Life-Threatening Bleeding Femoral A&V-10% dead in 3 min

Transcription

1 Life-Threatening Bleeding Femoral A&V-10% dead in 3 min 95

2 Life-Threatening Bleeding 0.5 mm Femoral Injury 15 min survival 96

3 Tourniquet Application Apply without delay for life-threatening bleeding in Care Under Fire phase Apply 2-3 inches above bleeding site Tighten it until bleeding stops Note time of application Periodically check to make sure bleeding doesn t restart 97

4 Do these wounds need Tourniquets? 98

5 Removing the Tourniquet Corpsman or medic should do this. Remove when direct pressure or hemostatic dressings are feasible and effective 99

6 Do Not Remove Tourniquet if: Casualty is in shock. Casualty cannot be monitored regularly for re-bleeding. Tourniquet has been in place for > 6 hours. 100

7 Tourniquet Removal REMEMBER: If unable to control bleeding except with a tourniquet, it is better to sacrifice a limb than to lose a life to excessive bleeding. 101

8 Tourniquets Allow constant direct pressure deep in tissue. Are hands free. Rarely damage tissue if properly applied and removed in less than two hours. Frequently work when nothing else will. 102

9 Tourniquets Used everyday in Operating Rooms throughout the world Non-elastic material Size: 2 4 inches wide Placement: 2 4 in. above wound and 2 4 in. below joint 103

10 Tourniquet Application Tighten the tourniquet until bleeding from the wound slows or stops 104

11 Tourniquet Application Convert to another form of dressing WITHIN ONE HOUR! 105

12 Tourniquet Indications: Care under fire: severe bleeding Stable situation: when other treatments failed Not indicated for venous bleeding 106

13 Moral Number One No one should bleed to death from an extremity wound. 107

14 Moral Number Two Direct pressure will stop almost all life threatening bleeding, but requires two hands. 108

15 Moral Number Three When good direct pressure isn t working, or the tactical situation requires guns in your hands, you need a tourniquet. 109

16 Somalia 1993 SF soldier manning mini gun has his leg partially blown off with a RPG 110

17 He places tourniquet and gets back behind the mini gun. 111

18 Packing Indications: Large, irregular, gaping wounds When direct pressure is not possible Allows pressure to reach bleeding site Roll of sterile conforming gauze Fill from bottom of wound 112

19 Questions?

20 Hemostatic Agents Scientific advances now offer several hemostatic dressings with varying properties HemCon dressing QuikClot agent 114

21 Hemostatic Agents: Preliminary Points They should not be used in the Care under Fire phase of care unless the bleeding is not controllable with a tourniquet (head, neck, torso, or groin wounds). 115

22 HemCon Bandage 116

23 Hematoma Formation (collection of accumulating blood) 117

24 QuikClot Hemostatic Agent 118

25 QuikClot Hemostatic Agent Works by adsorbing liquid portion of blood, leaving behind solid products (blood cells-clotting factors) which promotes clots Generates heat when mixed with liquid (Blood) Temperatures > 90 0 C Will cause pain on application may cause tissue damage. May work on some wounds where HemCon is not effective. 119

26 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. 120

27 QuikClot 3. If moderate to severe bleeding continues, hold pack away from face and tear open at tabs. 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. 121

28 QuikClot 5. Use only enough QuikClot to stop bleeding. If bleeding continues open a second packet of QuikClot and continue to use as directed. 6. Reapply firm pressure to QuikClot-covered wound for 5 minutes using sterile gauze. Wrap and tie bandage to maintain pressure. 122

29 QUESTIONS on Care Under Fire? 123

30 "Tactical Field Care" No longer under effective hostile fire. Applies to situations in which an injury has occurred on a mission, but there has been no hostile fire. Very limited medical equipment available Time prior to evacuation to an MTF is very variable. 124

31 Tactical Field Care: Areas to Cover 1. Disarm casualties with an altered mental status 2. Airway management 3. Breathing 4. Bleeding 5. IV 6. Fluid resuscitation 7. Prevention of hypothermia 8. Monitoring 9. Inspect and dress known wounds 125

32 Tactical Field Care: Areas to Cover 10. Check for additional wounds 11. Analgesia as necessary 12. Splint fractures and recheck pulse 13. Antibiotics 14. Reassure the patient 15. No cardiopulmonary resuscitation (CPR) 16. Document clinical assessments, treatments rendered, and changes in casualty s status, and forward this info with the casualty to the next level of care. 126

33 Disarming the Casualty May be resisted Suggested approaches if needed Let me check your weapon Let me hold this while we take care of your wound Drop magazine 127

34 Airway Management Casualty with airway obstruction or impending airway obstruction: Chin-lift or jaw-thrust Nasopharyngeal airway Allow conscious casualty to assume any position that best protects the airway, to include sitting up. Place unconscious casualty in recovery position If measures above unsuccessful, surgical cricothyroidotomy (with lidocaine if conscious) 128