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Wound Care, Part One

How to Stop the Bleeding

Presented by Cat Ellis & Chuck Hudson

To keep the legal team happy..

© Cat Ellis & Chuck Hudson 2015. All Rights Reserved

We are not doctors. We do not diagnose, prescribe, treat, or claim to cure any disease. If you need medical advice or treatment, please seek out a licensed physician.

All material presented here is for informational purposes only. Use at your own risk.

Neither Cat Ellis nor Chuck Hudson can be held responsible for negative outcomes from the use or misuse of this information, intended for last-ditch, worst-case, emergency situations where there is no chance for professional medical help to arrive.

Introductions

Cat Ellis

Herbalist

Preparedness Author

www.HerbalPrepper.com

Chuck Hudson

Former combat medic

Former EMT-P

Survival Educator

www.TheMedicShack.net

Course Objectives

To cover techniques for stopping blood loss, including:

Direct Pressure (how much, what to do in challenging locations like the neck, etc.)

Pressure at Pulse Points (to stop bleeding lower on a limb)

Tourniquets (different types, pros and cons)

Chemical agents (conventional medicine and herbal medicine)

Suturing & Stapling (pros and cons, alternatives)

Cardiovascular System

Function:

To move blood through the body

Bring oxygen to the cells and tissues

To bring depleted blood back through the system to be replenished for another cycle.

Consists of:

Heart- the primary pump

Arteries- carry oxygenated blood from the heart to cells

Capillaries- tiny blood vessels

Veins- carries de-oxygenated blood back to the lungs for more oxygen.

Bleeding: Arteries and Veins

Arteries Oxygenated blood vessels

Protected by being buried deep within the body, usually next to bones.

Have pulses and are pressurized.

Arterial wounds are always life-threatening.

Veins De-oxygenated blood vessels

Nearer to the surface

Do not have pulses and are not pressurized

Venous wounds can be life threatening

The Importance of Managing Blood Loss

Priorities in treating injuries:

Depending on the injury, dying from blood loss can happen in a matter of minutes.

A bleed from the femoral artery can cause a person can cause weakness in 15 seconds, and death in 60 seconds.

Brachial artery can bleed out in 2 minutes.

Brain damage can occur in 3 minutes, but permanent brain damage happens after 4 minutes.

The Importance of Managing Blood Loss (Continued)

In Vietnam, over 60% of battlefield casualties died of exsanguination (bleeding out) within 3 to 5 minutes and could have been saved with timely intervention.

In order to continue to decrease these statistics, you must: Rapidly identify and manage internal and external

hemorrhage.

Recognize the type of bleeding.

Apply the appropriate hemorrhage control techniques,

Understand the varying degrees of risk associated with types of hemorrhage

How to estimate blood loss.

This is not just for the battlefield, but also the homestead, the farm, the kitchen, hiking, car accidents... basically, anywhere.

Types of Hemorrhage

Hemorrhage: blood escaping from arteries, veins or capillaries.

Arterial - if an artery near the surface is damaged, bright red blood will gush out in spurts that are synchronized with the heartbeat.

Venous - blood from the veins is dark red. Venous bleeding is characterized by a steady, even flow.

Capillary - capillary blood is usually brick red in color. If capillaries bleed, the blood oozes out slowly.

Internal vs. External HemorrhageExternal hemorrhage

Massive blood loss

Obvious signs and symptoms of shock (Class II or IV shock)

Internal hemorrhage

Hematemesis (vomiting bright red blood)

Hemoptysis (coughing up bright red blood)

Melena (black tarry stools)

Hematuria (blood in the urine)

Ecchymosis (bruising)

Rapidly forming hematoma and edema

Rigidity with or without rebound tenderness upon palpation in the abdomen

Signs of shock

Signs and Symptoms of ShockClass II: Prime Shock- Hemorrhagic

Causes

Loss of plasma – Burns

Indirect Loss of Interstitial fluid – Diaphoresis, diabetes, emesis or diuresis

Clinical Manifestations

Poor skin turgor

Thirst

Oliguria

Low systemic and pulmonary preloads

Tachycardia

Treatment

Fluid replacement

Class IV: Septic Shock

Cause

Invasion of a microorganism, mainly gram negative but some maybe gram positive

Toxic shock may also be caused by a fungi or virus

Microorganism release of toxin inflammatory response.

