Hemorrhage Control  <ul><li>DEPARTMENT OF COMBAT MEDIC TRAINING </li></ul><ul><li>C168W003 </li></ul>
Terminal Learning Objective <ul><li>Given a simulated casualty with a severe bleeding injury in a combat environment, </li...
Enabling Learning Objective 1 <ul><li>Review Circulatory System  </li></ul><ul><li>and Hemorrhage Concepts  </li></ul><ul>...
<ul><li>Bleeding Videos: </li></ul><ul><li>Arterial  </li></ul><ul><li>Venous </li></ul><ul><li>Capillary </li></ul>
Components of The Blood
Clotting Physiology <ul><li>Injury to a blood vessel stimulates a series of chemical reactions in which clotting factors a...
Clotting Physiology
Disrupting Factors <ul><li>Hypothermia </li></ul><ul><li>Acidosis </li></ul><ul><li>Hemodilution </li></ul><ul><li>Medicat...
Hypothermia <ul><li>Prevention of hypothermia should begin as soon as the casualty is identified, regardless of the ambien...
Hypothermia <ul><li>When hypothermia is associated with significant injuries mortality rates increases dramatically. </li>...
Blizzard Survival Wrap
Ready Heat Blankets
Hypothermia Prevention and Management Kit ™ Contents: 1 x Heat Reflective Skull Cap 1 x Self Heating, Four Cell Shell Line...
Hypothermia Prevention and Management Kit ™
Hypothermia <ul><li>In some cases, the casualty may be warmed from the inside. </li></ul>
Acidosis <ul><li>When the body suffers from shock  </li></ul><ul><li>(inadequate tissue perfusion)  </li></ul><ul><li>lact...
Hemodilution <ul><li>When too much intravenous fluid has been given to a casualty.  </li></ul><ul><li>  </li></ul><ul><li>...
Medication <ul><li>Some medications inhibit the formation of clots, such as aspirin, ibuprofen, naproxen, and Warfarin (Co...
Blood Pressure <ul><li>The higher the blood pressure inside of a damaged vessel, the faster it will bleed. </li></ul><ul><...
Check on your Learning… <ul><li>Q: How does clotting work? </li></ul>A: The injured vessel stimulates chemical reactions, ...
Check on your Learning… <ul><li>Q: What factors can affect the body’s ability to form clots and what can be done to limit ...
Check on your Learning… <ul><li>Q: At what point should you prevent or treat the casualty for hypothermia? </li></ul>A: As...
Non-Compressible Hemorrhage
Compressible Hemorrhage
Hemorrhage <ul><li>What is the difference between compressible and non-compressible hemorrhage? </li></ul><ul><li>One can ...
Enabling Learning Objective 2 <ul><li>Apply a tourniquet to control life threatening hemorrhage,  </li></ul><ul><li>IAW th...
Tourniquets <ul><li>In your own words, how do tourniquets work? </li></ul>They compress the tissue around the vessel, whic...
Improvised Tourniquets <ul><li>Improvised tourniquets can be made with many different materials.  </li></ul><ul><li>We wil...
Improvised Tourniquets Effective Bilateral Improvised Tourniquets
Commercial Tourniquets <ul><li>There are many tourniquets available on the market today.  </li></ul><ul><li>Some work well...
Combat Application Tourniquet <ul><li>The CAT is the standard tourniquet in the IFAK </li></ul><ul><li>  All tourniquets a...
Combat Application Tourniquet
SOFTT <ul><li>Special Operations Forces Tactical Tourniquet </li></ul>
Emergency Medical Tourniquet
Tourniquet Use  Care under Fire <ul><li>When the tactical situation dictates, no intervention should be employed  </li></u...
Tourniquet Use  Care under Fire <ul><li>To maintain firepower supremacy,  </li></ul><ul><li>only extremity bleeding should...
Tourniquet Use  Care under Fire <ul><li>Tourniquets are the only recommended treatment during care under fire. </li></ul>
Tourniquet Use  Care under Fire <ul><li>Intervention should take place under suitable cover or concealment.  </li></ul><ul...
Tourniquet Use  Care under Fire <ul><li>Hasty Tourniquets- </li></ul><ul><li>Placed over the clothing, </li></ul><ul><li>A...
