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Clinically Related Operations: Bleeding
EMS 80810 Clinically Related Operations: Bleeding Chris Weinzapfel, FF, NREMTP(T) Firefighter/Paramedic/SWAT Medic Rowlett Fire Rescue Rowlett, Texas
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EMS 80810 Objectives Recognize role of history in prehospital hemorrhage treatment.
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EMS 80810 Objectives Identify methods/ techniques in prehospital bleeding control.
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EMS 80810 Objectives Indicate common issues associated with prehospital bleeding control.
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In the United States
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In the United States Military Medical Corps – 1862
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In the United States Military Medical Corps – 1862 integrated medical treatment
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In the United States Military Medical Corps – 1862 integrated medical treatment evacuation of personnel
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US Special Forces Combat Medics First Assignments ************
US Army “Special Forces Units” “Green Beret’s” Dual Role Operators and Medics President John F Kennedy
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90% of combat deaths occur on the battlefield before the casualty ever reaches a medical treatment facility. - Col. Ron Bellamy
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The hemorrhage that takes place when a main artery is divided is usually so rapid and so copious that the wounded man dies before help can reach him. - Col. H.M. Gray, 1919
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The overwhelming cause of preventable combat death continues to be extremity hemorrhage
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The American College of Surgeons and the Prehospital Trauma Life Support Guidelines no longer recommend elevation and pressure points for severe bleeding.
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Figure 1
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National Registry of Emergency Medical Technicians (NREMT) – February 2009
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Figure 2
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Internal Hemorrhage
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External Hemorrhage
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Types of Bleeding to Consider
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Types of Bleeding to Consider
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Types of Bleeding to Consider
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Types of Bleeding to Consider
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Bleeding from an arm or leg can usually be controlled by:
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Bleeding from an arm or leg can usually be controlled by:
trauma dressing
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Bleeding from an arm or leg can usually be controlled by:
trauma dressing emergency trauma dressing
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Bleeding from an arm or leg can usually be controlled by:
manual direct pressure and elevation
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Bleeding from an arm or leg can usually be controlled by:
manual direct pressure and elevation tourniquet (last resort?)
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In some situations, a tourniquet is applied first – since other methods will not be adequate to control the bleeding
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Hemorrhage and Shock
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Hemorrhage and Shock What happens when you start to bleed?
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Hemorrhage and Shock What happens when you start to bleed? – it depends on how much blood you lose
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Normal Adult Blood Volume
5 Liters Blood Volume
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Recognizing Shock
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Recognizing Shock Most useful in tactical combat casualty care (TCCC)
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Recognizing Shock mental status radial pulse heart rate (HR) blood pressure (BP) respiratory rate (RR) likelihood of death
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Recognizing Shock May be difficult to judge blood loss in combat except by mental status and radial pulse
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Recognizing Shock Heart rate and respiratory rate may be affected by exertion and combat stress as well as shock
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500 cc Blood Loss 4.5 Liters Blood Volume
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500 cc Blood Loss Mental state – alert Radial pulse – full Heart rate – normal or somewhat increased Systolic blood pressure – normal
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500 cc Blood Loss Respiratory Rate – normal Is he going to die from this? NO
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1000cc Blood Loss 4.0 Liters Blood Volume
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1000cc Blood Loss Mental state – alert
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1000cc Blood Loss Mental state – alert Radial pulse – full
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1000cc Blood Loss Mental state – alert Radial pulse – full Heart rate – 100+
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1000cc Blood Loss Systolic blood pressure – normal lying down Respiratory rate – may be normal Is he going to die from this? NO
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1500cc Blood Loss 3.5 Liters Blood Volume
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1500cc Blood Loss Mental state – alert but anxious Radial pulse – may be weak Heart rate – 100+
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1500cc Blood Loss Systolic blood pressure – may be decreased
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1500cc Blood Loss Systolic blood pressure – may be decreased Respiratory rate – 30
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1500cc Blood Loss Systolic blood pressure – may be decreased Respiratory rate – 30 Is he going to die from this? PROBABLY NOT
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2000cc Blood Loss 3.0 Liters Blood Volume
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2000cc Blood Loss Mental state – confused/lethargic Radial pulse – weak Heart Rate – 120+
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2000cc Blood Loss Systolic blood pressure – decreased Respiratory rate – >35 Is he going to die from this? MAYBE
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2500cc Blood Loss 2.5 Liters Blood Volume
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2500cc Blood Loss Mental state – unconscious Radial pulse – absent Heart rate – 140+
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2500cc Blood Loss Systolic blood pressure – markedly decreased Respiratory rate – over 35 Is he going to die from this? PROBABLY
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Expose the Wound
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Expose the Wound Push or cut away loose clothing
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Expose the Wound Push or cut away loose clothing DO NOT remove clothing that is stuck to the wound
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Expose the Wound DO NOT attempt to clean the wound
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Expose the Wound DO NOT attempt to clean the wound DO NOT probe the wound in order to remove an object from the wound
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Expose the Wound