Clinical Manifestations

Increased temperature due to pyrogenics

Increase WBC’s

Increased metabolic rate

Increased Heart rate (bounding pulse)

Pulmonary edema

Decreased Urine output

Metabolic acidosis from the build up of lactic acid

Treatment

Antibiotics

Four Methods To Stop Bleeding

Direct Pressure Elevation Pressure Point Chemical (Hemostatic Agents)

Direct Pressure

Direct pressure is the best way to stop bleeding

Place dressing on wound.

Apply pressure- lots of pressure.

If dressing becomes saturated, do not remove. It may be squirting. Cover with another dressing.

Photo credit: Kaninstudio

Link To Leg Laceration Videohttps://www.youtube.com/watch?v=-fFHikNgkuE

Pressure Dressings Gauze!!!! Lots of gauze!

H-Bandage

Israelieali Bandage

OLAES® Modular Bandage

Menstrual pad

Tampons- great for nose bleeds

T-shirts

Tourniquet (more later)

Belt (more later)

Use whatever you have! You may not have time to go grab your gear!

Bandages and Dressings

A bandage is any material used to hold a dressing in place. It can be applied to wrap or bind a body part or dressing. The bandage also provides additional pressure to the dressing or splint and protects and covers the dressing completely.

Things to keep in mind about bandages/dressings

- Ensure the dressing is tight enough.

- Provide pressure over the entire wound.

- Dressings must cover the entire wound, bandages must cover entire dressing.

- Leave the fingers and toes exposed

- Assess circulation and neurological status using PMS:

Pulse (check pulses in extremities)

Motor (movement)

Sensation (can the patient feel you touching them?)

- If hemorrhage continues, and you are certain of where the bleed is:

DO NOT remove the first pressure dressing; apply a second one over the first

Bandages and Dressing (Continued)

The following provides brief information regarding the types of bandages and dressings that you may encounter:

Kerlix gauze

Advantages:

- Extremely absorbent

- Weave of material makes roll stretchable

- Sterile

- Good for packing cavities

Disadvantages:

- Looses bulk when wet

- Catches debris and snags very easily

Ace wrap

Advantages:

- Can be applied quickly

- Gives pressure to the entire affected area

- Provides excellent support for sprains and strains

Disadvantages:

- Can decrease peripheral circulation

Cravats or Triangular Bandages (37”x37”x52”)

Advantages:

- Versatile

- Come in small packages with safety pins

- Can be used as a tourniquet

Disadvantages:

- Has very little absorbency

Bandages and Dressing (Continued)Cinch Tight, Sterile Compression Bandage (8”x10”)

These pressure dressings are four-inch wide elastic wraps with an 8x10 absorbent cotton pad attached close to the end of one side of the elastic wrap.

On the other side of the absorbent pad, in the middle on the elastic wrap side, is a steel S-hook that allows for self-application of the dressing and gives it the ability to be applied tightly.

Finally, at both ends of the elastic wrap are velcro strips that allow for ease of securing the dressing.

Bandages and Dressing (Continued)

“H”Bandage Combat Dressing

These pressure dressing bandages are 4” wide elastic wraps with 8”x 10” absorbent cotton pad attached close to the end of one side of the plastic wrap.

On the other side of the absorbent pad, in the middle on the elastic wrap side is a hard plastic H-anchor that allows for wrapping the dressing around the anchor to apply pressure directly over wound.

It also gives it the ability for self-application. pressure directly over wound.

Pressure dressings can be applied to extremity, chest, abdominal, and head wounds.

Estimating Loss of Blood

Gather a quick estimation of blood loss based on the following factors:

Look for blood surrounding the patient.

Inspect clothing for blood saturation.

Inspect bandage saturation for associated blood loss. See figure 1 for amount of blood. each dressing will hold when fully saturated.

Determine level of shock.

Elevation

To elevate a wound means to raise it above the level of the heart.

By elevating a wound, gravity helps to stop the blood flow. If possible, have the victim lay down

and raise the wound as high as possible. If the wound is in the victim's torso or abdomen,

try to have the victim roll on his side or place padding beneath the victim.

Pressure Points

Pressure points

Point within the body where an artery passes close to a bone.

Applied pressure at a pressure point can pinch off the artery and stop the blood flow to a limb.

Each arm and leg has one main artery that supplies most of the blood to that limb.

Pressure Points (Continued)

There are several pressure points that can help reduce bleeding. The image below comes from Chapter 4, US Army FM 21-76.

