External Hemorrhage Management

External Hemorrhage Management

• Direct pressure combined with pressure dressings and/or splints can manage external hemorrhage
• Tourniquets are preferred for external bleeding in an extremity that cannot be controlled with direct pressure or pressure dressing
• High flow oxygen and assisted ventilations should be provided if needed
• Direct pressure should be applied with gloved hands, using a sterile dressing, and checking for a distal pulse
• Pressure dressings should be firmly wrapped around the entire wound, covering the entire dressing above and below the wound, and tightened to control bleeding

Wound Packing

• Wound packing creates an internal pressure dressing that fills the wound cavity and applies pressure from within
• It involves taking standard initial steps to control bleeding, then pushing gauze into the wound with an index finger to completely and tightly pack the wound cavity
• Hemostatic agents should be used to enhance clot formation in the wound site
• Hemostatic agents adhere to damaged tissue, dehydrating the blood or stimulating the natural blood clotting cascade

Tourniquets

• Tourniquets are useful for severe hemorrhaging from an extremity injury below the axilla or groin when other methods of control are ineffective
• Available tourniquet kits include Combat Application Tourniquet (CAT), Special Operation Forces Tactical Tourniquet, Ratcheting Medical Tourniquet, and more
• If a commercial tourniquet is not available, a triangle bandage and a rod or stick can be used to apply a tourniquet
• Junctional tourniquets are used for hemorrhage in the inguinal or axillary areas, where a traditional tourniquet cannot be applied

Air Splints and Traction Splints

• Air splints are useful for controlling bleeding associated with severe soft tissue injuries
• Rigid splints can help stabilize fractures, reduce pain, and prevent further damage to soft tissue injuries
• Traction splints can stabilize isolated femur fractures, although they are rarely used in EMS

Nasal, Oral, and Auricular Hemorrhage

• Hemorrhaging from the nose, ears, and mouth can be caused by skull fractures, facial fractures, sinusitis, infections, high blood pressure, and coagulation disorders
• Bleeding from the nose or following a serious head injury may indicate a potential skull fracture
• Loosely cover the bleeding site with a sterile gauze pad and apply light compression by wrapping the dressing loosely around the head

Internal Hemorrhage

• Definitive care for internal hemorrhage is rapid transport to the ED
• Treatment should focus on treatment of shock, minimizing movement of the injured or bleeding part of the region, and rapid transport
• Give the patient nothing by mouth, and ensure IV access is gained, with fluids given if necessary, while keeping the patient warm and taking standard precautions

External Hemorrhage Management

• Direct pressure combined with pressure dressings and/or splints can manage external hemorrhage
• Tourniquets are preferred for external bleeding in an extremity that cannot be controlled with direct pressure or pressure dressing
• High flow oxygen and assisted ventilations should be provided if needed
• Direct pressure should be applied with gloved hands, using a sterile dressing, and checking for a distal pulse
• Pressure dressings should be firmly wrapped around the entire wound, covering the entire dressing above and below the wound, and tightened to control bleeding

Wound Packing

• Wound packing creates an internal pressure dressing that fills the wound cavity and applies pressure from within
• Hemostatic agents should be used to enhance clot formation in the wound site
• Hemostatic agents adhere to damaged tissue, dehydrating the blood or stimulating the natural blood clotting cascade

Tourniquets

• Tourniquets are useful for severe hemorrhaging from an extremity injury below the axilla or groin when other methods of control are ineffective
• Available tourniquet kits include Combat Application Tourniquet (CAT), Special Operation Forces Tactical Tourniquet, Ratcheting Medical Tourniquet, and more
• If a commercial tourniquet is not available, a triangle bandage and a rod or stick can be used to apply a tourniquet
• Junctional tourniquets are used for hemorrhage in the inguinal or axillary areas, where a traditional tourniquet cannot be applied

Air Splints and Traction Splints

• Air splints are useful for controlling bleeding associated with severe soft tissue injuries
• Rigid splints can help stabilize fractures, reduce pain, and prevent further damage to soft tissue injuries
• Traction splints can stabilize isolated femur fractures, although they are rarely used in EMS

Nasal, Oral, and Auricular Hemorrhage

• Hemorrhaging from the nose, ears, and mouth can be caused by skull fractures, facial fractures, sinusitis, infections, high blood pressure, and coagulation disorders
• Bleeding from the nose or following a serious head injury may indicate a potential skull fracture
• Loosely cover the bleeding site with a sterile gauze pad and apply light compression by wrapping the dressing loosely around the head

Internal Hemorrhage

• Definitive care for internal hemorrhage is rapid transport to the ED
• Treatment should focus on treatment of shock, minimizing movement of the injured or bleeding part of the region, and rapid transport
• Give the patient nothing by mouth, and ensure IV access is gained, with fluids given if necessary, while keeping the patient warm and taking standard precautions