1. Bleeding and Hemorrhage Control Bleeding always gets our attention! The more extreme the bleeding the more we are unsure how to control it.

2. Bleeding and Hemorrhage Control Sometimes it even causes us to miss other life threatening injuries.

3. Bleeding and Hemorrhage Control Not a whole lot has changed, but maintaining skills is important. Often times because something seems simple we fail to train or practice.

4. Bleeding and Hemorrhage Control I was told along time ago by Paramedic, “Paramedics save lives, but good EMT’s save Paramedics.”

5. Bleeding and Hemorrhage Control Often we get caught up in new techniques and the new gadgets in which we do our job. But when it comes to good patient care the basics are still what save lives. Remember the basics!

6. Bleeding and Hemorrhage Control Profuse bleeding is common to any major trauma. However, it can also result from ordinary reasons, such as ruptured vessels or nosebleeds.

7. Bleeding and Hemorrhage Control Controlling bleeding is crucial to volume retention and preventing hypovolemic shock. Doing it properly can make all the difference for patients in the prehospital setting.

8. Bleeding and Hemorrhage Control The most important concern in managing any hemorrhage is the safety of the provider. Infection control and BSI precautions are required. Be sure to wear disposable gloves, as well as a gown and or mask with eye protection, if the situation requires.

9. Bleeding and Hemorrhage Control Still the most commonly accepted methods of hemorrhage control are… 1.Direct pressure 2.Elevation 3.Pressure Dressing 4.Pressure points

10. Bleeding and Hemorrhage Control Direct Pressure Direct pressure is the most commonly used bleeding- control technique, and it usually controls most external bleeding. Try it first when the need arises.

11. Bleeding and Hemorrhage Control Direct Pressure First place a sterile gauze pad over the wound. Place your gloved hand over the pad and hold pressure until the bleeding is stopped. Use additional pads as they become blood soaked. Once bleeding has been controlled, bandage the gauze pad in place, making sure to wrap the bandage tight enough to keep the bleeding under control but not to limit circulation.

12. Bleeding and Hemorrhage Control Direct Pressure Remember, once a bandage is applied, it should not be removed in the prehospital environment unless absolutely necessary. Removal of a dressing may do further damage to the affected area and increase the bleeding.

13. Bleeding and Hemorrhage Control Elevation The second step in controlling bleeding is to elevate the injured extremity. Try and raise the injured site above the level of the heart. Immobilizing the area may also help in controlling the bleeding to the area.

14. Bleeding and Hemorrhage Control Pressure Dressing If you have tried direct pressure and elevation and you realize that the patient continues to bleed excessively, apply a pressure dressing. A pressure dressing can be applied snugly enough to control the blood flow but not so tight as to cut off all blood flow.

15. Bleeding and Hemorrhage Control Pressure Points If you have tried direct pressure, elevation and a pressure dressing and you realize that the patient continues to bleed excessively, locate a pressure point. A pressure point can be found proximal to any extremity. Usually located over a bony structure. Also known as pulse points-places.

16. Bleeding and Hemorrhage Control Pressure Points

17. Bleeding and Hemorrhage Control Pressure Points Pressure points can be found at the brachial artery (midway down the humerus).

18. Bleeding and Hemorrhage Control Pressure Points The radial artery (at the thumb side of the posterior wrist).

19. Bleeding and Hemorrhage Control Pressure Points The femoral artery (at the groin).

20. Bleeding and Hemorrhage Control Pressure Points The popliteal artery (on the posterior side of the knee joint).

21. Effects of Blood Loss The effects of the loss It decreases oxygen level to the cells It decreases waste elimination It changes the vital signs Increases heart rate Decreases blood pressure

22. Effects of Blood Loss In humans, blood is the fluid that transports nutrients and oxygen to every cell in the body. It also transports wastes away from cells. Blood keeps our body temperature steady by carrying excess heat from regions of the body to the skin where it can be dissipated. It also fights infection and carries chemicals that regulate many body functions.

23. Effects of Blood Loss Blood is composed of a yellowish fluid, called plasma. They are suspended in the millions of cells that constitute 45% by volume of whole blood. A cubic millimeter of human blood contains about 5 million red blood cells, or erythrocytes; 5,000 to 10,000 white blood cells or leukocytes; and 200,000 to 300,000 platelets or thrombocytes. The blood also carries many salts and organic substances in solution in the blood plasma.

24. Effects of Blood Loss In an average healthy adult, the volume of blood is about one-eleventh of the body weight. Most sources state the volume of blood in an average human adult, who is between 150 to 160 pounds, has between 4.7 and 5 liters. More recent sources state the volume of blood in an average adult is 4.7 liters or 1.24 gal. It is also found that an 80-pound child had about half that amount, and an 8-pound infant has about 8.5 ounces.

25. Effects of Blood Loss For the ease of understanding we will break Hemorrhage down into classes. Class I Hemorrhage Class II Hemorrhage Class III Hemorrhage Class IV Hemorrhage As an example we will use a adult male at 160 lb. with 5 liters of blood.

26. Effects of Blood Loss Class I Hemorrhage Involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary.

27. Effects of Blood Loss Class II Hemorrhage Involves 15-30% of total blood volume. A patient is often tachycardic (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient might start acting differently.

28. Effects of Blood Loss Class III Hemorrhage involves loss of 30-40% of circulating blood volume. The patient's blood pressure drops, the heart rate increases, peripheral perfusion, such as capillary refill worsens, and the mental status worsens. Fluid resuscitation is necessary. Assist Medic with I.V fluids.

29. Effects of Blood Loss Class IV Hemorrhage Involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death.

30. Effects of Blood Loss