1005 Hemorrhage control.ppt

7/25/2019 1005 Hemorrhage control.ppt

1/88

UNCLASSIFIED

UNCLASSIFIED

MASSIVE BLEEDING

MANAGEMENT


2/88

MANAGEMENT


3/88

UNCLASSIFIED

UNCLASSIFIED

The im)or!a"#e o hemorrhage #o"!rol i" )re*e"!a2le

#om2a! $ea!hs

A"a!om- a"$ )h-siolog-3 2loo$4 *essels a"$ 2loo$#ir#&la!io"

Bloo$ loss es!ima!io" #lasses o hemorrhage

HEMORRHAGE CONTROL METHODS

DIRECT PRESSURE ELEVATION PRESSURE POINTS

TOURNI5UETS COMBAT READ' CLAMP +CRoC. PRESSURE DRESSING PAC/ING DRESSING HAEMOSTATS TRANE6AMIC ACID

ENABLING LEARNING OBJECTIVES

3

NE6T CLASSES


4/88

UNCLASSIFIED

UNCLASSIFIED

Pre Hos)i!al Tra&ma Lie S&))or! +PHTLS.Military 7thed. 2011 ISBN 978-0-323-06503-0 Cha)!er 74 ))8 99:;99< Cha)!er 9=4 )8 :>7

Cha)!er >;7?: Cha)!er >74 ))8 79@;79

Ta#!i#al Com2a! Cas&al!- Care g&i$eli"es

S)e#ial O)era!io"s For#es Me$i#al Ha"$2ooUS Special Operatio! "o##ad 2ded. 2010 ISBN 978-0-16-08$7$$-8

REFERENCES

$


5/88

UNCLASSIFIED

UNCLASSIFIED

COMBAT DEATHS

/IA3 9 )e"e!ra!i"g hea$ !ra&ma

/IA3 >


6/88

UNCLASSIFIED

UNCLASSIFIED

PREVENTABLE DEATHS STILL OCCUR

ON THE BATTLEFIELD BECAUSE OF

UNCONTROLLED HEMORRHAGE

6


7/88

UNCLASSIFIED

UNCLASSIFIED

SEVERE BLEEDING IS THE SINGLE

GREATEST PREVENTABLE COMBAT DEATH

7

HEMORRHAGE = 9

Com)ressi2le E,!remi!ies >:8


8/88

UNCLASSIFIED

UNCLASSIFIED

Blee$i"g is !he loss o 2loo$4 hemorrhage orhaemorrhage is THE MEDICAL TERM FOR BLEEDING

Al!ho&gh !e#h"i#all- hemorrhage mea"s es#a)e o2loo$ !o e,!ra;*as#&lar s)a#e4 i" #ommo" &sage i!

mea"s )ar!i#&larl- SEVERE BLEEDING

HEMORRHAGE DEFINITION

8


9/88

UNCLASSIFIED

UNCLASSIFIED

BLOOD LOSS ESTIMATION

SEVERE (he" -o& #a" a#!&all- see 2loo$lo(i"g o&! o !he (o&"$

INDICATORS *i!al sig"s

hear! ra!e

res)ira!or- ra!e

2loo$ )ress&re

#a)illar- reill !ime +CRT. i"$i#a!or o )er&sio"

0RONG ESTIMATION o" #lo!hi"g gro&"$

"o";)oro&s a))ears lie a lo!

)oro&s soae$ see)i"g

i"!er"al hi$$e"

9


10/88

UNCLASSIFIED

UNCLASSIFIED

CLASS I3 9


11/88

UNCLASSIFIED

UNCLASSIFIED

CLASS III3 ?;:? o 2loo$ *ol&me

hear! ra!e4 2loo$ )ress&re4 )eri)heral

)er&sio" a"$ me"!al s!a!&s (orse" l&i$ res&s#i!a!io" (i!h BLOOD TRANSFUSION

is &s&all- "e#essar-

CLASS IV3 :? o 2loo$ *ol&me

all *i!al sig"s (orse" AGGRESSIVE RESUSCITATION IS RE5UIRED

11

CLASSES OF HEMORRHAGE +ATLS.


12/88

UNCLASSIFIED

UNCLASSIFIED

TO COMPENSATEBLOOD LOSS4 THE BOD' REACTS3

HEART FRE5UENC'

VASOCONSTRICTION o )eri)heral 2loo$ *essels

FLUID SHIFT3 l&i$ is lo(i"g rom !he e,!ra;*as#&lars)a#e i"!o !he i"!ra;*as#&lar s)a#e

FLUID RETENTION +e8g8 i$"e-s4 $iges!i*e s-s!em.