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Apply a Bandage or Combined Trauma Bandage
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Apply a Bandage or Combined Trauma Bandage
Israeli bandage/pressure dressing
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Apply an Emergency Trauma Dressing
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Apply an Emergency Trauma Dressing
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Apply Pressure Dressing Over First Aid Dressing
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Apply Pressure Dressing Over First Aid Dressing
When blood continues to seep from the field first aid dressing
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Apply an Agent to a Wound
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ChitoFlex™ Hemostatic Bandage
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Chitosan (ki’ to san) Dressing
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Addition to Chitosan Dressing
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Addition to Chitosan Dressing
Apply manual pressure
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Addition to Chitosan Dressing
Apply manual pressure A bandage may be applied to the chitosan dressing to prevent it from being dislodged
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Wound Stat
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Civilian Accessible Agents
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QuikClot®
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CELOX™
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Figure 3
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Apply Digital Pressure
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Apply Digital Pressure
Uses pressure from the fingers, thumbs, or the heel of the hand applied to an artery supplying the wound
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Apply Digital Pressure
Temporal Carotid Brachial Radial Femoral Posterior/anterior tibialis
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Tourniquet
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Tourniquet A constricting band placed around an extremity to stop arterial bleeding
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Tourniquet A constricting band placed around an extremity to stop arterial bleeding Only used on an arm, forearm, thigh, or leg
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Tourniquet Used when there is no time to control bleeding Used on an amputation of the arm, forearm, thigh, or leg
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Applying a Combat Application Tourniquet (CAT)
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Applying a CAT
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Marking the Casualty T
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Dressing an Amputation
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Dressing an Amputation
Place a dressing (soft/absorbent) over the end of the stump Secure the dressing with bandages
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Dressing an Amputation
Prevents contamination Protects from additional injury
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Applying an Improvised Tourniquet
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Applying an Improvised Tourniquet
Gather materials
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Applying an Improvised Tourniquet
Rigid object (windlass) such as a strong stick
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Applying an Improvised Tourniquet
Rigid object (windlass) such as a strong stick Tourniquet band (cravat) at least two inches wide
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Applying an Improvised Tourniquet
Rigid object (windlass) such as a strong stick Tourniquet band (cravat) at least two inches wide Securing material (cravat)
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Applying an Improvised Tourniquet
Twist windlass until bright red bleeding has stopped Wrap second cravat around limb
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Applying an Improvised Tourniquet
Wrap tails around end of windlass so the tourniquet will not unwind Tie tails in a non-slip knot
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Ranger Ratchet Tourniquet
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The Special Operations Forces Tactical Tourniquet (SOFT)
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Are any of the pre-fabbed tourniquets available outside the military?
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Have you ever used a blood BP cuff as a tourniquet?
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Wound Packing
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Wound Packing Slow the bleeding first with point pressure or tourniquet, depending on the location of the insult
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Wound Packing Pack and pack and pack until there is no more room, filling all the voids you can
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Wound Packing Using a gauze with a blood stopping agent will make the pack more effective
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Wound Packing Using a gauze with a blood stopping agent will make the pack more effective Check and recheck during transport or with movement
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Wound Packing Wound packing with a clotting agent can be helpful
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Summing It All Up
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Summing It All Up NREMT skill change
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Summing It All Up NREMT skill change Civilian accessible hemostatic agents
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Summing It All Up Techniques and equipment used in management of major bleeding
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Questions
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Are the blood clotting agents better for a trauma surgeon or emergency room doctor than they used to be – no more concrete clots?
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Will the clotting agents help control femoral artery bleed?
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Have the heat effects of some clotting agents improved?
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Is there any push-back from surgeons?
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Do these clotting agents have FDA (Food and Drug Administration) approval?
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Can you put Celox™ in the wound, bandage it, and release the patient?
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Conclusion
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Clinically Related Operations: Bleeding
EMS 80810 Clinically Related Operations: Bleeding If you have any questions about the program you have just watched, you may call us at: (800) or fax (806) Direct your inquiries to Customer Service. Be sure to include the program number, title and speaker.
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The accreditation for this program can be found by signing in to
EMS 80810 Release Date: 04/01/2010 The accreditation for this program can be found by signing in to
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80810 EMS Dallas, TX 75234 Phone: 972-247-4442 -lsibley@cecbems.com
This continuing education activity is approved by the Continuing Education Coordinating Board for Emergency Medical Services for 1.5 advanced CEH. You have participated in a continuing education program that has received CECBEMS approval for continuing education credit. If you have any comments regarding the quality of this program and/or your satisfaction with it, please contact CECBEMS at: CECBEMS Ford Road, Suite 478 Dallas, TX Phone:
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