Lecture 9A: Hemorrhage

Question 1

What are the S/S of capillary bleeding and how would you treat them?

Answer 1

S/s: ooze, risk of infection
tx: disinfect, dressing, bandage

Question 2

What are the S/S of venous bleeding and how would you treat them?

Answer 2

s/s: profuse, dark, risk shock
tx: direct pressure, more pressure/dressing, bandage, O2, shock prevention

Question 3

What are the S/S of arterial bleeding?

Answer 3

s/s: spurting, bright red, risk shock

Question 4

What are the important factors in successful control of bleeding?

Answer 4

apply pressure firmly and for a long time

Question 5

How long does it take for a dangerous bleed to lead to exsanguination?

Answer 5

1-2 minutes

Question 6

When is a tourniquet indicated?

Answer 6

if attempt at direct pressure/ pressure dressing fails to control emergent hemorrhage within 10seconds

Question 7

TRUE or FALSE. A tourniquet can be removed by anyone after it has been applied.

Answer 7

FALSE. DO NOT REMOVE a tourniquet before the person is seen in an ER. There has been no cases of amputations with tourniquet placed <2h

Question 8

Should wounds of the chest, abdomen or pelvis be packed?

Answer 8

they should not be packed because bleeding from these wounds is generally from a very deep source that can’t be reached from the outside. Should be performed at the discretion of local medical direction.

Question 9

Why shouldn’t neck wounds be packed?

Answer 9

they aren’t generally packed because of the risk for airway compromise

Question 10

What should you do in an urban setting?

Answer 10

Extremity packed (if no extremity tourniquet available)
junctional area packed (if no junctional tourniquet)
Back packed (outside of cavity)

Question 11

What should you do in a wilderness/rural setting?

Answer 11

if a tourniquet is initially placed on an extremity wound, it may later be replaced with a pressure dressing or with packing, which may be more comfortable for the patient and provide for a moderate amount of distal circulation

Question 12

Should transport be delayed for extensive packing and repacking of the wound?

Answer 12

No

Question 13

Epinephrine gel is contraindicated for what?

Answer 13

fingers, toes, penis, nose

Question 14

What is monsell’s solution?

Answer 14

a coagulant used to assist with minor bleed management

Question 15

What is Urgent QR?

Answer 15

hydrophilic polymer + K salt
apply to wound creates hematrix scab

Question 16

What is ActCel?

Answer 16

cellulose gauze converts to glucose gel upon contact with blood, controlling bleed fast acting for minor bleeds

Question 17

What are some management considerations for epistaxis?

Answer 17

MOI?
Trauma related?
Affected structures?
Cervical or TBI?
Profuse uncontrolled bleeding?
Anterior vs Posterior bleed?

Question 18

What are the management steps for epistaxis?

Answer 18

remain calm
initially pinch soft area of nose
place a gauze under bleeding nostril to limit contagion
sit upright, to keep the head above heart level
Lean forward slightly to prevent blood entering the throat
ideally have any blood leaks contained in a bin in front of athlete
bleeding should stop within 15 minutes
initially avoid placing gauze or tampon or other in nose (unless minor and RTP)

Question 19

When should you do an emergency referral for a nose bleed?

Answer 19

if bleeding has not stopped after 20min and/or overall condition of athlete has not improved, an ambulance/further care is needed
if blood is felt or tasted in throat even if bleeding has stopped
if nosebleed occurs after an injury with symptoms: dizziness, fever, fainting, vomiting
more blood than usual
bleeding interferes with breathing
if possible that bleeding is linked to a medical condition or medication use