationLaceration



Puncture Wound Puncture Wound



Amputation Amputation



Abrasion Abrasion



ncisionncision



nternal Bleedingnternal Bleeding



n!ured nternal Organsn!ured nternal Organs



"ources o# Bleeding"ources o# Bleeding

► ArterialArterial Rapid, profuse and pulsatingRapid, profuse and pulsating

Bright red in colorBright red in color

► VenousVenous Stead !o"Stead !o"

#ar$ red or %aroon in color#ar$ red or %aroon in color

► CapillarCapillar Slo" and oo&ingSlo" and oo&ing

'ften clots spontaneousl'ften clots spontaneousl



Arterial Bleed Arterial Bleed



nternal "igns o#nternal "igns o#

HemorrhageHemorrhage Soft tissue (ruisingSoft tissue (ruising

A(do%inal tendernessA(do%inal tenderness

)e%optsis *(lood fro% lungs+)e%optsis *(lood fro% lungs+

)e%ate%esis *(lood fro% sto%ach+)e%ate%esis *(lood fro% sto%ach+

Melena *(lood stools+Melena *(lood stools+



$reatment $reatment

Assess the tactical situationAssess the tactical situation

Epose the "ound, cut a"a loose clothingEpose the "ound, cut a"a loose clothing

%o not%o not re%o-e clothing that is stuc$ to the "oundre%o-e clothing that is stuc$ to the "ound Chec$ for eit "oundChec$ for eit "ound

.lace a E%ergenc Bandage o-er the "ound and appl.lace a E%ergenc Bandage o-er the "ound and appl

pressure/pressure/ If under ene% 0re rapid appl a tourni1uet and %o-eIf under ene% 0re rapid appl a tourni1uet and %o-e

casualt to co-ercasualt to co-er



Expose the Wound Expose the Wound

► %o not%o not atte%pt to clean the "oundatte%pt to clean the "ound

► %o not%o not pro(e the "ound in order topro(e the "ound in order to

re%o-e an o(2ect fro% the "oundre%o-e an o(2ect fro% the "ound

► %o not%o not atte%pt to re%o-eatte%pt to re%o-e

an o(2ect i%paled in thean o(2ect i%paled in the"ound"ound



$reatment $reatment

Bleeding nor%all canBleeding nor%all can(e controlled (3(e controlled (3

►

E%ergenc Trau%aE%ergenc Trau%a#ressing#ressing

► First4aid, ManualFirst4aid, Manualpressure andpressure andele-ationele-ation

► Tourni1uet Tourni1uet

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Emergency $raumaEmergency $rauma

%ressing%ressing►All in one dressing used as aAll in one dressing used as a

0eld5pressure dressing to stop %ild to0eld5pressure dressing to stop %ild tose-ere (leedingse-ere (leeding

►Ma (e used on an part of the (odMa (e used on an part of the (od

►6ot reco%%ended for use as a6ot reco%%ended for use as a

tourni1uet for se-ere arterial (leeding,tourni1uet for se-ere arterial (leeding,although the sa%e procedure can (ealthough the sa%e procedure can (eused to increase pressure on the "oundused to increase pressure on the "ound



Emergency $raumaEmergency $rauma

%ressing%ressing







$ourni&uet $ourni&uet

#he need for immediateaccess to a tourni&uetin such situationsma'es it clear that all

soldiers on combatmissions should have asuitable tourni&uetreadily available in astandard location intheir battle gear and betrained to use it.

(s the tactical situation permits and more timeand safety is available) consider loosening the

tourni&uet * %O +O# ,E-O!E ) and using directpressure and/or a pressure dressing to control the



$ourni&uet 'emoval $ourni&uet 'emoval

,E-E-0E,1 f unableto control bleedingexcept "ith a

tourni&uet) it is betterto sacrice a limb thanto lose a life toexcessive bleeding.



Combat ApplicationCombat Application


#ourni&uet of

choice

3ontrols 0leeding

Light"eight

Easy touse

The recommended means to control

bleeding in a tactical environment.







4tep 4tep 6lace the"ounded

extremitythrough the loopof the 4elf7adhering 0and

6lacetourni&uet above

the

4tep 24tep 2



6ull the free7running endof the 4elf7

adhering0and tightand securelyfasten it bac'on itself.

(dhere 4elf7adhering 0andcompletelyaround the limbuntil the clip is

reached.

4tep 84tep 8

Step 4Step 4



#"ist the9indlass ,od

until thebleeding hasstopped.

