1005 Hemorrhage

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    UNCLASSIFIED

    UNCLASSIFIED

    MASSIVE BLEEDING

    MANAGEMENT

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    MANAGEMENT

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    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

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    NE6T CLASSES

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    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

    $

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    UNCLASSIFIED

    UNCLASSIFIED

    COMBAT DEATHS

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

    /IA3 >

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    PREVENTABLE DEATHS STILL OCCUR

    ON THE BATTLEFIELD BECAUSE OF

    UNCONTROLLED HEMORRHAGE

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    UNCLASSIFIED

    UNCLASSIFIED

    SEVERE BLEEDING IS THE SINGLE

    GREATEST PREVENTABLE COMBAT DEATH

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    HEMORRHAGE = 9

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

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    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

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    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

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    UNCLASSIFIED

    UNCLASSIFIED

    CLASS I3 9

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    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

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    CLASSES OF HEMORRHAGE +ATLS.

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    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.

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    HEMORRHAGE COMPENSATIONEARL' MECHANISMS

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    MAJOR MECHANISM TO STOP PREVENT BLOOD LOSS

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    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

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    COAGULATION

    1$

    B' FAR MORE COMPLE6

    BUT

    'OU DONT NEED TO LEARN THIS

    UNCLASSIFIED

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    UNCLASSIFIED

    T0O S'STEMS IN COMPETITION

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    COAGULATION SIMPLIFIED

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    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

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    TRANE6AMIC ACID

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    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

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    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.

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    TRAUMATIC BLEEDING

    UNCLASSIFIED

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

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    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

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    UNCLASSIFIED 20

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

    UNCLASSIFIED

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

    PRESSURE

    VESSELS ANATOMICAL STRUCTURE

    BLOOD COLOUR + OF O6'GENATION.

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    !-)es o HEMORRHAGES

    UNCLASSIFIED

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    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&"$

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    ARTERIAL 2lee$i"g

    UNCLASSIFIED

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    ARTERIAL 2lee$i"g

    UNCLASSIFIED

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    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

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    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.

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    CAPILLAR' 2lee$i"g

    UNCLASSIFIED

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    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&!)&!

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    UNCLASSIFIED

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    SAFE APPROACH ELEVATE THE E6TREMIT' +LIMBS.

    DIRECT MANUAL PRESSURE

    PRESSURE POINTS

    TOURNI5UET

    COMBAT READ' CLAMP +CRoC.

    PRESSURE DRESSING

    PAC/ING DRESSING

    HEMOSTATS

    T6A

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    E,!er"al Hemorrhage CONTROL

    NE6T CLASSES

    UNCLASSIFIED

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    Be determined in achieving yourgoals