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TITLE: Hemorrhage Control, 62 pages (slides)

SLIDE TOPICS, SUBTOPICS and CONTENTS:

Hemorrhage Control
Introduction
Review methods of hemorrhage control in a tactical environment.

Hemorrhage is the leading cause of preventable death on the battlefield.

Hemorrhage control save lives.

New Hemostatic agents available.

Cardiovascular System
Blood Vessels
Arteries
Arterioles
Capillaries
Venules
Veins
Pulses
Left ventricle contracts.
Peripheral pulses:
Radial
Brachial
Posterior tibial
Dorsalis pedis
Central pulses:
Carotid
Femoral
Blood
Adult body:
Contains approximately 5 to 6 liters of blood
Loss of 1 pint of blood without harmful effects
Loss of 2 pints may cause shock
Three phases of hemostasis:
Vascular spasm
Platelet plug formation
Blood clotting (coagulation cascade)

Hemorrhage
Pulse vs. Blood Pressure.
How long until there are changes?
Young healthy adults compensate for long periods, then decompensate rapidly.
At what blood pressure do casualties lose consciousness?
@ 50 mm Hg
Clinical Signs of Acute Hemorrhage
Sources of Hemorrhage
External:
Visible blood is hard to estimate
Internal:
May be hidden within the torso or even in the extremities secondary to fractures

Sources of External Bleeding
Arterial:
Rapid, profuse and pulsating
Bright red in color
Venous:
Steady flow
Dark red or maroon in color
Capillary:
Slow and oozing
Often clots spontaneously
Extremity Hemorrhage
Internal Signs of Hemorrhage
Soft tissue bruising.
Abdominal tenderness.
Hemoptysis.
Hematemesis.
Melena.
Injured Internal Organs
Hemorrhage Control
Assess the tactical situation.
Expose the wound.
Attempt to control the bleeding with direct pressure or a pressure dressing.


Hemorrhage Control
Life-threatening arterial bleeding (amputation) may require early use of a tourniquet.
If under enemy fire or in a dangerous position rapidly apply a tourniquet and move casualty to cover.


Tourniquets
Several new tourniquets have been selected as primary means to control hemorrhage in combat.
Combat Application Tourniquet
C-A-T Step 1
C-A-T Step 2
C-A-T Step 3
C-A-T Step 4
C-A-T Step 5
C-A-T Step 6
C-A-T Step 7
C-A-T Step 8
C-A-T Tourniquet
C-A-T Tourniquet
C-A-T: Lower Extremity
C-A-T: Lower Extremity
C-A-T Tourniquet
C-A-T: Lower Extremity
SOFTT
SOFTT Application
Similar to the CAT:
Slide loop over extremity
Pull strap tight
Twist windlass until bleeding stops
Latch the windlass with one of the tri-rings
Tighten the safety screw
SOFTT Application
Improvised Tourniquet
Place cravat between heart and wound.
Tie a half-knot on upper surface.
Place a short stick on half-knot.
Tie a square knot on top of stick.
Twist stick (windlass) to tighten.
UNTIL BLEEDING STOPS.
Secure windlass to prevent unwinding.
Improvised Tourniquet
Tourniquet Principles
Never cover a tourniquet.
Mark a “T” on the casualty's forehead or somewhere obvious (sharpie pen).
In combat when the tactical situation allows, loosening a tourniquet is appropriate.
Tourniquet Removal
Once the tactical situation allows, tourniquets should be loosened and other methods to stop bleeding applied.
Direct pressure - pressure dressing
HemCon Chitosan Bandage
QuikClot powder
Tourniquet Removal
When loosening a tourniquet, do not remove it from the limb.
If the tourniquet has been in place for
> 6 hours, do not remove.
If fluid resuscitation is required, it should be accomplished before the tourniquet is removed.
Tourniquets are very painful, provide pain medications as needed.
Tourniquet Removal
If tourniquet has been in place for only 1-2 hours, loosening and using other methods to control hemorrhage can salvage limbs.
Remember: if unable to control hemorrhage by other means, re-tighten the tourniquet.
It is better to sacrifice the limb than to lose a life to hemorrhage.
Amputation
Apply a pressure dressing to cover the end of the stump.
Kerlix and 6” Ace wrap for effective pressure dressing.
Rinse amputated part free of debris.
Wrap loosely in saline-moistened sterile gauze.

Preservation of Amputation Parts
Seal amputated part in a plastic bag or cravat.
Place in a cool container; do not allow to freeze.
Never place an amputated part in water.
Never place amputated part directly on ice.
Never use dry ice to cool an amputated part.
Hemostatic Agents
HemCon® Chitosan Bandage.

QuikClot® Hemostatic Powder.

Chitosan Hemostatic Dressing







Hold the foil over-pouch so that instructions can be read. Identify unsealed edges at the top of the over-pouch.
Chitosan Hemostatic Dressing







Peel open over-pouch by pulling the unsealed edges apart.
Chitosan Hemostatic Dressing







Trap dressing between bottom foil and non-absorbable green/black polyester backing with your hand and thumb.
Chitosan Hemostatic Dressing








Hold dressing by the non-absorbable polyester backing and discard the foil over-pouch. Hands must be dry to prevent dressing from sticking to them.
Chitosan Hemostatic Dressing
Chitosan Hemostatic Dressing
Place the light colored sponge portion of the dressing directly to the wound area with the most severe bleeding. Apply pressure for 2 minutes or until the dressing adheres and bleeding stops. Once applied and in contact with the blood and other fluids, the dressing cannot be repositioned.
A new dressing should be applied to other exposed bleeding sites; each new dressing must be in contact with tissue where bleeding is heaviest. Care must be taken to avoid contact with the casualty’s eyes.
Chitosan Hemostatic Dressing
If dressing is not effective in stopping bleeding after 4 minutes, remove the original and apply a new dressing. Additional dressings cannot be applied over ineffective dressings.
Apply a battle dressing/bandage to secure a hemostatic dressing in place.
Hemostatic dressings should only be removed by responsible persons after evacuation to the next level of care.



QuikClot
Warning: Avoid contact with wet skin; product reacts with small amounts of water and can cause burning.
Stop burning by brushing away granules and flooding area with large volume of water.
If ingested, immediately drink two or more glasses of water.
QuikClot
Directions:
1-Apply direct firm pressure to wound using sterile dressing or best available substitute

2-If bleeding is stopped or nearly stopped after approximately 1 minute of pressure, wrap and tie bandage to maintain pressure on wound

3-If moderate to severe bleeding continues, hold pack away from face and tear open at tabs


QuikClot
4-Use wiping motion to remove gauze and excess blood – immediately start a slow pouring of one QuikClot packet directly onto the wound. Stop pouring as soon as dry granules cover the wound area

5-Use only enough QuikClot to stop bleeding. If bleeding continues open a second packet of QuikClot and continue to use as directed
QuikClot
6-Reapply firm pressure to QuikClot covered wound using sterile gauze. Wrap and tie bandage to maintain pressure

Treatment Goals
Hemorrhage control continues to be the priority in battlefield care.

Hemorrhage is the leading cause of preventable death on the battlefield.

Our focus must be on stopping soldiers from bleeding to death on the battlefield.

Questions?