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HEMORRHAGE CONTROL. RIFLES LIFESAVERS. Introduction. Review types of injuries Review Tactical Combat Casualty Care Evaluate and control bleeding Take home message: HEMORRHAGE CONTROL SAVES LIVES. Facts and Tips. Blood volume of the adult human body Approximately 5 to 6 liters - PowerPoint PPT Presentation
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HEMORRHAGE HEMORRHAGE CONTROLCONTROL
RIFLES LIFESAVERSRIFLES LIFESAVERS
Core SkillsCore Skills Control BleedingControl Bleeding 22
IntroductionIntroduction Review types of injuriesReview types of injuries Review Tactical Combat Casualty Review Tactical Combat Casualty
CareCare Evaluate and control bleedingEvaluate and control bleeding Take home message:Take home message:
HEMORRHAGE CONTROL SAVES HEMORRHAGE CONTROL SAVES LIVESLIVES
Core SkillsCore Skills Control BleedingControl Bleeding 33
Facts and TipsFacts and Tips Blood volume of the adult human bodyBlood volume of the adult human body
Approximately 5 to 6 litersApproximately 5 to 6 liters Loss of as little as 2 pints may cause Loss of as little as 2 pints may cause
shockshock Field blood pressures, when palpable pulse Field blood pressures, when palpable pulse
is appreciatedis appreciated Carotid: SBP>60 mmHgCarotid: SBP>60 mmHg Femoral: SBP>70 mmHgFemoral: SBP>70 mmHg Radial: SBP>80 mmHgRadial: SBP>80 mmHg
Core SkillsCore Skills Control BleedingControl Bleeding 44
Sources of BleedingSources of Bleeding ArterialArterial
- Rapid, profuse and pulsating- Rapid, profuse and pulsating- Bright red in color- Bright red in color
VenousVenous- Steady flow, nonpulsating- Steady flow, nonpulsating- Dark red or maroon in color- Dark red or maroon in color
CapillaryCapillary- Slow and oozing- Slow and oozing- Often clots spontaneously, not dangerous- Often clots spontaneously, not dangerous
Core SkillsCore Skills Control BleedingControl Bleeding 55
External BleedingExternal Bleeding
Core SkillsCore Skills Control BleedingControl Bleeding 66
Types of External BleedingTypes of External Bleeding Lacerations Lacerations Abrasions Abrasions Puncture woundsPuncture wounds AmputationsAmputations AvulsionsAvulsions
Core SkillsCore Skills Control BleedingControl Bleeding 77
LacerationLaceration
Core SkillsCore Skills Control BleedingControl Bleeding 88
AbrasionAbrasion
Core SkillsCore Skills Control BleedingControl Bleeding 99
Puncture WoundPuncture Wound
Core SkillsCore Skills Control BleedingControl Bleeding 1010
AmputationsAmputations
Core SkillsCore Skills Control BleedingControl Bleeding 1111
AvulsionAvulsion
Core SkillsCore Skills Control BleedingControl Bleeding 1212
Internal BleedingInternal Bleeding Can occur with blunt or penetrating Can occur with blunt or penetrating
traumatrauma Suspicion based on mechanism of injurySuspicion based on mechanism of injury
FallsFalls Blast injuriesBlast injuries Penetrating traumaPenetrating trauma
Core SkillsCore Skills Control BleedingControl Bleeding 1313
Causes of Internal BleedingCauses of Internal Bleeding Blunt TraumaBlunt Trauma
Auto vs. Auto vs. pedestrianpedestrian
Motor vehicle Motor vehicle accidentsaccidents
FallsFalls Blast injuriesBlast injuries Etc.Etc.