12

HEMORRHAGE COMPENSATIONEARL' MECHANISMS


13/88

UNCLASSIFIED

UNCLASSIFIED

MAJOR MECHANISM TO STOP PREVENT BLOOD LOSS

13

COAGULATION +CLOTTING.ESSENTIALS

ACTIVATED PLATELETS

#olle#! o" !he 2lee$i"g si!e

a irs! so! a"$ ell-;lieUNSTABLERED CLOT

FIBRIN2i"$s !he )la!ele!s !oge!her !ra))i"g !he re$

#ells i"si$e +some ser&m #a" s!ill go !ro&gh !he #lo!. a irm a"$ SOLID 0HITE CLOT a#!s as a )l&g

H-)o!hermia ae#!s !he #lo!!i"g )ro#ess1

Ha"$le (i!h #are !o )reser*e !he irs! re$ #lo!1

UNCLASSIFIED


14/88

UNCLASSIFIED

UNCLASSIFIED

COAGULATION

1$

B' FAR MORE COMPLE6

BUT

'OU DONT NEED TO LEARN THIS

UNCLASSIFIED


15/88

UNCLASSIFIED

UNCLASSIFIED

T0O S'STEMS IN COMPETITION

15

UNCLASSIFIED


16/88

UNCLASSIFIED

UNCLASSIFIED

COAGULATION SIMPLIFIED

16

TISSUE FACTOR+release$ 2- $amage$ !iss&es*essels.lea$s !o

THE TRANSFORMATION FROM FIBRINOGEN TO FIBRIN

THIS S'STEM STARTS FIRST AND AIMS TO THE

DEVELOPMENT OF THE 0HITE CLOT

IT 0INS AGAINST HIS COMPETITOR

+THE PLASMINOGEN ; PLASMIN S'STEM.

UNLESS THE RED CLOT IS NOT PRESERVED

+e8g8 DIRECT PRESSURE RELEASED TOO SOON4

AGGRESSIVE FLUID RESUSCITATION4

IMPROPER HANDLING4 e!#8.

UNCLASSIFIED


17/88

UNCLASSIFIED

UNCLASSIFIED

TRANE6AMIC ACID

17

IMPROVES THE CLOT

B' SLO0ING DO0N THE CLOT BREA/DO0N

Dea!hs $&e !o all #a&ses $e#rease$ 2-

Dea!hs $&e !o 2lee$i"g $e#rease$ 2- 9


18/88

UNCLASSIFIED

UNCLASSIFIED

E6TERNAL

e.%. peetrati%& 'i(e) *S+) !hrapel) etc.

,e!!el! #ay e cateri!ed y hot (ra%#et! or pro/ectile!

INTERNAL

e.%. lt tra#a& la!t) a!!alt ith a cl) (all) M) etc.

18

TRAUMATIC BLEEDING

UNCLASSIFIED


19/88

UNCLASSIFIED

UNCLASSIFIED

I"!er*e"!io";Base$ Classii#a!io"

19

THE BEST 'OU CAN DO E,!er"al hemorrhage

Lim2s To&r"i%&e!s +T5.

J&"#!io"al CRoC4 JETT

No" #om)ressi2le Pa#i"g +Haemos!a!i# ga&es.

S&ll4 a2$ome"4 #hes!4 e!#8

I"!er"al hemorrhage Clo! )reser*a!io"

I ra$ial )&lse )al)a2le re$e IV l&i$s

I a*aila2le hemorrhage #lass II Bloo$ T6A

A$$i!io"al #are Ha"$le (i!h #are

O"goi"g resear#h +i"!ra)eri!o"eal oam.

UNCLASSIFIED


20/88

UNCLASSIFIED

UNCLASSIFIED 20

E,!er"al hemorrhage is a mi, o

UNCLASSIFIED


21/88

UNCLASSIFIED

UNCLASSIFIED

ARTERIAL4 VENOUS OR CAPILLAR' BLEEDINGare $iere"! 2e#a&se o3

PRESSURE

VESSELS ANATOMICAL STRUCTURE

BLOOD COLOUR + OF O6'GENATION.

21

!-)es o HEMORRHAGES

UNCLASSIFIED


22/88

UNCLASSIFIED

UNCLASSIFIED

ARTERIAL BLEEDING IS LIFE-THREATENING

AND DIFFICULT TO CONTROL

Ar!eries are 2loo$ *essels !ha! #arr- a HIGH PRESSURE

2loo$ a(a- rom !he hear!

Ar!eries ha*e a THIC/ER MUSCULAR 0ALL!o s!a"$

!he )ress&re8 Be#a&se o !heir !e"sio" a"$ elas!i#i!-

!he- #o"!ra#! a"$ re!ra#! (he" #&! s&$$e"l-

Ar!erial 2lee$i"g is BRIGHT RED

The BLOOD QSPURTSQ rom !he (o&"$

22

ARTERIAL 2lee$i"g

UNCLASSIFIED


23/88

UNCLASSIFIED

UNCLASSIFIED 23

ARTERIAL 2lee$i"g

UNCLASSIFIED


24/88

UNCLASSIFIED

UNCLASSIFIED

VENOUS BLEEDING IS NOT LIFE-THREATENING

UNLESS SEVERE OR NOT CONTROLLED

Vei"s are 2loo$ *essels !ha! #arr- a LO0 PRESSURE

2loo$ !o !he hear!

Vei"s ha*e THIN 0ALLS a"$ also 2e#a&se o !he lo(

i"!er"al )ress&re !he- !e"$ !o #olla)se (he" #&!

Ve"o&s 2lee$i"g is DAR/ RED OR MAROON

The BLOOD FLO0S IN A STEAD' STREAM

2$

VENOUS 2lee$i"g

UNCLASSIFIED


25/88

UNCLASSIFIED

UNCLASSIFIED

Ca)illaries are *er- small 2loo$ *essels !ha! #arr- aLO0 PRESSURE 2loo$ !oa(a- rom all !iss&es o!he 2o$-

Ca)illaries ha*e THINNER 0ALLS +o"e la-er.

