We've got a bleeder oemta
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We’ve Got a Emergency Hemorrhage Control
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Transcript of We've got a bleeder oemta
We’ve Got a
Emergency Hemorrhage Control
The student shall be able to effectively recognize uncontrolled hemorrhage and immediately provide the indicated treatment.
Upon completion of this course, the student will be able to:
1. Recognize uncontrolled hemorrhage2. Identify the proper method of treatment3. Discuss the indication for tourniquet use4. Demonstrate the proper use of a tourniquet
Objectives5. Discuss the indication for the use of Combat Gauze6. Demonstrate the proper use of Combat Gauze7. Discuss the indication for the use of Phenylephrine8. Demonstrate the proper use of Phenylephrine9. Discuss the indication and use of TXA
LacerationsPenetrationsAmputations
AssessmentScene Safety & PPEPrimary SurveyHospital Notification
Primary Survey CareControl Arterial BleedingOpen and Maintain Airway
Minimize on scene time
En Route CareReassessOxygenation/VentilationVascular AccessSecondary Survey
BLS SkillsIdentificationTourniquetHemostatic AgentHospital Notification
BLS Before ALS
Battlefield testedEndorsed by PHTLSAssociated complications <1.5%
Uncontrollable Hemorrhage
How long does it take for death to occur due to complete femoral artery and vein dissection?
As little as
3 minutes
Combat Application Tourniquet(C-A-T)
Apply just proximal to the bleeding wound Route the band around the extremity
Pass the band through the outside slit of buckle The friction adaptor buckle locks the band in place
Pull the self-adhering band tight and secure
Twist the rod until the bleeding has stopped.
Lock the rod in place with the windlass clip
Secure the rod with the strapIndicate the time of tourniquet applicationLeave area uncovered
TK 0945
Video
Eliminate distal pulseDo not loosenSecond tourniquet may be required
Conscious patients may experience painUtilize pain management protocol
Combat Gauze
Mechanism of ActionImpregnated with Kaolin
Promotes activation of Factor XIIInitiates the clotting cascade
IndicationHemorrhage not controllable with tourniquet or
other meansC-A-T ineffectiveWound location does not allow use of a C-A-T
ApplicationRemove pooled bloodPack gauze into woundHold pressure over bleeding source
3 minutes or hemostasisApply pressure bandage
The Newest Kid on the Block
274 Hospitals40 Countries20,211 adult trauma patients
With, or risk of, significant bleedingHR > 110, SBP <90, clinical judgement
Treatment within 8 hours of injuryTXA or placebo
Death in hospital within 4 weeksBleedingVascular Occlusion (MI, Stroke, PE)Multiorgan FailureHead InjuryOther
Vascular Occlusive EventsNeed for blood/surgery
All Cause Mortality9.1% Increase in survival
Bleeding8.5% Increase in survival
Did Not reduce the need for bloodthe need for surgery
Did increase survival
TXA is SafeTXA Makes a DifferenceTXA Increases SurvivalTXA doesn’t create clots in bad places
RetrospectiveCombat Casualties in AfghanistanBritish Helo PhysiciansTXA vs No TXA
1+ unit(s) PRBC10+ units of PRBC
896 Patients293 received TXA
Characterize TXA use in combat injury careEffect of TXA on
Blood Product UseBad ClotsMortality (24 hrs., 48hrs., 30 days)
~7 times more likely to survive with TXA
Slight increase in DVT & PE formation
Higher Injury = Increase Risk of ClotsMilitary Theater – penetrating/orthoSurvival allows DVT/PE to be diagnosed
Increase SurvivalMassive Transfusion
TXA independent predictor of survivalBenefit shown after 48 hours
Possible anti-inflammatory componentEarlier is Better
If a casualty is anticipated to need significant blood transfusion:
presents with hemorrhagic shockone or more major amputationsPenetrating torso traumaEvidence of severe bleeding
Administer 1 gram of tranexamic acid in 100 cc Normal Saline or Lactated Ringers as soon as possible but NOT later than 3 hours after injury.
Begin second infusion of 1 gm TXA after Hextend or other fluidtreatment.
Formulary
Anti-Fibrinolytic
Promotes clot formation
Hemorrhagic shock Trauma < 3 hours oldSuspected need for massive blood transfusion
In metropolitan Tulsa:sustained tachycardia ≥ 110
AND sustained hypotension systolic BP≤ 90
Non-hemorrhagic shock Non-traumatic hemorrhagic shock Hemorrhagic shock stabilized with other hemostatic
agents/measures
Onset of action within 4 hours after IV administrationDelayed effects up to 48 hours consistent with anti-
inflammatory actions.
While a theoretical concern, TXA has not been shown to cause significant increase in:deep venous thrombosispulmonary embolismmyocardial infarctionstroke
1 gram IVPB over 10 minutes. Administer in 100 mL or 250 mL NS.
The CRASH-2 Collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with signifcant hemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376: 23–32.
Jonathan J. Morrison; Joseph J. Dubose; Todd E. Rasmussen; Mark J. Midwinter. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2011
Medical Control Board. EMS Protocols for Metropolitan Oklahoma City and Tulsa. 2013.
Tactical Combat Casualty Care Guidelines. Prehospital Trauma Life Support. 2012.