Penetrating Penetrating injuriesinjuries Gunshot woundsGunshot wounds Stab woundsStab wounds Shrapnel woundsShrapnel wounds
Core SkillsCore Skills Control BleedingControl Bleeding 1414
Internal BleedingInternal Bleeding Signs and SymptomsSigns and Symptoms
Pain, tenderness, swelling, Pain, tenderness, swelling, discoloration at injury sitediscoloration at injury site
Bleeding from any body orifice Bleeding from any body orifice Vomiting blood Vomiting blood Tender, rigid, or distended abdomenTender, rigid, or distended abdomen
Core SkillsCore Skills Control BleedingControl Bleeding 1515
Internal Bleeding Internal Bleeding
Core SkillsCore Skills Control BleedingControl Bleeding 1616
Injured Internal OrgansInjured Internal Organs
Core SkillsCore Skills Control BleedingControl Bleeding 1717
Internal BleedingInternal Bleeding Can result in rapid progression to Can result in rapid progression to
hypovolemic shock and deathhypovolemic shock and death IV fluids may buy timeIV fluids may buy time The scalpel is the cure: The rapidly The scalpel is the cure: The rapidly
spiraling patient requires surgical spiraling patient requires surgical interventionintervention
Immediate evacuationImmediate evacuation
Core SkillsCore Skills Control BleedingControl Bleeding 1818
CARE UNDER FIRECARE UNDER FIRE ““The best medicine on any battlefield is The best medicine on any battlefield is
fire superiority”fire superiority” Control of hemorrhage is essential since Control of hemorrhage is essential since
injury to a major vessel can result in injury to a major vessel can result in hypovolemic shock in a short time hypovolemic shock in a short time frameframe
2/3 of all preventable combat deaths 2/3 of all preventable combat deaths are due toare due to hemorrhage from extremitieshemorrhage from extremities
Core SkillsCore Skills Control BleedingControl Bleeding 1919
CARE UNDER FIRECARE UNDER FIRE Prompt use of tourniquets to Prompt use of tourniquets to stop stop
the bleedingthe bleeding may be life saving may be life saving Various types of tourniquets existVarious types of tourniquets exist
Combat application tourniquet (CAT)Combat application tourniquet (CAT) TherabandTheraband Cloth and stickCloth and stick
Core SkillsCore Skills Control BleedingControl Bleeding 2020
TACTICAL FIELD CARETACTICAL FIELD CARE Evaluation begins with ABCs with Evaluation begins with ABCs with
attention to prioritiesattention to priorities Any bleeding site not previously Any bleeding site not previously
controlled should be addressedcontrolled should be addressed Significant bleeding should be Significant bleeding should be
controlled using a tourniquetcontrolled using a tourniquet Initiate IV fluidsInitiate IV fluids Prepare for evacuationPrepare for evacuation
Core SkillsCore Skills Control BleedingControl Bleeding 2121
STOP THE BLEEDING !STOP THE BLEEDING ! Apply direct pressure with gauze or Israeli Apply direct pressure with gauze or Israeli
dressingdressing Elevate the extremity above the heartElevate the extremity above the heart Apply additional dressings if wound Apply additional dressings if wound
continues to bleedcontinues to bleed Apply pressure to appropriate pressure Apply pressure to appropriate pressure
point if continues to bleedpoint if continues to bleed Immobilize injured extremity with a splintImmobilize injured extremity with a splint Apply tourniquet if continues to bleedApply tourniquet if continues to bleed Initiate IV fluids and treatment for shock Initiate IV fluids and treatment for shock
as neededas needed
Core SkillsCore Skills Control BleedingControl Bleeding 2222
Pressure PointsPressure Points May be helpful with severe bleeding May be helpful with severe bleeding
as an adjunctas an adjunct Apply when bleeding not controlled Apply when bleeding not controlled
by direct pressure and elevation by direct pressure and elevation Apply pressure to appropriate Apply pressure to appropriate
pressure pointpressure point
(
Core SkillsCore Skills Control BleedingControl Bleeding 2323
Important Pressure PointsImportant Pressure Points
BrachialBrachial
FemoralFemoral
(
Core SkillsCore Skills Control BleedingControl Bleeding 2424
Brachial Pressure PointBrachial Pressure Point Located in upper arm above the Located in upper arm above the