Pressure Points (Continued)

How to Use Pressure Points In The Leg to Stop Bleeding

The leg's pressure points are located in the bowl of the hip on either side of the groin, where the leg joins the torso.

Press hard on that point with the heel of the hand to stop the blood flow.

When using the pressure point on the femoral artery remember the acronym NAVEL. Starting from the middle of the leg push hard and you can feel the femur. Move to the inside until you feel the “bowl”. At that point the word NAVEL comes into play, and the point found by going in order..

Navel =

Nerve

Artery

Vein

Empty space

Ligament.

Pressure Points (Continued)

How to use pressure points in the arm to stop bleeding

The arm's pressure points are located halfway along the upper arm, on the inside.

Press between the bicep (the anterior muscle) and the tricep (the posterior muscle) until you can feel the bone. The artery is there (the pulse can be felt there, too).

Push hard to stop the blood flow.

Chemical- Hemostatic Agents

A hemostatic agent causes the wound to develop a clot that stops the flow of blood and will remain within the wound until removed by medical personnel.

It is applied to wounds with moderate to severe bleeding (venous or arterial). Hemostatic agents have strengths and liabilities and carry with them the requirement for specific training for all members of the combat team.

The two most common manufactured clotting agents...

Quik Clot

Celox

These are often premixed with gauze bandage.The treated bandages are so popular, you almost cannot get just the mix anymore.

Herbal Styptics

Yarrow Kaolin Clay Shepherd's Purse

Chemical- Hemostatic Agents (Continued)

Before turning to an agent like Quick Clot, try to stop the bleeding first with pressure- compression bandages, tourniquet, etc.

How to Use Quik Clot

If a tourniquet was used, loosen it slowly and check for spurting. If rebleeding occurs, retighten the tourniquet to regain control of the hemorrhage.

Tear open bag, and remove pressure dressing and gauze from wound, wiping any excess pooled blood, preserving any clots already in the wound if possible.

Pack enough bags of QuikClot ACSTM into the wound to cover the injury.

Reapply pressure.

Pack wound with the gauze roll

Manual pressure for three minutes is best, then apply pressure dressing, remembering to keep the gauze between your hand and the QuikClot ACSTM.

If situation does not allow for manual pressure, apply pressure dressing directly over the roll of gauze.

Casualty Movement

Do not remove bandage or QuikClot. If you are able to loosen tourniquet with no re- bleeding, do so and leave it around the patient’s limb.

Seek professional medical care as soon as possible.

Make sure empty pack is attached to or sent with casualty. Removal instructions are on the back of QuikClot pack.

Chemical- Hemostatic Agents (Continued)

Cautions: Do not ingest.

Exothermic reaction possible if water (not blood) is not wiped from wound. As QuikClot adsorbs fluid molecules, energy in the form of heat can be released. This temperature spike is very short in duration. The thermal increase is directly proportional to the ratio of QuikClot ACSTM to the volume of blood. Use as few bags as possible

Quik Clot Combat Gauze

Combat Gauze is tailored to the needs of combat and tactical medical personnel. It combines surgical gauze with an inorganic material that stops arterial and venous bleeding in seconds.

It creates no heat, is inert and non-allergenic. It can be fit to any size or shape wound, including penetrating wounds. Combat Gauze comes in rolls four yards long by three inches wide.

Chemical- Hemostatic Agents (Continued)

To apply Quik Clot bandage:- Expose injury by opening or cutting away clothing.

- Remove excess blood from wound while preserving any clots that may have formed, if possible.

- Locate the source of the most active bleeding.

- Remove Combat Gauze from package and pack it tightly into the wound directly over the site of the most active bleeding. (More than one roll of Combat Gauze may be required to control the hemorrhage.)

- Combat Gauze may be re-packed or adjusted in the wound to ensure proper placement.

- Apply direct pressure quickly with enough force to stop the bleeding.

- Hold direct pressure for a minimum of 3 minutes.

- Reassess for bleeding control.

- Once applied, Combat Gauze is not to be removed (except by proper medical authority). If bleeding continues, reinforce would with another roll of Combat Gauze and hold pressure.

- Leave Combat gauze in place and secure with a pressure dressing.

- Document, place empty package near wound, and transport patient.

Chemical- Hemostatic Agents (Continued)

There are several options for herbal hemostatics, aka styptics. Kaolin clay is the active ingredient in Quik Clot. It is also sold as China Clay and Cosmetic Clay.