Ca)illar- 2lee$i"g is a MI6 OF DAR/ AND BRIGHTRED BLOOD

BLOOD OOES 2e#a&se o !he slo( lo( +e8g8

a2rasio"s s#ra)s.

25

CAPILLAR' 2lee$i"g

UNCLASSIFIED


26/88

U C SS

UNCLASSIFIED

E,!er"al Hemorrhage

SIGNS S'MPTOMS

BLOOD E6ITING AN OPEN 0OUND= HEMORRHAGE

SHOC/= HYPOVOLEMIC SHOCK

)ale #lamm- si" $ii"ess (ea"ess

le*el o #o"s#io&s"ess

hear! ra!e tachycardia

2loo$ )ress&re +(eaa2se"! ra$ial. = hypotension

res)ira!or- re%&e"#- = tachypnea

#a)illar- reill !ime +CRT.

&ri"e o&!)&!

26

UNCLASSIFIED


27/88

UNCLASSIFIED

SAFE APPROACH ELEVATE THE E6TREMIT' +LIMBS.

DIRECT MANUAL PRESSURE

PRESSURE POINTS

TOURNI5UET

COMBAT READ' CLAMP +CRoC.

PRESSURE DRESSING

PAC/ING DRESSING

HEMOSTATS

T6A

27

E,!er"al Hemorrhage CONTROL

NE6T CLASSES

UNCLASSIFIED


28/88

UNCLASSIFIED

Be determined in achieving yourgoals

but understand the situation frst !!!but understand the situation frst !!!

SAFE APPROACH

28

UNCLASSIFIED


29/88

UNCLASSIFIED

ELEVATION

I!s ee#! is o!e" UNDERESTIMATED

Raise !he (o&"$ +lim2. ABOVE HEART LEVEL

29

UNCLASSIFIED


30/88

UNCLASSIFIED 30

DIRECT PRESSURE

UNCLASSIFIED


31/88

UNCLASSIFIED

THE FIRST AND MOST IMPORTANT RESPONSE

IN AN' SETTING4 FOR ALL HEMORRHAGES

Press&re a))lie$ ON THE 0OUND AROUND IT #a"#o"!rol mos! o e,!er"al 2lee$i"gs 2- #om)ressi"g !hear!er- agai"s! !he &"$erl-i"g s!r!&res +m&s#le 2o"e.

Mai"!ai" )ress&re or AT LEAST < MINUTES 2eore#he#i"g !he ee#!i*e"ess o #lo!!i"g

USE AN'THING !ha! (ill assis! -o& i" a))l-i"g $ire#!

)ress&re +ga&e4 #lo!h4 $am) #lo!h4 (ha!e*er !he (o&"$ is "o!

s!erile4 a s!erile 2a"$age $oes "o! mae i! s!erile.

31

DIRECT PRESSURE

UNCLASSIFIED


32/88

UNCLASSIFIED

DIRECT PRESSURE

IF 'OU SEE IT BLEED4'OU CAN STOP IT 0ITH DIRECT PRESSURE

DO NOT LET THEM BLEED TO DEATH

(hile assessi"g !he si!&a!io"4

$e#i$i"g o" a #o&rse o a#!io"4

looi"g or a"- !o&r"i%&e!

or haemos!a!i# age"!

32

UNCLASSIFIED


33/88

UNCLASSIFIED 33

PRESSURE POINTS

APPL' PRESSURE-o&r !eam;ma!es or -o&r FIST OR /NEEo*er !he #as&al!-s ARMPIT GROINIOT OCCLUDE THE ARTER'+2ra#hial or emoral.

BU' TIME 2- slo(i"g $o(" !he hemorrhage rom

!he e,!remi!-

*roi pre!!re !hold e re%arded a! the (ir!t procedre to cotrol

leedi% (ro# a hi%h le% a#ptatio) hil!t a tori4et i! atte#pted adorother treat#et! e#o!tatic %ae to pac' the od (ield dre!!i%!: are

!ed to !top leedi%.

U; *ood practice %ide Sep 2010

UNCLASSIFIED


34/88

UNCLASSIFIED 3$

PRESSURE POINTS

UNCLASSIFIED


35/88

UNCLASSIFIED

DIFFUSE PRESSURE is !he e- +e8g8 EMThos)i!al T5. more ee#!i*e $&e !o !he s&ra#e area #o*ere$

allo(s or grea!er )ress&re !o 2e a))lie$

a2le !o 2e mai"!ai"e$ o*er lo"g )erio$s

less $amage !o !iss&es

FINGER TIP PRESSURE $oes "o! e"s&re &ll #o"!a#!

(i!h (o&"$ +"o ar!er- h&"!i"g (i!h i"ger !i)s.

GAUES haemos!a!i# ga&es m&s! 2e i" &ll #o"!a#!