<ul><li>Hasty Tourniquet </li></ul>Tourniquet Use  Care under Fire
Tourniquet Use  Tactical Field Care <ul><li>Once fire superiority has been gained  </li></ul><ul><li>AND  </li></ul><ul><l...
<ul><li>Complete the first blood sweep for bleeding. </li></ul><ul><li>You should assess the Neck, axillary area, upper ex...
<ul><li>Deliberate tourniquets </li></ul><ul><li>A tourniquet used to control bleeding of extremities that is placed: </li...
Tourniquet Use  Tactical Field Care <ul><li>Deliberate Tourniquet </li></ul>
<ul><li>Q: What should you do if, after placement of a deliberate tourniquet, the distal pulse is still present? </li></ul...
Tourniquet Use  Tactical Field Care Two tourniquets applied side by side controls the hemorrhage.
<ul><li>Why is it important to tighten a tourniquet until a distal pulse is absent and not just to the point that bleeding...
<ul><li>In the case of amputations, the tourniquet should be tightened until the bleeding stops. </li></ul>Tourniquet Use ...
Tourniquets All members of your unit must be trained on tourniquets, you may not be around.
Check on your Learning… <ul><li>What is the difference between a hasty and a deliberate tourniquet?  </li></ul><ul><li>Has...
Check on your Learning… <ul><li>Is one type of tourniquet application better  </li></ul><ul><li>than the other? </li></ul>...
You are the Medic <ul><li>An IED explodes in a market place.  The blast rips off the casualty’s lower left leg. </li></ul>...
<ul><li>Demonstration and Practical Exercise </li></ul><ul><li>Improvised Tourniquet </li></ul><ul><li>Combat Application ...
Enabling Learning Objective 3 <ul><li>Pack a wound, </li></ul><ul><li>IAW Tactical Combat Casualty Care Principles and Pre...
Hemostatic Agents <ul><li>What is special about a dressing that is impregnated with a hemostatic agent? </li></ul><ul><li>...
Hemostatic Agents <ul><li>Which  </li></ul><ul><li>hemostatic agent does the Army recommended in combat zones? </li></ul><...
Gauze Packing <ul><li>Compressed or roller gauze is an effective method of hemorrhage control.  </li></ul><ul><li>  </li><...
Wound Packing <ul><li>Follow the  </li></ul><ul><li>4 “P’s”  </li></ul><ul><li>of Wound Packing </li></ul><ul><li>Peel  th...
Wound Packing: The 4 P’s WOUND Gauze Pile above the skin! Elastic Bandage
Pressure Dressings <ul><li>Elastic bandages wrapped tightly around a body part to put external pressure on the wounds. </l...
 
Pressure Bandages  <ul><li>It may be a challenge to apply pressure with pressure dressings to certain wound locations. </l...
Pressure Bandages  <ul><li>What and where are the anchor points? </li></ul><ul><li>An area of the body that is used to sec...
Principles of Wound Packing <ul><li>How does wound location affect how it is treated? </li></ul><ul><li>Hemostatic agents ...
Principles of Wound Packing <ul><li>Wound depth may affect how it is treated. </li></ul><ul><li>Moderate and deep wounds m...
Wound Packing <ul><li>Q: After packing a wound, how will you know if the bleeding has NOT been controlled? </li></ul>You m...
Check on your Learning… <ul><li>How do hemostatic agents work? </li></ul><ul><li>Dressings impregnated with chemicals that...
Check on your Learning… <ul><li> Q: What are anchor points, where are they and why are they important? </li></ul>Neck woun...
Check on your Learning… <ul><li>  What are the four &quot;P&quot; of wound packing?  Explain each. </li></ul><ul><li>Peel ...
Check on your Learning… Based on what you see, does it appear bleeding has been controlled?  Why or why not?
<ul><li>Demonstration and Practical Exercise </li></ul><ul><li>Emergency Bandage </li></ul><ul><li>Neck Wounds  </li></ul>...
Enabling Learning Objective 4 <ul><li>Replace a Tourniquet Using Alternate Means of Hemorrhage Control, </li></ul><ul><li>...
<ul><li>Demonstration and Practical Exercise </li></ul><ul><li>Change a Hasty Tourniquet  </li></ul><ul><li>to a Deliberat...
Principles of Tourniquet Conversion <ul><li>Tourniquet conversion reduces unnecessary damage to an extremity. </li></ul><u...