Loc' the ,od in

place "ith the9indlass 3lip

4tep 54tep 5

Step 6Step 6



For small extremities)continue to adherethe 4elf7adhering0and around theextremity and overthe 9indlass ,od.

:rasp the9indlass

4trap) pull ittight) andadhere it tothe velcro onthe 9indlass

3lip.

4tep ;4tep ;

Step 8Step 8





#he 3(# #ourni&uet is no" ready fortransport.





+O#E1

#he friction adaptor

buc'le is notnecessary forproper 3.(.#.application to an

arm. t -<4# beused "ith t"ohands "henapplying to a leg.





Large Extremity ApplicationLarge Extremity Application



Large Extremity ApplicationLarge Extremity ApplicationCombat ApplicationCombat Application


#o use) "rapthe 4elf7adhering 0and

through thefrictionadaptorbuc'le.

Large Extremity ApplicationLarge Extremity Application



Large Extremity ApplicationLarge Extremity ApplicationCombat ApplicationCombat Application


#his preventsthe 4elf7adhering 0andfrom looseningduring

transport.



$he "pecial Operations(orces $actical $ourni&uet




►Forceful, arterial (leedingForceful, arterial (leeding

*a%putation+ %a re1uire earl*a%putation+ %a re1uire earl

use of a tourni1uet/use of a tourni1uet/

►#' 6'T WASTE TIME atte%pting a#' 6'T WASTE TIME atte%pting a

pressure dressing in these casespressure dressing in these cases

A l i dA l i d



Apply an mprovised Apply an mprovised


►7se an %aterial to %a$e an7se an %aterial to %a$e an

i%pro-ised tourni1uet3i%pro-ised tourni1uet3

►Cra-ats, grenade ring, rigid o(2ectCra-ats, grenade ring, rigid o(2ect

such as a strong stic$, tape, &ipsuch as a strong stic$, tape, &ip

ties, riggers (elt, etc/ties, riggers (elt, etc/



Apply a $ourni&uet Apply a $ourni&uet

► 6e-er co-er a tourni1uet6e-er co-er a tourni1uet

► 8T9 on casualt8s forehead or so%e"here8T9 on casualt8s forehead or so%e"here*Sharpie pen+/*Sharpie pen+/

►

In co%(at "hen the tactical situationIn co%(at "hen the tactical situationallo"s, loosening a tourni1uet isallo"s, loosening a tourni1uet is

appropriate/appropriate/




► When loosening a tourni1uet do not re%o-e itWhen loosening a tourni1uet do not re%o-e itfro% the li%(/fro% the li%(/

► If the tourni1uet has (een in place for : ;If the tourni1uet has (een in place for : ;

hours do not re%o-e/hours do not re%o-e/

► If !uid resuscitation is re1uired it should (eIf !uid resuscitation is re1uired it should (eacco%plished (efore the tourni1uet isacco%plished (efore the tourni1uet is

re%o-ed/re%o-ed/

► Tourni1uets are -er painful, pro-ide pain Tourni1uets are -er painful, pro-ide pain%eds as needed/%eds as needed/




►'nce the tactical situation allo"s,'nce the tactical situation allo"s,

tourni1uets should (e loosened andtourni1uets should (e loosened and

other %ethods to stop (leeding appliedother %ethods to stop (leeding applied

►#irect pressure4pressure dressing#irect pressure4pressure dressing

►)e%Con Chitosan Bandage)e%Con Chitosan Bandage




► If tourni1uet has (een in place for onl <4=If tourni1uet has (een in place for onl <4=

hours, loosening and other %ethods tohours, loosening and other %ethods to

control he%orrhage can sal-age li%(s/control he%orrhage can sal-age li%(s/

► Re%e%(er3 if una(le to control he%orrhageRe%e%(er3 if una(le to control he%orrhage

( other %eans re4tighten the tourni1uet/( other %eans re4tighten the tourni1uet/

► It is (etter to sacri0ce the li%( than to loseIt is (etter to sacri0ce the li%( than to lose

a life to he%orrhage/a life to he%orrhage/



Amputation Amputation

►Apply pressure dressing to cover end of theApply pressure dressing to cover end of the

stump(stump(

►)erlix and !in Ace wrap for effective pressure)erlix and !in Ace wrap for effective pressuredressing(dressing(

►Rinse amputated part free of debrisRinse amputated part free of debris

►*rap loosely in saline+moistened sterile gaue*rap loosely in saline+moistened sterile gaue