(i!h !he (o&"$ 2lee$i"g si!e !o 2e ee#!i*e

35

PALM *s FINGER TIP )ress&re

UNCLASSIFIED


36/88

UNCLASSIFIED

Oh4 "ooo more !o&r"i%&e!s1

BECAUSE TOURNI5UETS SAVE LIVES

I2" Si"a Hos)i!a4 Bag$a$4 >??7

9 li*es sa*e$ i" 7 mo"!hs )erio$ 2- !he &seo )re;hos)i!al !o&r"i%&e!s4 a&!hor es!ima!es

>??? LIVES SAVED IN OIF

;ra%h) et al) al! o( Sr%ery) 2009

36

UNCLASSIFIED


37/88

UNCLASSIFIED

Oh4 "ooo more !o&r"i%&e!s1

PREVENTABLE COMBAT DEATHS FROMNOT USING TOURNI5UETS STILL OCCUR

Mo&gho" Mili!ar- Me$i#i"e4 9=?3 Vie!"am

9 o >47??

=8: o !o!al

/ell- Jo&r"al o Tra&ma4 >??@3 OIF K OEF

=> o @>

=8@ o !o!alEas!ri$ge Jo&r"al o Tra&ma4 >?9>3 OIF K OEF

99 o :487 o !o!al

37

UNCLASSIFIED


38/88

UNCLASSIFIED

To&r"i%&e!s PRINCIPLES

A CONSTRICTING BAND si"gle &se "o";elas!i# a! leas!


39/88

UNCLASSIFIED

No! all !-)es a*aila2le ha*e !he same EFFECTIVENESS

PATIENT MUST GET PAIN MEDICATION To&r"i%&e!s

are )ai"&l (he" a))lie$ 2&! !he (orse )ai" #omes

(he" is#hemia se!s i" a))ro, >? mi" a!er a))li#a!io"

The- ha*e LIMITATIONS TO LOCATION

39

To&r"i%&e!s CONSIDERATIONS

UNCLASSIFIED


40/88

UNCLASSIFIED

M&s! STOP ARTERIAL BLOOD FLO0i" !he e,!remi!-

More ee#!i*e i" sa*i"g li*es (he" a))lie$ BEFORE

THE CASUALT' HAS GONE INTO SHOC/rom 2loo$

loss

IN THE CARE UNDER FIRE PHASEm&s! 2e a))lie$

irs!4 OVER THE CASUALT'S UNIFORM4 si"#e !here is

"o !ime or e,)osi"g !he (o&"$ a"$ or o!her me!ho$s

+!he- #o&l$ "o! 2e a$e%&a!e !o #o"!rol !he 2lee$i"g.

$0

Cri!eria or !o&r"i%&e!

EFFECTIVENESS

UNCLASSIFIED


41/88

UNCLASSIFIED

Pi# a goo$ o"e1

Carr- i! (i!h -o& all !he !imea"$ more !ha" o"e4

i i! is )ermi!!e$

Lear" ho( !o a))l- i! )ro)erl- as %&i# a"$ as)ro,imal as )ossi2le

Trai"4 2&$$- ai$4 sel ai$4 i" !he $ar"ess

re%&e"!l-1 Use !he !o&r"i%&e! rom !he #as&al!-

E*e"!&all- #o"*er! !o )ress&re 2a"$age

$1

To&r"i%&e!s TRAINING

UNCLASSIFIED


42/88

UNCLASSIFIED

DAMAGE TO THE LIMB is rare i !he !o&r"i%&e! is le!o" less !ha" !(o ho&rs8 A"-(a- i" !he a#e o massi*e

e,!remi!- hemorrhage i! is 2e!!er !o a##e)! a small ris

o $amage !o !he lim2 !ha" !o ha*e a #as&al!- 2lee$ !o

$ea!h +a))ro,ima!el- !ra"sie"! "er*e )aral-sis a"$"o am)&!a!io" $&e !o !o&r"i%&e! &se (ere re)or!e$.

)la#e i! >; INCHES ABOVE THE BLEEDING

A BELT ALONE IS EFFECTIVE

NEVER LOOSEN IT

$2

To&r"i%&e!s M'TH

UNCLASSIFIED


43/88

UNCLASSIFIED

NOT USING ONE 0HEN 'OU SHOULD

NOT TIGHTENING IT ENOUGH TO STOP THE

ARTERIAL FLO0

NOT APPL'ING A SECOND ONE SIDE;B';SIDE IF

THE FIRST IS NOT COMPLETEL' EFFECTIVE +BIG

THIGHS OFTEN RE5UIRE T0O T5.

PUTTING IT ON TOO LO0 ON THE E6TREMIT'

PUTTING IT TOO CLOSE TO A JOINT

USING ONE 0HEN 'OU SHOULD NOT

NOT TA/ING IT OFF 0HEN 'OU COULD

NOT USING THE CASUALT'S T5 FIRST $3

To&r"i%&e!s MISTA/ES

UNCLASSIFIED


44/88

UNCLASSIFIED

T0O TOURNI5UETS

UNCLASSIFIED

TIME OF APPLICATION


45/88

UNCLASSIFIED

Some T5 ha*e a TAG(here !o (ri!e $o(" !he !ime

0ri!e a T +or To&r"i%&e!. o" !he #as&al!-s FOREHEAD(i!h a" i"$eli2le i" marer a"$ !he !ime o a))li#a!io"

10:45

TIME OF APPLICATION

T

$5

UNCLASSIFIED

CONVERTING !h ! i !
http://gattuso.org/portfolio/images/forehead.jpghttp://gattuso.org/portfolio/images/forehead.jpghttp://gattuso.org/portfolio/images/forehead.jpg