Principles of Tourniquet Conversion Effectively Converted Tourniquet
Principles of Tourniquet Conversion <ul><li>Under what circumstances should a tourniquet NOT be loosened or converted? </l...
<ul><li>DO NOT periodically loosen the tourniquet to get blood to the limb.  This can be rapidly fatal. </li></ul><ul><li>...
<ul><li>What circumstances must be present for a tourniquet to be converted? </li></ul><ul><li>The wound has been exposed ...
Check on your Learning… <ul><li>A casualty is brought into your BAS. This is what you see.  What is the wound doing under ...
<ul><li>Demonstration and Practical Exercise </li></ul><ul><li>Covert a Tourniquet to Trauma Bandage </li></ul><ul><li>usi...
Summary <ul><li>Q: How is hemorrhage controlled during  </li></ul><ul><li>care under fire? </li></ul><ul><li>Q: How is hem...
Summary <ul><li>The tools Medics have available to control hemorrhage- </li></ul><ul><li>  </li></ul><ul><li>Tourniquets –...
Summary <ul><li>Give an example of a realistic combat casualty scenario where each hemorrhage control tool could be used. ...
Summary <ul><li> When should tourniquets NOT be loosened? </li></ul><ul><li>  When the tactical situation or the wound doe...
Convert or Leave in Place?  <ul><li>For the next four slides answer this question:  </li></ul><ul><li>should the tournique...
Convert or Leave in Place?
Convert or Leave in Place?
Convert or Leave in Place?
Convert or Leave in Place?
Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Loc...
<ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Location Ap...
Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Loc...
Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Loc...
Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Loc...
Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Loc...
Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Loc...
Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Loc...
Summary <ul><li>Why do we convert tourniquets? </li></ul><ul><li>Tourniquet conversion reduces unnecessary damage to an ex...
QUESTIONS? This combat-casualty with triple amputations survived because the first responders and medics applied tournique...
Upcoming SlideShare
Loading in...5
×

Hemorrhage Control

9,599

Published on

Published in: Education
0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
9,599
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
470
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide
  • This is a visual review with class participation. Ensure all members of the class participate. Use Ask, Pause, Call. The wound is over the knee, therefore the CAT is applied 2-3 inches above the knee.
  • This is a visual review with class participation. Ensure all members of the class participate. Use Ask, Pause, Call. The wound is over the foot, so the CAT is applied 2-3 inches above the ankle.
  • This is a visual review with class participation. Ensure all members of the class participate. Use Ask, Pause, Call. The wound is in the axilla and Combat Gauze is used.
  • This is a visual review with class participation. Ensure all members of the class participate. Use Ask, Pause, Call. The wound is in the groin and Combat Gauze is used.
  • This is a visual review with class participation. Ensure all members of the class participate. Use Ask, Pause, Call. This one is a little tricky. There are 2 life-threatening wounds, one on the left mid-thigh, the other is over the left calf The CAT is applied 2-3 inches above the thigh wound until both have stopped bleeding and the posterior tibialis pulse is not palpable. In Kragh’s study, there were 4 casualties like this with a tourniquet above the distal wound only. QUESTION: How many patient scenarios in training have you seen with this wound pattern? We often only present 1 wound per extremity.
  • This is a visual review with class participation. Ensure all members of the class participate. Use Ask, Pause, Call. The wound is in the neck and Combat Gauze is used.
  • This is a visual review with class participation. Ensure all members of the class participate. Use Ask, Pause, Call. The wound is over the foot, so the CAT is applied 2-3 inches above the wound.
  • This is a visual review with class participation. Ensure all members of the class participate. Use Ask, Pause, Call. This one is also a little complicated. The hemorrhaging wound is in the upper calf, but if we apply the CAT 2-3 inches above it, it would be over the knee. So we need to apply the CAT 2-3 inches above the knee.