Preservation o#Preservation o#

Amputation Parts Amputation Parts► -eal amputated part in a plastic bag or cravat-eal amputated part in a plastic bag or cravat

► 'lace in a cool container, do not freee'lace in a cool container, do not freee

► Never Never place amputated part in waterplace amputated part in water

► Never Never place amputated part directly on iceplace amputated part directly on ice

► Never Never use dry ice to cool an amputated partuse dry ice to cool an amputated part



%ressing an Amputation%ressing an Amputation

►.lace a dressing *soft 5 a(sor(ent+.lace a dressing *soft 5 a(sor(ent+o-er the end of the stu%po-er the end of the stu%p

►Secure the dressing "ith (andagesSecure the dressing "ith (andages

►

.re-ents conta%ination

.re-ents conta%ination

►.rotects fro% additional in2ur.rotects fro% additional in2ur

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Ace Wrap)*erlix Ace Wrap)*erlix

►.ac$ large "ounds "ith >erli gau&e.ac$ large "ounds "ith >erli gau&eand "rap "ith an Ace Wrapand "rap "ith an Ace Wrap

►Secure end of Ace Wrap -ia t"o %eans3Secure end of Ace Wrap -ia t"o %eans3 Circu%ferential tapeCircu%ferential tape

Cut <?@ do"n center of Ace Wrap and tieCut <?@ do"n center of Ace Wrap and tie

►Chec$ distal pulse after application toChec$ distal pulse after application toan etre%itan etre%it



+uic,Clot +uic,Clot

H C ChitHemCon Chitosan



HemCon ChitosanHemCon Chitosan

%ressing%ressing

Chit H t tiChit H t ti



Chitosan HemostaticChitosan Hemostatic

%ressing%ressing

)old the foil o-er4)old the foil o-er4pouch so thatpouch so thatinstructions can (einstructions can (eread/ Identifread/ Identifunsealed edges at theunsealed edges at thetop of the o-er4pouchtop of the o-er4pouch

.eel open o-er4pouch ( pulling.eel open o-er4pouch ( pullingthe unsealed edges apartthe unsealed edges apart

Chit H t tiChitosan Hemostatic




%ressing%ressing

Trap dressing betweenTrap dressing between

bottom foil and non-bottom foil and non-

absorbable green/blackabsorbable green/black

polyester backing withpolyester backing with

your hand and thumb your hand and thumb

Hold dressing by theHold dressing by thenon-absorbablenon-absorbable

polyester backing andpolyester backing and

discard the foil over-discard the foil over-

pouch Hands must bepouch Hands must be





%ressing%ressing





%ressing%ressing

► .lace the light colored sponge portion of.lace the light colored sponge portion ofthe dressing directl to the "ound areathe dressing directl to the "ound area"ith the %ost se-ere (leeding/ Appl"ith the %ost se-ere (leeding/ Applpressure for = %inutes or until the dressingpressure for = %inutes or until the dressing

adheres and (leeding stops/ 'nce appliedadheres and (leeding stops/ 'nce appliedand in contact "ith the (lood and otherand in contact "ith the (lood and other!uids, the dressing cannot (e repositioned/!uids, the dressing cannot (e repositioned/

► A ne" dressing should (e applied to otherA ne" dressing should (e applied to othereposed (leeding sites Each ne" dressingeposed (leeding sites Each ne" dressing%ust (e in contact "ith tissue "here%ust (e in contact "ith tissue "here(leeding is hea-iest/ Care %ust (e ta$en to(leeding is hea-iest/ Care %ust (e ta$en toa-oid contact "ith the patients ees/a-oid contact "ith the patients ees/





%ressing%ressing

► If dressing is not eecti-e in stoppingIf dressing is not eecti-e in stopping(leeding after %inutes, re%o-e original(leeding after %inutes, re%o-e originaland appl a ne" dressing/ Additionaland appl a ne" dressing/ Additionaldressings cannot (e applied o-erdressings cannot (e applied o-erineecti-e dressingineecti-e dressing

► Appl a (attle dressing5(andage toAppl a (attle dressing5(andage tosecure he%ostatic dressing in placesecure he%ostatic dressing in place

► )e%ostatic dressings should onl (e)e%ostatic dressings should onl (ere%o-ed ( responsi(le persons afterre%o-ed ( responsi(le persons after

e-acuation to the net le-el of caree-acuation to the net le-el of care



Female ra&i patient

Iraqi National;

No Bleeding;

Survived



+uestions----+uestions----

Documents

Bleeding Control