Hey Rob,
In my departments and in general in this area, Hemostatic agents (QuikClot, Celox) are not used due to the administration, time, and the cleaning process that must be completed after use of the agent and before any in-hospital treatment can occur. Administration is sometimes difficult as with some of the agents it must be placed directly on the vessel for occlusion to occur and to get the agent to the vessel can be very time consuming depending on the location of the vessel. It is my understanding, from EC Trauma Docs and RNs, that the process to clean the wound is very tedious and time consuming which results in the patient waiting even longer to recieve surgical care (I have not seen this because we do not use these agents but I do have faith in the staff that relayed this info).
As for the order of controlling bleeding. I have always been taught and use this method; Direct Pressure, Elevation and Pressure Point (DPEPP).
Grab the site with a gloved hand (preferably) and the appropriate dressing (it may be a large trauma dressing or an ABD dressing which is fairly small) and place firm pressure on the site. The firm part is really emphasized when dealing with deep veins and arteries such as the femoral artery but should be used at all sites. Remember to NEVER remove the dressing from the site. If it becomes soaked in blood keep stacking more dressings on top of it.
If the bleeding is not stopped elevate the extremity above the level of the heart which in turn will slow the amount of blood flow since it is "travelling up hill". When elevating the extremity be sure to watch for possible spinal cord injuries, fractures, angulations of the joints and any other possible trauma, and if present skip this step. You should consider the patient to have a spinal cord injury if any trauma exists around the spine or head (I know that is a pretty big area but you do not want to turn your buddy into a quad) or depending on the mechanism of injury (fall, MVC, etc.).
If the bleeding still has not stopped, use pressure points. In the lower extremities the pressure point that we use is the femoral artery regardless of the location of the wound. To access the site you must remove any heavy clothing from the patient and place the heal of the hand in the crease formed where the leg and lower abdomen meet. Typically the site is just above the level of the gentalia in the crease. This is a very deep artery and will require a great deal of pressure to occlude. In the upper extremities use the brachial artery which can be located under the arm, along the bone between the bicep and tricep muscles. It is not as deep as the femoral but still requires a great deal of pressure.
Hopefully at this point the bleeding has stopped!!! or your buddy/family member is being transported to the nearest appropriate medical facility by trained personnel with a lot better equipment than you.
If not, this is the point where I would consider the tourniquet for me or my immediate family. I say it like this because there are a few VERY IMPORTANT things to remember when you use a tourniquet. Yes, it will stop bleeding in an emergency situation where the patient may literally bleed to DRT (dead right there). But remember if the patient is not bleeding that much and you place a tourniquet on the extremity you are essentially killing that limb. It is a fact that tourniquets cause irreversible nerve and tissue damage if left on for a prolonged period of time. This is due to the shunting of blood from the area (the bleeding will be stopped) which in turn is also robbing the remainder of the limb from recieving oxygen and nutrients from the bloodstream.
I hope this helps.
Disclaimer: These are the methods that I use and was taught in school and through many classes. If you use it and your patient becomes DRT, DO NOT come looking for me. I am only giving this info to hopefully help someone if they are ever placed in this situation. It is by no means meant to replace thorough training. Just as we all love to train with our EBRs and 1911s for what you hope never happens (home defense, personal defense), you should also at a minimum recieve training in First Aid.
Plus, I am a FF/EMT-I with a wife, two kids and an expensive firearms habit, so I am broke!
Last edited by Joe_Friday; 03-04-09 at 08:13.
Guard against the impostures of pretended patriotism.
George Washington, Farewell Address, September 19, 1796
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