  • Hemorrhage Control

    1. 1. Hemorrhage Control <ul><li>DEPARTMENT OF COMBAT MEDIC TRAINING </li></ul><ul><li>C168W003 </li></ul>
    2. 2. Terminal Learning Objective <ul><li>Given a simulated casualty with a severe bleeding injury in a combat environment, </li></ul><ul><li>control the bleeding, </li></ul><ul><li>IAW the concepts and principles of Tactical Combat Casualty Care (TC-3) and Prehospital Trauma Life Support Chapters 7, 20 and 21. </li></ul>
    3. 3. Enabling Learning Objective 1 <ul><li>Review Circulatory System </li></ul><ul><li>and Hemorrhage Concepts </li></ul><ul><li>IAW Prehospital Trauma Life Support Chapter 7. </li></ul>
    4. 4. <ul><li>Bleeding Videos: </li></ul><ul><li>Arterial </li></ul><ul><li>Venous </li></ul><ul><li>Capillary </li></ul>
    5. 5. Components of The Blood
    6. 6. Clotting Physiology <ul><li>Injury to a blood vessel stimulates a series of chemical reactions in which clotting factors are activated and a fibrin net is formed over the injury of the vessel. The clotting cascade is a series of chemical reactions involving clotting factors. </li></ul><ul><li>  </li></ul><ul><li>Platelets and red blood cells stick to the fibrin net forming a clot. </li></ul>
    7. 7. Clotting Physiology
    8. 8. Disrupting Factors <ul><li>Hypothermia </li></ul><ul><li>Acidosis </li></ul><ul><li>Hemodilution </li></ul><ul><li>Medications </li></ul><ul><li>Blood pressure </li></ul>
    9. 9. Hypothermia <ul><li>Prevention of hypothermia should begin as soon as the casualty is identified, regardless of the ambient temperature. </li></ul><ul><li>Hypothermia occurs with equal frequency in both cold and hot environments. </li></ul>
    10. 10. Hypothermia <ul><li>When hypothermia is associated with significant injuries mortality rates increases dramatically. </li></ul>
    11. 11. Blizzard Survival Wrap
    12. 12. Ready Heat Blankets
    13. 13. Hypothermia Prevention and Management Kit ™ Contents: 1 x Heat Reflective Skull Cap 1 x Self Heating, Four Cell Shell Liner 1 x Heat Reflective Shell
    14. 14. Hypothermia Prevention and Management Kit ™
    15. 15. Hypothermia <ul><li>In some cases, the casualty may be warmed from the inside. </li></ul>
    16. 16. Acidosis <ul><li>When the body suffers from shock </li></ul><ul><li>(inadequate tissue perfusion) </li></ul><ul><li>lactic acid builds up in tissues. </li></ul><ul><li>  </li></ul><ul><li>If not corrected, lactic acid builds up to change the pH level inside the body. </li></ul><ul><li>  </li></ul><ul><li>Normal clotting requires a normal pH. </li></ul>
    17. 17. Hemodilution <ul><li>When too much intravenous fluid has been given to a casualty. </li></ul><ul><li>  </li></ul><ul><li>The clotting proteins, platelets and red blood cells have been “washed out” of the vascular space through ongoing hemorrhage and the addition of fluids that do not contain clotting factors. </li></ul>
    18. 18. Medication <ul><li>Some medications inhibit the formation of clots, such as aspirin, ibuprofen, naproxen, and Warfarin (Coumadin). </li></ul><ul><li>“ ASA is not indicated for military members in combat. ASA prolongs the clotting time of blood which may cause the service member to bleed excessively.” </li></ul><ul><li>(See Pharmacology Lesson) </li></ul>
    19. 19. Blood Pressure <ul><li>The higher the blood pressure inside of a damaged vessel, the faster it will bleed. </li></ul><ul><li>Clotting requires time to form a fibrin clot. </li></ul><ul><li>Shunting may slow or stop hemorrhage from peripheral vessels. </li></ul><ul><li>As pressure decreases, hemorrhage slows and clots may form. </li></ul>
    20. 20. Check on your Learning… <ul><li>Q: How does clotting work? </li></ul>A: The injured vessel stimulates chemical reactions, clotting factors are activated. A fibrin net is formed over the injury and platelets and red blood cells stick to the fibrin net forming a clot.
    21. 21. Check on your Learning… <ul><li>Q: What factors can affect the body’s ability to form clots and what can be done to limit the damage of these contributing factors? </li></ul><ul><li>Hypothermia </li></ul><ul><li>Acidosis </li></ul><ul><li>Hemodilution </li></ul><ul><li>Medications </li></ul><ul><li>Blood pressure </li></ul>
    22. 22. Check on your Learning… <ul><li>Q: At what point should you prevent or treat the casualty for hypothermia? </li></ul>A: As soon as the casualty is identified, regardless of the ambient temperature.