46/88

UNCLASSIFIED

IN THE TACTICAL FIELD CARE PHASE4 o"#e -o& ha*e !ime !o

)ro)erl- e*al&a!e a"$ !rea! !he #as&al!- E6POSE a"$ re;e*al&a!e$ !he (o&"$

APPL' a !ra&ma 2a"$age or a )ress&re $ressi"g

a!er a))l-i"g a )ress&re 2a"$age4 LOOSEN THE T5 BUT

LEFT IN PLACE CHEC/ THE BANDAGE FOR BLEEDING a"$ i a"- mae !he

!o&r"i%&e! !igh! agai"

I" #ase o $ela-e$ e*a#&a!io"4 !o #o"*er! !he T5 (ill mae i!

more liel- !ha! !he lim2 #a" 2e sa*e$

Ne*er loose" a T5 i" #ase o am)&!a!io"s or i !he #as&al!- (ill

arri*e a! a hos)i!al i" > ho&rs or less a!er a))li#a!io"

$6

CONVERTING !he !o&r"i%&e!

UNCLASSIFIED

C 2 ! A li !i T i !


47/88

UNCLASSIFIED$7

Com2a! A))li#a!io" To&r"i%&e!

+CAT.

UNCLASSIFIED

C 2 ! A li !i T i !


48/88

UNCLASSIFIED$8

< THE MOST COMMONL' USED AND /NO0N

< Re$ !i) (here !o s!ar! &")a#i"g i!

< 0i"$lass s!ra) ma- 2e (hi!e +!ime o a))li#a!io" #a"

2e (ri!!e" o" i!.

< 0i"$lass ro$ ma$e o har$ )las!i# #o&l$ 2rea

< NOT COMPLETEL' RELIABLE 0HEN 0ET OR DIRT'

< Vel#ro #o&l$ mae !he a))li#a!io" $ii#&l!


+CAT.

UNCLASSIFIED

S i l O !i F


49/88

UNCLASSIFIED

S)e#ial O)era!io"s For#es

Ta#!i#al To&r"i%&e! +SOFTT.

$9

UNCLASSIFIED



50/88

UNCLASSIFIED50

< IT IS EFFECTIVE ON LARGER THIGHS

< IT HAS A SECONDAR' SECURIT' +s#re(.

< Same 2asi# #om)o"e"!s

< I! has a !ag (here !o (ri!e !ime o a))li#a!io"

< LESS SURFACE PRESSURE MORE TISSUE DAMAGE

0i"$lass s!ra) is !hi""er !ha" !he CAT o"e< HARDER TO SECURE THE ROD THROUGH THE V RING

< Me!al ro$ a"$ o!her me!al )ar!s #o&l$ #orro$e

< S#re( #a" loose"



UNCLASSIFIED



51/88

UNCLASSIFIED51

< Same 2asi# #om)o"e"!s 2&! THE BUC/LE

< MORE SURFACE PRESSURE LESS TISSUE DAMAGE

The (i"$lass s!ra) is (i$er

< Me!al ro$ a"$ o!her )ar!s ma$e o al&mi"&m

< HARDER TO SECURE THE ROD THROUGH THE V RING


Ta#!i#al To&r"i%&e! +SOFTT0 .

UNCLASSIFIED

Emerge"#- a"$ Mili!ar-


52/88

UNCLASSIFIED52


To&r"i%&e! +EMT.

UNCLASSIFIED



53/88

UNCLASSIFIED

< HAS BEEN FOUND HAVING THE BEST PERFORM ANCEa"$ i! is s!ro"gl- s&gges!e$ i" emerge"#- $e)ar!me"!s

< MORE SURFACE PRESSURE LESS TISSUE DAMAGE

< THE INFLATABLE RUBBER CUFF MA' DETERIORATE= )rolo"ge$ !ime i" !he iel$= e,)ose$ !o high lo( !em)era!&res

= e,)ose$ !o shra)"el s!ries

< MORE E6PENSIVE

< LARGER PAC/AGE SIE

53


To&r"i%&e! +EMT.

UNCLASSIFIED

NATO To&r"i%&e! OOM


54/88

UNCLASSIFIED

NATO To&r"i%&e! OOM

5$

UNCLASSIFIED

NATO To&r"i%&e! OOM


55/88

UNCLASSIFIED55

< LESS COMPONENTS

< EFFECTIVE UNDER ALL 0EATHER CONDITIONS

< MORE DURABLE

< HARDER TO USE IN SELF;AID +ARM.

< LESS SURFACE PRESSUREMORE TISSUE DAMAGE s!ra) is

!hi""er a"$ #o&l$ )i"#h !he si" or 2e#ame s!ri"g;lie (hile

!(is!i"g

< NOT 'ET APPROVED

< NO TAG 0HERE TO 0RITE TIME OF APPLICATION

NATO To&r"i%&e! OOM

UNCLASSIFIED



56/88

UNCLASSIFIED


+CAT.

56

UNCLASSIFIED



57/88

UNCLASSIFIED



57

UNCLASSIFIED

0IDER IS BETTER +SOFTT 0.


58/88

UNCLASSIFIED

0IDER IS BETTER +SOFTT0.

58

UNCLASSIFIED

IMPROVISED To&r"i%&e!


59/88

UNCLASSIFIED


A )re*e"!a2le $ea!h i" >??

