Emergency bleeding control is the steps or actions taken to control bleeding from a patient who has suffered a traumatic injury or who has a medical condition which has led to bleeding.
Many bleeding control techniques are taught as part of first aid throughout the world,[1][2] although some more advanced techniques such as tourniquets, are often taught as being reserved for use by health professionals, or as an absolute last resort, in order to mitigate the risks associated with them, such as potential loss of limbs.[3]
Contents |
The type of wound (incision, laceration, puncture etc.) will have a major effect on the way a wound is managed, as will the area of the body affected and the presence of any foreign objects in the wound. The key principles of wound management are:[1]
In situations where direct pressure and elevation are either not possible or proving ineffective, and there is a risk of exsanguination, some training protocols advocate the use of pressure points to constrict the major artery which feeds the point of the bleed. This is usually performed at a place where a pulse can be found, such as in the femoral artery. There are significant risks involved in performing pressure point constriction, including necrosis of the area below the constriction, and most protocols give a maximum time for constriction (often around 10 minutes). There is particularly high danger if constricting the carotid artery in the neck, as the brain is sensitive to hypoxia and brain damage can result within minutes of application of pressure. Other dangers in use of a constricting method include rhabdomyolysis, which is a build up of toxins below the pressure point, which if released back in to the main bloodstream may cause cardiogenic shock
Another method of achieving constriction of the supplying artery is via the use of a tourniquet - a tightly tied band which goes around a limb to restrict blood flow. Tourniquets are routinely used in order to bring veins to the surface for cannulation, although their use in emergency medicine is more limited, and is restricted in most countries (with France being a notable exception) to professionals such as physicians and paramedics, as this is often considered beyond the reach of first aid and those acting in good faith as a good samaritan. A key exception is the military, where many armies carry a tourniquet as part of their personal first aid kit. Most Police in Australia are also authorised to apply a tourniquet to bleeding victims, which is often the case if they arrive onsite before ambulance personnel do. This is reflective of the higher chance of receiving massive trauma (such as amputation) and the increased time involved in reaching definitive care.
Improvised tourniquets, however, usually fail to achieve force enough to compress the arteries of the limb and thus do not only fail to stop arterial bleeding but actually increase bleeding due to the impaired venous bloodflow. Some argue that tourniquets should never be used in the pre-hospital setting, not even for amputations. Evidence from mine-infested areas also show a higher mortality for mine victims treated with tourniquets pre-hospitaly. An emergency tourniquet should in any case never be applied to the forearm or lower leg since the arteries in these locations run between bones and can not be compressed.
Some protocols call for the use of clotting accelerating agents, which can either by externally applied as a powder, gel or pre-dosed in a dressing, or as an intravenous injection. These may be particularly useful in situations where the wound is not clotting, which can be due to external factors, such as size of wound, or medical factors such as haemophilia.
Internal wounds (usually to the torso) are harder to deal with than external wounds, although they often have an external cause. The key dangers of internal bleeding include hypovolaemic shock (leading to exsanguination, causing a tamponade on the heart or a haemothorax on the lung.
In the event of the bleeding being caused by an external source (trauma, penetrating wound), the patient is usually inclined to the injured side, in order to ensure that the 'good' side can continue to function properly, without interference from the blood inside the body cavity.
The definitive treatment for internal bleeding is always surgical treatment, and medical advice must be sought as soon as possible for any victim of internal bleeding.
The aortic aneurysm is a special case where the aorta, the body's main blood vessel, become ruptured through an inherent weakness. This is one of the most serious medical emergencies a patient can face, as the only treatment is rapid surgery, although exertion, raised blood pressure or sudden movements could cause a sudden catastrophic failure
|