    23. 23. Non-Compressible Hemorrhage
    24. 24. Compressible Hemorrhage
    25. 25. Hemorrhage <ul><li>What is the difference between compressible and non-compressible hemorrhage? </li></ul><ul><li>One can be stopped with direct pressure, </li></ul><ul><li>wound packing and pressure bandages the other requires a surgeon. </li></ul>Thoracotomy at the CSH Heart Left Lung Hemostat clamped on bleeding vessel inside the chest. Rib Spreaders
    26. 26. Enabling Learning Objective 2 <ul><li>Apply a tourniquet to control life threatening hemorrhage, </li></ul><ul><li>IAW the principles of Tactical Combat Casualty Care and Prehospital Trauma Life Support Chapters 20 and 21. </li></ul>
    27. 27. Tourniquets <ul><li>In your own words, how do tourniquets work? </li></ul>They compress the tissue around the vessel, which then compresses the vessel.
    28. 28. Improvised Tourniquets <ul><li>Improvised tourniquets can be made with many different materials. </li></ul><ul><li>We will teach 1 way. </li></ul>
    29. 29. Improvised Tourniquets Effective Bilateral Improvised Tourniquets
    30. 30. Commercial Tourniquets <ul><li>There are many tourniquets available on the market today. </li></ul><ul><li>Some work well, some don’t work. </li></ul><ul><li>The following tourniquets were shown to stop arterial blood flow 100% of the time in both upper and lower extremities. </li></ul>
    31. 31. Combat Application Tourniquet <ul><li>The CAT is the standard tourniquet in the IFAK </li></ul><ul><li>  All tourniquets are one time use only. </li></ul>
    32. 32. Combat Application Tourniquet
    33. 33. SOFTT <ul><li>Special Operations Forces Tactical Tourniquet </li></ul>
    34. 34. Emergency Medical Tourniquet
    35. 35. Tourniquet Use Care under Fire <ul><li>When the tactical situation dictates, no intervention should be employed </li></ul><ul><li>unless and until: </li></ul><ul><li>  </li></ul><ul><li>The unit can afford to have the provider drop out of the fire fight long enough to intervene. </li></ul><ul><li>  </li></ul><ul><li>Efforts to direct the self-aid / buddy aid have failed. </li></ul>
    36. 36. Tourniquet Use Care under Fire <ul><li>To maintain firepower supremacy, </li></ul><ul><li>only extremity bleeding should warrant any intervention during this phase </li></ul><ul><li>When approaching the casualty, if blood is apparent on the shirt sleeve or the pant leg that is all of the proof necessary to warrant application of a tourniquet. </li></ul>
    37. 37. Tourniquet Use Care under Fire <ul><li>Tourniquets are the only recommended treatment during care under fire. </li></ul>
    38. 38. Tourniquet Use Care under Fire <ul><li>Intervention should take place under suitable cover or concealment. </li></ul><ul><li>This may require that you initially move the casualty before placing a tourniquet. </li></ul><ul><li>  </li></ul><ul><li>The intervention should be tactically feasible as to avoid a circumstance where the care giver is an additional casualty. </li></ul>
    39. 39. Tourniquet Use Care under Fire <ul><li>Hasty Tourniquets- </li></ul><ul><li>Placed over the clothing, </li></ul><ul><li>As high on the extremity as possible without capturing the shoulder or the buttock, </li></ul><ul><li>As tightly as possible </li></ul>
    40. 40. <ul><li>Hasty Tourniquet </li></ul>Tourniquet Use Care under Fire
    41. 41. Tourniquet Use Tactical Field Care <ul><li>Once fire superiority has been gained </li></ul><ul><li>AND </li></ul><ul><li>The tactical leader decides that medical treatment is appropriate </li></ul><ul><li>AND </li></ul><ul><li>The casualty has been moved behind cover and concealment… </li></ul><ul><li>Tactical field care casualty assessment and treatment may begin. </li></ul>
    42. 42. <ul><li>Complete the first blood sweep for bleeding. </li></ul><ul><li>You should assess the Neck, axillary area, upper extremities, inguinal area and lower extremities </li></ul><ul><li>If you find bleeding at the neck, axillary, or inguinal areas, treat with direct pressure and hemostatic agents </li></ul>Tourniquet Use Tactical Field Care
    43. 43. <ul><li>Deliberate tourniquets </li></ul><ul><li>A tourniquet used to control bleeding of extremities that is placed: </li></ul><ul><li>Directly to the skin. </li></ul><ul><li>2-3 inches above (proximal to) the wound. </li></ul><ul><li>Not over a joint. </li></ul><ul><li>Tightened until the bleeding has stopped and the distal pulse is absent. </li></ul>Tourniquet Use Tactical Field Care
    44. 44. Tourniquet Use Tactical Field Care <ul><li>Deliberate Tourniquet </li></ul>
    45. 45. <ul><li>Q: What should you do if, after placement of a deliberate tourniquet, the distal pulse is still present? </li></ul>Tourniquet Use Tactical Field Care A: Attempt to tighten the tourniquet more. Q: What should you do if, the distal pulse is still present? A: Apply a second tourniquet (side by side) just above the original tourniquet.