This #as&al!- (as (o&"$e$ 2- a" RPG e,)losio" a"$

s&s!ai"e$ a !ra&ma!i# am)&!a!io" o !he righ! arm a"$ a

righ! leg (o&"$8 He 2le$ !o $ea!h rom his leg (o&"$

$es)i!e !he )la#eme"! o !hree iel$;e,)e$ie"! !o&r"i%&e!s

!he s!ri"gs #&! si" a"$ m&s#les (i!ho&! o##l&$i"g !he ar!erial lo(59

UNCLASSIFIED



60/88

UNCLASSIFIED


60

This #as&al!- (as (o&"$e$ 2- a" IED8 The )rom)!a))li#a!io" o iel$;e,)e$ie"! !o&r"i%&e!s +T;shir!s a"$

2ra"#hes. sa*e$ his lie8 The irs! res)o"$er "e( (ha! !o$o +(as he )ro)erl- !rai"e$ i" ho( !o $o i!.

T5s (ere )la#e$ )ro,imall-4 "o! !igh!e"e$ or se#&re$ e"o&gh

The s!&m)s (ere "o! $resse$ a! all

UNCLASSIFIED

APPL'ING a" im)ro*ise$ !o&r"i%&e! 9


61/88

UNCLASSIFIED

APPL'ING a" im)ro*ise$ !o&r"i%&e! 9

GATHER MATERIALS3

rigi$ o2e#! +0INDLASS. sh as a s!ro"g s!i#

!o&r"i%&e! 2a"$ +CRAVAT. AT LEAST > 0IDE

SECURING MATERIAL +CRAVAT.

61

UNCLASSIFIED

APPL'ING a" im)ro*ise$ !o&r"i%&e! >


62/88

UNCLASSIFIED

98 A))l- 2a"$ ma!erial aro&"$ !he groi" arm)i!

a2o*e (o&"$ am)&!a!io"

>8 Tie 2a"$ (i!h a hal;"o!

8 Pla#e (i"$lass ro$ o" !o) o "o!

:8 Tie a &ll "o! +s%&are "o!. o*er (i"$lass

62

APPL'ING a" im)ro*ise$ !o&r"i%&e! >

UNCLASSIFIED

APPL'ING a" im)ro*ise$ !o&r"i%&e!


63/88

UNCLASSIFIED


64/88

UNCLASSIFIED

J&"#!io"al i"&ries

Are 2e#omi"g more re%&e"!

Are &s&all- more se*ere

Their rele*a"#e amo"g !he #a&ses o 2lee$i"g

is gro(i"g si"#e !o&r"i%&e!s 2e#ame ee#!i*ei" s!o))i"g !he 2lee$i"g rom !he e,!remi!ies

Resear#hes $e*elo)me"! i"#rease$

De*i#es ee#!i*e"ess has 2ee" !es!e$

TCCC g&i$eli"es #&rre"!l- re#omme"$ CRoC

6$

UNCLASSIFIED


65/88

UNCLASSIFIED 65

UNCLASSIFIED

JUNCTIONAL HEMORRHAGE


66/88

UNCLASSIFIED


Com2a! Rea$- Clam) +CRoC.

66

UNCLASSIFIED

CRoC i"s!r!ors a"$ s!&$e"!s


67/88

UNCLASSIFIED

CRoC i"s!r!ors a"$ s!&$e"!s

COMMENT

< It or'!& e((ecti,e i !toppi% /ctioal he#orrha%e

< It i! the oly oe a,ailale "o>""" appro,ed

< ea,y (or the #edic?! a%

< @,e a(ter traii%) it ta'e! ti#e to a!!e#le it

< Ai((iclt to a!!e#le he et dirty

< @a!ily di!lod%ed hile hadli% the ca!alty

UNCLASSIFIED



68/88

UNCLASSIFIED 68

JUNCTIONAL HEMORRHAGEJ&"#!io"al Emerge"#- Trea!me"! Tool +JETT.

UNCLASSIFIED



69/88

UNCLASSIFIED


69

UNCLASSIFIED



70/88

UNCLASSIFIED 70


UNCLASSIFIED



71/88

UNCLASSIFIED

JUNCTIONAL HEMORRHAGEJ&"#!io"al Emerge"#- Ta#!i#al To&r"i%&e!

JETT

71

Bel!;ee#!

pel,ic !li%

i(re4et di!lod%#et

> me#ha"i#al &"#!io"al !o&r"i%&e!s

pre!!re applicale o ri%ht le(t oth !ide!

at the !a#e ti#e

cp! #odeled %roi tria%lar-!hape

UNCLASSIFIED

HEMOSTATIC FORCEPS


72/88

UNCLASSIFIED

NOT 'OUR FIRST CHOICE OF ACTION

ONL' 0HEN THE BLEEDING IS3

LOCAL

VISIBLE-o& #a" easil- lo#a!e +see. !he r&)!&re$ 2loo$ *essel

SUPERFICIAL

72

HEMOSTATIC FORCEPS

UNCLASSIFIED

MASSIVE E6TERNAL BLEEDING MANAGEMENT


73/88

UNCLASSIFIED

SUMMAR'

FOCUS"ee$e$ !o &"$ers!a"$ ho( !o $eal (i!h hemorrhage

BU' SOME TIME !o rea#! 2- ra)i$l- a))l-i"g goo$ $ire#!

