5.2 Hemorrhage control techniques

Hemorrhage control is crucial in first aid. From identifying bleeding types to applying direct pressure, these techniques can save lives. Understanding factors affecting bleeding severity and recognizing signs of shock are key to effective management.

Advanced methods like tourniquets and hemostatic agents are vital for severe cases. Proper shock management, including positioning and monitoring vital signs, complements bleeding control. These skills are essential for anyone learning first aid.

Hemorrhage Assessment and Classification

Identifying Bleeding Type and Severity

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• Distinguish between arterial bleeding which is bright red, spurting, and hard to control vs. venous bleeding that is darker, steadier, and easier to manage
• Assess the wound thoroughly noting location, size, depth, and any foreign objects present
• Classify hemorrhage as minor (superficial wounds with minimal bleeding), moderate (deeper wounds with increased bleeding), or severe (life-threatening bleeding from deep wounds or amputations)
• Understand the role of clotting factors in the body's natural response to bleeding (platelets, fibrin, thrombin)

Factors Affecting Bleeding Severity

• Consider factors that can impair clotting such as certain medications (anticoagulants, NSAIDs), medical conditions (hemophilia, liver disease), and alcohol consumption
• Evaluate the impact of the wound location on bleeding severity as some areas are more prone to severe bleeding (head, neck, torso, groin)
• Assess the patient's overall health status and ability to tolerate blood loss based on age, fitness level, and pre-existing conditions
• Monitor for signs of shock (rapid pulse, pale skin, dizziness) which can occur with severe blood loss and requires immediate treatment

Direct Pressure Techniques

Manual Pressure Methods

• Apply firm, direct pressure to the wound using a clean cloth or dressing to constrict blood vessels and promote clotting
• Utilize pressure points located near the wound to compress major arteries and reduce blood flow to the area (brachial artery for arm wounds, femoral artery for leg wounds)
• Elevate the wounded area above the level of the heart, if possible, to reduce blood flow via gravity and aid in bleeding control
• Apply compression bandages snugly over the wound dressing to maintain consistent pressure and prevent further bleeding

Considerations for Effective Pressure Application

• Ensure the wound is covered completely with the dressing material before applying pressure to avoid contamination and promote clotting
• Avoid removing the initial dressing if it becomes blood-soaked as this can disrupt clot formation; instead, add additional layers on top
• Maintain pressure consistently for at least 5-10 minutes to allow sufficient time for clotting to occur before checking the wound status
• Monitor the patient's response to pressure application and adjust techniques as needed based on the level of bleeding control achieved

Advanced Hemorrhage Control

Tourniquets for Extremity Bleeding

• Apply a tourniquet proximal to the wound on an extremity (arm or leg) for severe, life-threatening bleeding not controlled by direct pressure
• Ensure proper tourniquet placement by selecting a site 2-3 inches above the wound, avoiding joints, and tightening until bleeding stops
• Record the time of tourniquet application and communicate this information to medical personnel for proper care and monitoring
• Understand the risks of prolonged tourniquet use (tissue damage, nerve injury) and the importance of timely medical intervention

Hemostatic Agents and Wound Packing

• Use hemostatic agents (QuikClot, Celox) that promote clotting when applied directly to the wound for severe bleeding not amenable to tourniquet use
• Pack deep wounds with hemostatic gauze or regular sterile gauze, filling the cavity completely to apply internal pressure and control bleeding
• Apply pressure dressings over packed wounds to maintain consistent pressure and secure the packing material in place
• Monitor packed wounds closely for signs of continued bleeding or saturation, replacing packing material as needed until bleeding is controlled

Shock Management

Recognizing and Treating Shock

• Identify signs of shock (rapid, weak pulse; cool, clammy skin; altered mental status) which can result from severe blood loss and inadequate tissue perfusion
• Place the patient in a supine position with legs elevated (shock position) to promote blood flow to vital organs
• Keep the patient warm using blankets or extra clothing to prevent further heat loss and maintain body temperature
• Avoid giving the patient anything by mouth, including water or medications, as this can interfere with medical treatment and worsen shock

Monitoring and Supporting Vital Functions

• Assess the patient's level of consciousness and responsiveness regularly, noting any changes or deterioration in mental status
• Monitor the patient's breathing and airway, providing support (jaw thrust, rescue breaths) if necessary to maintain adequate oxygenation
• Check the patient's pulse rate and quality frequently to assess circulatory status and the effectiveness of hemorrhage control measures
• Provide reassurance and emotional support to the patient, keeping them calm and informed about their condition and the care being provided