    46. 46. Tourniquet Use Tactical Field Care Two tourniquets applied side by side controls the hemorrhage.
    47. 47. <ul><li>Why is it important to tighten a tourniquet until a distal pulse is absent and not just to the point that bleeding stops? </li></ul>Tourniquet Use Tactical Field Care Tightening until the pulse is absent decreases the chances of developing a compartment syndrome later. Compartment syndrome can result in tissue death and loss of extremity or other disability.
    48. 48. <ul><li>In the case of amputations, the tourniquet should be tightened until the bleeding stops. </li></ul>Tourniquet Use Tactical Field Care
    49. 49. Tourniquets All members of your unit must be trained on tourniquets, you may not be around.
    50. 50. Check on your Learning… <ul><li>What is the difference between a hasty and a deliberate tourniquet? </li></ul><ul><li>Hasty Deliberate . </li></ul>Over the clothing As high on the extremity as possible. As tightly as possible Directly to the skin. 2-3 inches above wound. Not over a joint Tightened until bleeding stops and distal pulse is absent. As tightly as possible.
    51. 51. Check on your Learning… <ul><li>Is one type of tourniquet application better </li></ul><ul><li>than the other? </li></ul><ul><li>Ultimately, no. </li></ul><ul><li>Each application stops life threatening extremity bleeding and is dependent on the tactical environment. </li></ul>
    52. 52. You are the Medic <ul><li>An IED explodes in a market place. The blast rips off the casualty’s lower left leg. </li></ul><ul><li>The leg is missing but the wound not bleeding. </li></ul><ul><li>How would you treat this and why? </li></ul>
    53. 53. <ul><li>Demonstration and Practical Exercise </li></ul><ul><li>Improvised Tourniquet </li></ul><ul><li>Combat Application Tourniquet </li></ul>
    54. 54. Enabling Learning Objective 3 <ul><li>Pack a wound, </li></ul><ul><li>IAW Tactical Combat Casualty Care Principles and Prehospital Trauma Life Support Chapter 7 and 21. </li></ul>
    55. 55. Hemostatic Agents <ul><li>What is special about a dressing that is impregnated with a hemostatic agent? </li></ul><ul><li>These dressings will have chemical properties that stimulate clotting when placed in wounds. </li></ul>
    56. 56. Hemostatic Agents <ul><li>Which </li></ul><ul><li>hemostatic agent does the Army recommended in combat zones? </li></ul><ul><li>Combat Gauze </li></ul>
    57. 57. Gauze Packing <ul><li>Compressed or roller gauze is an effective method of hemorrhage control. </li></ul><ul><li>  </li></ul><ul><li>Gauze fills wounds and puts pressure on blood vessels to promote clotting by slowing the bleeding and giving clotting proteins and platelets time to form a clot. </li></ul>
    58. 58. Wound Packing <ul><li>Follow the </li></ul><ul><li>4 “P’s” </li></ul><ul><li>of Wound Packing </li></ul><ul><li>Peel the gauze off the roll </li></ul><ul><li>Push gauze into cracks and crevices inside wound </li></ul><ul><li>Pile the gauze above the level of the skin </li></ul><ul><li>Pressure dressing/bandage over the top of wound </li></ul>
    59. 59. Wound Packing: The 4 P’s WOUND Gauze Pile above the skin! Elastic Bandage
    60. 60. Pressure Dressings <ul><li>Elastic bandages wrapped tightly around a body part to put external pressure on the wounds. </li></ul>
    61. 62. Pressure Bandages <ul><li>It may be a challenge to apply pressure with pressure dressings to certain wound locations. </li></ul>Axilla Neck
    62. 63. Pressure Bandages <ul><li>What and where are the anchor points? </li></ul><ul><li>An area of the body that is used to secure/stabilize a bandage on the body. </li></ul><ul><li>Neck wounds - under the axilla opposite of the wound. </li></ul><ul><li>Axillary wounds - over the opposite shoulder against the neck </li></ul><ul><li>Inguinal wounds - casualty's thigh, buttocks or belt. </li></ul>