)ress&re or o" )ress&re )oi"!s

DEVISE COMMUNICATE A PLAN

NO HESITATIONo"#e a #o&rse o a#!io" is i"i!ia!e$

ACHIEVE CONTROLo si!&a!io" %&i#l-3 T54 CRoC4 )a#i"g

0OR/ TOGETHER!o(ar$ a" im)ro*eme"!

(or UNTIL 'OU ARE SATISFIED-o& a#hie*e$ !he o2e#!i*e

B' MINIMIING BLOOD FLO0!he (o&"$ si!e #a" 2e ma"age$

FURTHERING MANAGEMENT(i!h )ress&re $ressi"g

REMEMBER THE BASICS1

Basi# !rea!me"!s $o"e (ell (ill mae !he 2igges! $iere"#e

73

UNCLASSIFIED

INTERNAL HEMORRHAGE


74/88

UNCLASSIFIED

CHEC/ ENTIRE BOD'4 ALL ORIFICES INCLUDED

CHEC/ CAVITIES+!hora#i#4 a2$omi"al4 )el*i#.

!he- #a" hi$e large *ol&mes o 2loo$

CHEC/ FOR SIGNS OF SHOC/ +#om)e"sa!e$ la!e"!.!he ass&m)!io" !ha! #as&al!ies (ho loo goo$ are "o!

2lee$i"g i"!er"all- is re%&e"!l- *er- (ro"g

Co"!i"&e$ REASSESSMENTo !ra&ma )a!ie"!s is

esse"!ial

7$

INTERNAL HEMORRHAGE

UNCLASSIFIED

INTERNAL HEMORRHAGE


75/88

UNCLASSIFIED

SIGNS OF SHOC/

E6TERNAL BLEEDING THROUGH A NATURAL OPENING 2loo$ i" !he STOOL +a))ears 2la#4 maroo"4 or 2righ! re$.

2loo$ i" !he URETHRAL MEATUS OR IN THE URINE +a))ears re$4

)i"4 or !ea;#olore$.

VAGINAL 2lee$i"g +hea*ier !ha" &s&al or a!er me"o)a&se.

2loo$ i" !he VOMIT +loos 2righ! re$4 or 2ro(" lie #oee;gro&"$s.

PAIN

TENSION

S0OLLEN AREA +a2$ome"4 )el*is4 #hes!.

75

INTERNAL HEMORRHAGE

SIGNS S'MPTOMS

UNCLASSIFIED

INTERNAL HEMORRHAGE


76/88

UNCLASSIFIED

INSPECTION+e8g8 2r&isi"g.

AUSCULTATION +e8g8 2o(el so&"$s re$e$ .

PERCUSSION +e8g8 $&ll"ess.

PALPATION+$e!e#! a"- !e"$er"ess4 resis!a"#e4 rea#!io"4 )ai"

a"$ s(elli"g. VITAL SIGNS;SHOC/ SIGNS

Diag"os!i# )eri!o"eal la*age

Ul!raso&"$FAST +Fo#&se$ A2$omi"al Ul!raso&"$ or Tra&ma.

76

INTERNAL HEMORRHAGE

E6AMINATION

'OUR JOB IS TO SUSPECT IT AND TO SUSTAIN THE CIRCULATION

INTERNAL BLEEDING NEEDS SURGICAL TREATMENT11

UNCLASSIFIED

ABDOMINAL 0OUNDS


77/88

UNCLASSIFIED

A))l- *er- ge"!le )ress&re !o s!o) !he e,!er"al 2lee$i"g

A"- )e"e!ra!i"g a2$omi"al (o&"$ "ee$s URGENTSURGICAL TREATMENT

E*is#era!io"

$o "o! !r- !o )&sh 2o(elsorga"s 2a# i"!o !hea2$ome"4 &"less !he- sli$e 2a# i" 2- li!i"g !he(o&"$ e$ges

#o*er !he i"&r- (i!h a mois!e"e$ #lo!h or 2a"$age

I sig"s o hemorrhagi# sho# a!er !ra&ma (i!ho&!e,!er"al 2lee$i"g !he" s&s)e#! !he )ossi2ili!- o se*erei"!er"al 2lee$i"g

77

ABDOMINAL 0OUNDS

UNCLASSIFIED

A2$omi"al 2l&"! !ra&ma The s)lee"


78/88

UNCLASSIFIED

The s)lee" is a l-m)h "o$e+imm&"e s-s!em.4 i! has

me#ha"i#al &"#!io"s as (ell3 reser*oir o )la!ele!s4re!e"!io" a"$ remo*al o ol$ a2"ormal RBCs

R&)!&re o !he s)lee" is res)o"si2le or :? oi"!er"al a2$omi"al 2lee$i"g a!er 2l&"! !ra&ma

+r&)!&re o !he li*er >?4 r&)!&re o 2o(el


79/88

UNCLASSIFIED

,ailale #id-pril 2012 >he tar%et o( the co#pre!!io i! the AORTIC BIFURCATION

at the ado#ial-pel,ic /ctio to occlde lood (lo i the

i%ial arterie!

It i! a circ#(eretial de,ice applied to the #id-ado#e)ti%hteed ad i(lated

May re#ai o (or p to a hor !a(ely

79

The A2$omi"al Aor!i# To&r"i%&e!

