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 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 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 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

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

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

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 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 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 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

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

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