    63. 64. Principles of Wound Packing <ul><li>How does wound location affect how it is treated? </li></ul><ul><li>Hemostatic agents should be strongly considered with wounds of the neck, axillary area and inguinal area, especially if there is a presence of life threatening hemorrhage. </li></ul><ul><li>Wounds involving large vessels may require hemostatics and lots of pressure to control the bleeding </li></ul>
    64. 65. Principles of Wound Packing <ul><li>Wound depth may affect how it is treated. </li></ul><ul><li>Moderate and deep wounds may require hemostatic agents and gauze packing. </li></ul><ul><li>  </li></ul><ul><li>For superficial wounds, pressure bandages may be all that is necessary. </li></ul>
    65. 66. Wound Packing <ul><li>Q: After packing a wound, how will you know if the bleeding has NOT been controlled? </li></ul>You may not know and should not assume, always consider bleeding may still continue internally. A: Blood visible and spreading on bandaging/dressing Signs your casualty is entering or progressing further into hemorrhagic shock.
    66. 67. Check on your Learning… <ul><li>How do hemostatic agents work? </li></ul><ul><li>Dressings impregnated with chemicals that stimulate clotting when placed in wounds. </li></ul><ul><li>  </li></ul><ul><li>Combat Gauze is the hemostatic agent being used by the Army </li></ul><ul><li>  </li></ul>
    67. 68. Check on your Learning… <ul><li> Q: What are anchor points, where are they and why are they important? </li></ul>Neck wounds - Axillary wounds - Inguinal wounds - A: An area of the body that is used to secure/stabilize a bandage on the body. Under the axilla opposite of the wound. O ver the opposite shoulder against the neck Casualty's thigh, buttocks or belt.
    68. 69. Check on your Learning… <ul><li>  What are the four &quot;P&quot; of wound packing? Explain each. </li></ul><ul><li>Peel the gauze off the roll </li></ul><ul><li>Push gauze into cracks and crevices inside wound </li></ul><ul><li>Pile the gauze above the level of the skin </li></ul><ul><li>Pressure dressing/bandage over the top of wound </li></ul>
    69. 70. Check on your Learning… Based on what you see, does it appear bleeding has been controlled? Why or why not?
    70. 71. <ul><li>Demonstration and Practical Exercise </li></ul><ul><li>Emergency Bandage </li></ul><ul><li>Neck Wounds </li></ul><ul><li>Axillary Wounds </li></ul><ul><li>Inguinal Wounds </li></ul>
    71. 72. Enabling Learning Objective 4 <ul><li>Replace a Tourniquet Using Alternate Means of Hemorrhage Control, </li></ul><ul><li>IAW Tactical Combat Casualty Care Principles and Prehospital Trauma Life Support Chapter 21. </li></ul>
    72. 73. <ul><li>Demonstration and Practical Exercise </li></ul><ul><li>Change a Hasty Tourniquet </li></ul><ul><li>to a Deliberate Tourniquet </li></ul>
    73. 74. Principles of Tourniquet Conversion <ul><li>Tourniquet conversion reduces unnecessary damage to an extremity. </li></ul><ul><li>If the evacuation to a definitive treatment facility is significantly delayed (hours), you can reduce tissue damage by changing to another method of hemorrhage control. </li></ul><ul><li>In certain cases, resulting in restored collateral circulation and blood flow to the extremity. </li></ul>
    74. 75. Principles of Tourniquet Conversion Effectively Converted Tourniquet
    75. 76. Principles of Tourniquet Conversion <ul><li>Under what circumstances should a tourniquet NOT be loosened or converted? </li></ul><ul><li>Casualty will arrive at a surgical facility within 2 hours </li></ul><ul><li>Tourniquet has been in place for longer than 6 hours </li></ul><ul><li>The tourniquet was placed above an amputation </li></ul><ul><li>Casualty is in profound shock, ensure fluids have been administered. </li></ul>
    76. 77. <ul><li>DO NOT periodically loosen the tourniquet to get blood to the limb. This can be rapidly fatal. </li></ul><ul><li>Tourniquets are very painful. </li></ul><ul><li>If unable to control bleeding with other methods, retighten the tourniquet </li></ul><ul><li>(Remember, never remove a tourniquet, only loosen.) </li></ul>Principles of Tourniquet Conversion