elbow in the groove between elbow in the groove between musclesmuscles
Apply pressure to the inside of the Apply pressure to the inside of the arm over the bone using the fingers arm over the bone using the fingers or thumbor thumb
Core SkillsCore Skills Control BleedingControl Bleeding 2525
Brachial Pressure PointBrachial Pressure Point
Core SkillsCore Skills Control BleedingControl Bleeding 2626
Brachial Pressure Point Brachial Pressure Point
Core SkillsCore Skills Control BleedingControl Bleeding 2727
Femoral Pressure PointFemoral Pressure Point To control severe To control severe
bleeding of thigh bleeding of thigh and lower legand lower leg
Located at front, Located at front, center part of center part of crease crease in the the groingroin
Core SkillsCore Skills Control BleedingControl Bleeding 2828
SplintsSplints Immobilization of the injured Immobilization of the injured
extremity is one of the best ways to extremity is one of the best ways to stop bleedingstop bleeding
Broken bone fragments may lacerate Broken bone fragments may lacerate blood vesselsblood vessels
Muscular activity will increase rate of Muscular activity will increase rate of blood flowblood flow
Core SkillsCore Skills Control BleedingControl Bleeding 2929
TourniquetsTourniquets Early use of a tourniquet in Early use of a tourniquet in
the setting of forceful the setting of forceful arterial bleeding, such as an arterial bleeding, such as an amputation, may be life-amputation, may be life-savingsaving
STOP THE BLEEDING!STOP THE BLEEDING!
Core SkillsCore Skills Control BleedingControl Bleeding 3030
TourniquetsTourniquets
Use a commercial tourniquet, such as the Use a commercial tourniquet, such as the Combat Application Tourniquet, if Combat Application Tourniquet, if availableavailable
If not available, then use..If not available, then use.. CravatCravat BeltBelt RopeRope Strap from LBEStrap from LBE Any available materialAny available material
Core SkillsCore Skills Control BleedingControl Bleeding 3131
Combat Application Combat Application TourniquetTourniquet
WINDLASS
OMNI TAPE BANDWINDLASS STRAP
Core SkillsCore Skills Control BleedingControl Bleeding 3232
Tourniquet ApplicationTourniquet Application Place tourniquet between Place tourniquet between
the heart and woundthe heart and wound Wrap tourniquet around Wrap tourniquet around
extremity extremity Tighten Tighten UNTIL BLEEDING UNTIL BLEEDING
STOPSSTOPS
Core SkillsCore Skills Control BleedingControl Bleeding 3333
Tourniquet ApplicationTourniquet Application
Core SkillsCore Skills Control BleedingControl Bleeding 3434
Tourniquet Self-ApplicationTourniquet Self-Application
Core SkillsCore Skills Control BleedingControl Bleeding 3535
Tourniquet EtiquetteTourniquet Etiquette Never cover a tourniquet with Never cover a tourniquet with
another dressing, etc.another dressing, etc. Write “T” on the casualty's Write “T” on the casualty's
forehead with pen or bloodforehead with pen or blood Never loosen or remove a Never loosen or remove a
tourniquet once placedtourniquet once placed
Core SkillsCore Skills Control BleedingControl Bleeding 3636
AmputationAmputation First,First, STOP THE BLEEDING! STOP THE BLEEDING! Use direct pressure, Israeli dressing, Use direct pressure, Israeli dressing,
or tourniquet as necessaryor tourniquet as necessary Apply dressing to cover end of the Apply dressing to cover end of the
stumpstump Blood vessels may collapse, retract Blood vessels may collapse, retract
or curl closed and limit bleedingor curl closed and limit bleeding
Core SkillsCore Skills Control BleedingControl Bleeding 3737
SummarySummary Care Under FireCare Under Fire: Stop significant bleeding : Stop significant bleeding
with tourniquet while returning firewith tourniquet while returning fire Tactical Field CareTactical Field Care: ABCs with attention to : ABCs with attention to
stopping significant bleedingstopping significant bleeding Evacuation CareEvacuation Care: Treat shock with IV : Treat shock with IV
fluids, rapid evacuation to surgical assetsfluids, rapid evacuation to surgical assets This knowledge will save lives in Iraq, This knowledge will save lives in Iraq,
maybe your ownmaybe your own
Core SkillsCore Skills Control BleedingControl Bleeding 3838
Questions?Questions?