AAT

UNCLASSIFIED

0ha! or(ar$ sol&!io"


80/88

UNCLASSIFIED

FOAM ; o"goi"g resear#h +s!ar!e$ o" >??=.

T(o $iere"! li%&i$ #om)o"e"!s are i"e#!e$ a! !he same !ime i"!o

!he INTAPERITONEAL SPACE4 !he- rea#! (i!h a mil$ e,o!hermal

#hemi#al rea#!io" +ma- 2e 2e"ei#ial. ge"era!i"g a Styro(oa#-li'e

hydrophoic (oa# that epad! %eerate! pre!!re: ad !olidi(ie! i"

less !ha" 7?se# i a co(or#al cotact ith ti!!e! ithot adherece

re#o,ale i oe piece ri%ht a(ter laparoto#y:

Does"! s!o) !he 2lee$i"g 2&! slo(s i! $o(" so !ha! more ho&rs are

a*aila2le 2eore s&rger-

Pro!o!-)e 3 )e"$i"g %&es!io"s

Ho( mh4 ae#!s res)ira!io" )ress&re agai"s! $ia)hragm#o"!rai"$i#a!e$ i" hea$ i"&r- +h-)o#ar2i#.4 re!ai"e$ oam )ar!i#les4

migra!io" i"!o !he )le&ral s)a#e i" #ase o $ia)hragm la#era!io"s

+more !ha" > #m (i$e.4 leai"g o&! rom holes (o&"$s +seal !hem.4

s&i!a2le or re!ro)eri!o"eal hemorrhage

80

0ha! or(ar$ sol&!io"

UNCLASSIFIED

COMING SOON


81/88

UNCLASSIFIED

COMING SOON

SAFE APPROACH

ELEVATE THE E6TREMIT' +LIMBS.

DIRECT MANUAL PRESSURE

PRESSURE POINTS

TOURNI5UET

COMBAT READ' CLAMP +CROC.

PRESSURE DRESSING

PAC/ING DRESSING

HEMOSTATS

T6A

81

UNCLASSIFIED

0OUND HEMORRHAGE CONTROL


82/88

UNCLASSIFIED

0OUND HEMORRHAGE CONTROLPAC/ING +AMPUTATIONS CAVITIES.

82

UNCLASSIFIED

0OUND HEMORRHAGE CONTROL


83/88

UNCLASSIFIED

OU O G CO OPAC/ING +AMPUTATIONS CAVITIES.

83

UNCLASSIFIED

Me$i#s ra!i"g


84/88

UNCLASSIFIED

g

8$

UNCLASSIFIED

SUMMAR' STOP THE BLEEDING


85/88

UNCLASSIFIED

SAFE APPROACH3 se#&re area a"$ -o&rsel

INITIAL ASSESSMENT M8A8R8 Ele*a!e !he e,!remi!- +lim2s.

A))l- $ire#! ma"&al )ress&re

A))l- )ress&re !o )ress&re )oi"!s

To&r"i%&e! +#o"*er! !o )ress&re 2a"$age (he"

i"$i#a!e$.

J&"#!io"al !o&r"i%&e!s CRoC JETT

Hemos!a!i# ga&es Pa#i"g $ressi"g

Press&re $ressi"g

a! !he same !ime4 #alm a"$ reass&re !he *i#!im4!he sigh! o 2loo$ #a" 2e *er- righ!e"i"g

85

UNCLASSIFIED

SUMMAR' PRESERVE THE CLOT


86/88

UNCLASSIFIED

DO NOTha"$le !he #as&al!- (i!ho&! e,!reme )re#a&!io"

DO NOT&"$er es!ima!e !he ee#! o h-)o!hermia

+h-)o!hermia 2a$l- ae#!s !he #lo!!i"g )ro#ess.

DO NOT)&sh I8V8 l&i$s i a ra$ial )&lse is )rese"!

DO NOTorge! !o im)ro*e !he #lo! (i!h T6A

DO NOT$is!&r2 !he (o&"$

+remo*e !he ga&e4 )ee a! !he (o&"$4 #lea" !he (o&"$.

86

UNCLASSIFIED

DONT CAUSE E6TRA INJURIES


87/88

UNCLASSIFIED

DO NOT)ro2e a (o&"$ or )&ll o&! a"- em2e$$e$o2e#! rom a (o&"$W !his (ill &s&all- #a&se more2lee$i"g a"$ harm

DO NOT!r- !o #lea" a large (o&"$W !his #a" #a&sehea*ier 2lee$i"g

DO NOTremo*e !he irs! $ressi"g i i! 2e#omessoae$ (i!h 2loo$ +&"less i i! is a haemos!a!i#ga&e.W a$$ a "e( o"e o" !o)

DO NOT)ee a! a (o&"$ !o see i !he 2lee$i"g iss!o))i"gW !he less a (o&"$ is $is!&r2e$4 !he moreliel- i! is !ha! -o&Xll 2e a2le !o #o"!rol !he 2lee$i"g

DO NOT!r- !o #lea" a (o&"$ a!er -o& ge! !he2lee$i"g &"$er #o"!rolW ge! me$i#al hel)

RE;BLEEDING

87

UNCLASSIFIED


88/88

Documents

1005 Hemorrhage control.ppt