    77. 78. <ul><li>What circumstances must be present for a tourniquet to be converted? </li></ul><ul><li>The wound has been exposed and assessed. </li></ul><ul><li>  The tactical situation allows. </li></ul><ul><li>  There is enough time before evacuation to complete the intervention. </li></ul>Principles of Tourniquet Conversion
    78. 79. Check on your Learning… <ul><li>A casualty is brought into your BAS. This is what you see. What is the wound doing under the bandage? What is wrong with this treatment and what would you do to fix it? </li></ul>
    79. 80. <ul><li>Demonstration and Practical Exercise </li></ul><ul><li>Covert a Tourniquet to Trauma Bandage </li></ul><ul><li>using: </li></ul><ul><li>Hemostatic agent </li></ul><ul><li>Kerlix, compressed gauze, roller gauze </li></ul><ul><li>Emergency bandage </li></ul><ul><li>Elastic Bandage </li></ul>
    80. 81. Summary <ul><li>Q: How is hemorrhage controlled during </li></ul><ul><li>care under fire? </li></ul><ul><li>Q: How is hemorrhage controlled during </li></ul><ul><li>tactical field care? </li></ul>A: With a tourniquet A: Based on the wound, with tourniquets, hemostatic agents, wound packing and pressure bandages.
    81. 82. Summary <ul><li>The tools Medics have available to control hemorrhage- </li></ul><ul><li>  </li></ul><ul><li>Tourniquets – CAT, SOFTT, EMT </li></ul><ul><li>Hemostatic agent – Combat Gauze </li></ul><ul><li>Gauze - Kerlix, compressed or roller </li></ul><ul><li>Emergency Bandages </li></ul><ul><li>Elastic Bandage – Ace wrap </li></ul>
    82. 83. Summary <ul><li>Give an example of a realistic combat casualty scenario where each hemorrhage control tool could be used. </li></ul><ul><li>  </li></ul>
    83. 84. Summary <ul><li> When should tourniquets NOT be loosened? </li></ul><ul><li>  When the tactical situation or the wound does not permit </li></ul><ul><li>Casualty will arrive at a surgical facility within 2 hours </li></ul><ul><li>Tourniquet has been in place for longer than 6 hours </li></ul><ul><li>The tourniquet was placed above an amputation </li></ul><ul><li>Casualty is in profound shock, ensure until after fluids have been administered. </li></ul>
    84. 85. Convert or Leave in Place? <ul><li>For the next four slides answer this question: </li></ul><ul><li>should the tourniquet be converted to alternate means of hemorrhage control or left in place? </li></ul><ul><li>Based on what you have learned in this lesson, justify your treatment decisions. </li></ul>
    85. 86. Convert or Leave in Place?
    86. 87. Convert or Leave in Place?
    87. 88. Convert or Leave in Place?
    88. 89. Convert or Leave in Place?
    89. 90. Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Location Applied? CAT
    90. 91. <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Location Applied? Summary CAT
    91. 92. Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Location Applied?
    92. 93. Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Location Applied?
    93. 94. Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Location Applied? CAT
    94. 95. Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Location Applied?
    95. 96. Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Location Applied? CAT
    96. 97. Summary <ul><li>Identify the appropriate measures for a hemorrhaging wound at the </li></ul>Hemorrhage Control Device? Location Applied? CAT
    97. 98. Summary <ul><li>Why do we convert tourniquets? </li></ul><ul><li>Tourniquet conversion reduces unnecessary damage to an extremity. </li></ul><ul><li>You can reduce tissue damage. </li></ul><ul><li>Restore collateral circulation and blood flow to the extremity. </li></ul>
    98. 99. QUESTIONS? This combat-casualty with triple amputations survived because the first responders and medics applied tourniquets.
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×