External Hemorrhage Management

External Hemorrhage Management

• Direct pressure combined with pressure dressings and/or splints can manage external hemorrhage
• Tourniquet use is preferred for external bleeding in an extremity that cannot be controlled with direct pressure or pressure dressing
• Apply direct local pressure to the bleeding site with a fingertip or hand over a sterile dressing
• Create a pressure dressing by firmly wrapping a sterile self-adhering roller bandage around the entire wound to control bleeding and check for a distal pulse

Wound Packing with Hemostatic Agents

• Wound packing creates an internal pressure dressing that fills the wound cavity and applies pressure from within
• Standard initial steps to control bleeding must be taken before wound packing
• Push gauze into the wound with an index finger to completely and tightly pack the wound cavity
• Hold firm direct manual pressure on the wound for at least 3 minutes or secure the wound with a snug pressure dressing
• Hemostatic agents enhance clot formation, adhere to damaged tissue, and stimulate the natural blood clotting cascade

Tourniquet Use

• Tourniquets are useful for severe hemorrhaging from an extremity injury below the axila or groin when other methods of control are ineffective
• Commercial tourniquet kits include Combat Application Tourniquet (CAT), Special Operation Forces Tactical Tourniquet, Ratcheting Medical Tourniquet, and others
• If a commercial tourniquet kit is not available, use a triangle bandage and a rod or stick to create a makeshift tourniquet

Junctional Tourniquet

• Used when hemorrhage is inguinal or axillary (in the hip and armpit areas) and a tourniquet cannot be applied
• Ensure the tourniquet is proximal to the zone of injury and as close to the groin or axila as possible
• Use the widest bandage possible and tighten securely, but never cover with a bandage

Air Splints and Rigid Splints

• Air splints are good for controlling bleeding associated with severe soft tissue injuries
• Rigid splints help stabilize fractures, reduce pain, and prevent further damage to soft tissue injuries
• Traction splints stabilize isolated femur fractures

Internal Hemorrhage Management

• There is no pre-hospital treatment for internal hemorrhage, so focus on rapid transport to the ED
• Treatment should focus on treatment of shock, minimizing movement of the injured or bleeding part, and rapid transport
• Give the patient nothing by mouth, establish IV access, and provide fluids if necessary
• Keep the patient warm, focus on extenuating hemorrhage, and take standard precautions to ensure scene safety

External Hemorrhage Management

• Combining direct pressure with pressure dressings and/or splints can effectively manage external hemorrhage
• Tourniquet use is preferred for external bleeding in an extremity that cannot be controlled with direct pressure or pressure dressing
• Apply direct local pressure to the bleeding site with a fingertip or hand over a sterile dressing
• Create a pressure dressing by firmly wrapping a sterile self-adhering roller bandage around the entire wound to control bleeding and check for a distal pulse

Wound Packing with Hemostatic Agents

• Wound packing creates an internal pressure dressing that fills the wound cavity and applies pressure from within
• Standard initial steps to control bleeding must be taken before wound packing
• Push gauze into the wound with an index finger to completely and tightly pack the wound cavity
• Hold firm direct manual pressure on the wound for at least 3 minutes or secure the wound with a snug pressure dressing
• Hemostatic agents enhance clot formation, adhere to damaged tissue, and stimulate the natural blood clotting cascade

Tourniquet Use

• Tourniquets are useful for severe hemorrhaging from an extremity injury below the axila or groin when other methods of control are ineffective
• Commercial tourniquet kits include Combat Application Tourniquet (CAT), Special Operation Forces Tactical Tourniquet, Ratcheting Medical Tourniquet, and others
• If a commercial tourniquet kit is not available, use a triangle bandage and a rod or stick to create a makeshift tourniquet

Junctional Tourniquet

• Used when hemorrhage is inguinal or axillary (in the hip and armpit areas) and a tourniquet cannot be applied
• Ensure the tourniquet is proximal to the zone of injury and as close to the groin or axila as possible
• Use the widest bandage possible and tighten securely, but never cover with a bandage

Air Splints and Rigid Splints

• Air splints are effective for controlling bleeding associated with severe soft tissue injuries
• Rigid splints help stabilize fractures, reduce pain, and prevent further damage to soft tissue injuries
• Traction splints are used to stabilize isolated femur fractures

Internal Hemorrhage Management

• Focus on rapid transport to the ED as there is no pre-hospital treatment for internal hemorrhage
• Treat shock, minimize movement of the injured or bleeding part, and provide rapid transport
• Give the patient nothing by mouth, establish IV access, and provide fluids if necessary
• Keep the patient warm, focus on extenuating hemorrhage, and take standard precautions to ensure scene safety

Learn how to manage external hemorrhage using direct pressure, pressure dressings, splints, and tourniquets. Understand the steps to control bleeding and create a pressure dressing.