In herbal medicine, yarrow is at the top of the list for styptics. It was known as the “battlefield herb” for a reason. Yarrow has been used for both external and internal bleeding, but do not bypass proper medical care if available.

Yarrow's aerial parts can be shoved directly into a bleeding wound if necessary. However, preparing either a powder or a tincture is preferable.

Powder: Dry the aerial parts, mostly flowers and leaves, and grind into a fine powder, and include in wound powders.

Tincture: Soak the flower heads and leaves in grain alcohol, vodka, or highest food-grade alcohol you have. Use the tincture as a wound wash, into a wound, or ingest, 30-60 drops. Not generally recommended for a child or pregnant/nursing woman. Labor is ok.

Another herb that works similarly, especially for situations like uterine hemorrhage associated with labor is shepherd's purse.

TourniquetsCivilian and Tactical usage of tourniquets differ. In civilian use, tourniquets are used when pressure alone does not stop the bleeding. In tactical use, tourniquets are used as initial treatment.

Tourniquets have come a long way. These are the types we will be discusing.

CAT = Combat Application Tourniquet

RAT = Rapid Application Tourniquet

SOF-T = SOF Tactical Tourniquet

Improvised = Use what you have on hand- belt, tie, etc.

CAT Tourniquet

Fast

One or two handed

Current standard for US military use

RAT Tourniquet

Fast

Bungee cord with a metal cleat

Wrap cord three times (if possible) and secure with cleat.

SOF-T Tourniquet

Very similar to CAT

Same application for 1 or 2 handed application

Tourniquets (Continued) Improvised Tourniquet

To minimize skin damage, ensure that the improvised tourniquet is at least 2 inches wide.

The tourniquet must be easily identified or easily seen.

DO NOT use wire or shoestring for a tourniquet band.

DO NOT cover the tourniquet-you should leave it in full view.

Mark the casualty's forehead with a "T" and the time to indicate a tourniquet has been applied.

Two Parts:

1) Placing the Tourniquet

2) Applying the Tourniquet

Tourniquets

PlacingPlace the tourniquet around the limb, between the

wound and the body trunk (or between the wound and the heart). Never place it directly over a wound, a fracture, or joint. Tourniquets, for maximum effectiveness, should be placed on the upper arm or above the knee on the thigh

The tourniquet should be well-padded. If possible, place the tourniquet over the smoothed sleeve or trouser leg to prevent the skin from being pinched or twisted. If the tourniquet is long enough, wrap it around the limb several times, keeping the material as flat as possible. Damaging the skin may deprive the surgeon of skin required to cover an amputation. Protection of the skin also reduces pain.

Applicationa. Tie a half-knot. (A half-knot is the same as the

first part of tying a shoe lace.)

b. Place a stick (or similar rigid object) on top of the half-knot

c. Tie a full knot over the stick

d. Twist the stick until the tourniquet is tight around the limb and/or the bright red bleeding has stopped. In the case of amputation, dark oozing blood may continue for a short time. This is the blood trapped in the area between the wound and tourniquet.

e. Fasten the tourniquet to the limb by looping the free ends of the tourniquet over the ends of the stick. Then bring the ends around the limb to prevent the stick from loosening. Tie them together on the side of the limb

Sutures and Staples?This is the one skill everyone wants to learn and imagines themselves doing.

Closing a wound in the field is a bad idea.

You run a serious risk of infection.

WHAT YOU SHOULD DO AND IN WHAT ORDER:

1) Stop the bleeding

2) Relocate to a cleaner environment

3) Clean & dress the wound

4) Then, think about closing the wound (staples are easy).

5) Be on the alert for signs of infection.

Next Wound Care Class

Wound Care, Part 2: Cleaning and Dressing the Wound

Thursday, January 14, 2016

8pm to 10pm EST

Wound Care, Part 3: Wound ClosuresTBA

Wound Care, Part 4: InfectionsTBA

THANK YOU!!!

You will receive an email with a link where you can view the recording for this webinar within the next 24 hours.

Please look for this email which will be coming from Cat@HerbalPrepper.com.

If you have questions after class:

Email Cat- Cat@HerbalPrepper.com

Email Chuck- TheMedicShack@gmail.com

Thank you for participating in this class. We hope you join us for Part 2, Cleaning and Dressing the Wound!