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MSTC, FT LEWIS WAMSTC, FT LEWIS WA
Bleeding Control Bleeding Control
Lesson FiveLesson Five
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OverviewOverview
►Review methods of controlling bleeding in aReview methods of controlling bleeding in a
tactical environmenttactical environment
►Hemorrhage is the leading cause ofHemorrhage is the leading cause ofpreventable death on the battlefieldpreventable death on the battlefield
►Hemorrhage control save livesHemorrhage control save lives
►New Hemostatic agentsNew Hemostatic agents
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Extremity HemorrhageExtremity Hemorrhage
Control Control
Extremity Hemorrhage continues tobe the leading cause of preventable
death on the battleeld.
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Extremity HemorrhageExtremity Hemorrhage
Control Control
Over 25deathsoccurred in!ietnam
secondary tohemorrhagefromextremity"ounds.
#hesecasualtieshad no otherin$uries.
#he tactical situation maynot allo" the time norsafety for conventional
methods of controlling the
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Blood Blood
► Hemorrhage or bleeding:Hemorrhage or bleeding:
Escape of blood from capillaries, veins, and arteriesEscape of blood from capillaries, veins, and arteries
► Adult bodyAdult body::
Contains approximately to ! liters of bloodContains approximately to ! liters of blood
" pint of blood without harmful effects" pint of blood without harmful effects
# pints may cause shoc$ # pints may cause shoc$
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External BleedingExternal Bleeding
► %ncision%ncision
► &aceration&aceration
► AbrasionAbrasion
► 'uncture wounds'uncture wounds
► AmputationAmputation
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LacerationLaceration
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Puncture Wound Puncture Wound
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Amputation Amputation
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nternal Bleedingnternal Bleeding
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n!ured nternal Organsn!ured nternal Organs
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"ources o# Bleeding"ources o# Bleeding
► ArterialArterial Rapid, profuse and pulsatingRapid, profuse and pulsating
Bright red in colorBright red in color
► VenousVenous Stead !o"Stead !o"
#ar$ red or %aroon in color#ar$ red or %aroon in color
► CapillarCapillar Slo" and oo&ingSlo" and oo&ing
'ften clots spontaneousl'ften clots spontaneousl
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Arterial Bleed Arterial Bleed
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nternal "igns o#nternal "igns o#
HemorrhageHemorrhage Soft tissue (ruisingSoft tissue (ruising
A(do%inal tendernessA(do%inal tenderness
)e%optsis *(lood fro% lungs+)e%optsis *(lood fro% lungs+
)e%ate%esis *(lood fro% sto%ach+)e%ate%esis *(lood fro% sto%ach+
Melena *(lood stools+Melena *(lood stools+
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$reatment $reatment
Assess the tactical situationAssess the tactical situation
Epose the "ound, cut a"a loose clothingEpose the "ound, cut a"a loose clothing
%o not%o not re%o-e clothing that is stuc$ to the "oundre%o-e clothing that is stuc$ to the "ound Chec$ for eit "oundChec$ for eit "ound
.lace a E%ergenc Bandage o-er the "ound and appl.lace a E%ergenc Bandage o-er the "ound and appl
pressure/pressure/ If under ene% 0re rapid appl a tourni1uet and %o-eIf under ene% 0re rapid appl a tourni1uet and %o-e
casualt to co-ercasualt to co-er
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Expose the Wound Expose the Wound
► %o not%o not atte%pt to clean the "oundatte%pt to clean the "ound
► %o not%o not pro(e the "ound in order topro(e the "ound in order to
re%o-e an o(2ect fro% the "oundre%o-e an o(2ect fro% the "ound
► %o not%o not atte%pt to re%o-eatte%pt to re%o-e
an o(2ect i%paled in thean o(2ect i%paled in the"ound"ound
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$reatment $reatment
Bleeding nor%all canBleeding nor%all can(e controlled (3(e controlled (3
►
E%ergenc Trau%aE%ergenc Trau%a#ressing#ressing
► First4aid, ManualFirst4aid, Manualpressure andpressure andele-ationele-ation
► Tourni1uet Tourni1uet
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Emergency $raumaEmergency $rauma
%ressing%ressing►All in one dressing used as aAll in one dressing used as a
0eld5pressure dressing to stop %ild to0eld5pressure dressing to stop %ild tose-ere (leedingse-ere (leeding
►Ma (e used on an part of the (odMa (e used on an part of the (od
►6ot reco%%ended for use as a6ot reco%%ended for use as a
tourni1uet for se-ere arterial (leeding,tourni1uet for se-ere arterial (leeding,although the sa%e procedure can (ealthough the sa%e procedure can (eused to increase pressure on the "oundused to increase pressure on the "ound
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Emergency $raumaEmergency $rauma
%ressing%ressing
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$ourni&uet $ourni&uet
#he need for immediateaccess to a tourni&uetin such situationsma'es it clear that all
soldiers on combatmissions should have asuitable tourni&uetreadily available in astandard location intheir battle gear and betrained to use it.
(s the tactical situation permits and more timeand safety is available) consider loosening the
tourni&uet * %O +O# ,E-O!E ) and using directpressure and/or a pressure dressing to control the
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$ourni&uet 'emoval $ourni&uet 'emoval
,E-E-0E,1 f unableto control bleedingexcept "ith a
tourni&uet) it is betterto sacrice a limb thanto lose a life toexcessive bleeding.
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Combat ApplicationCombat Application
$ourni&uet $ourni&uet
#ourni&uet of
choice
3ontrols 0leeding
Light"eight
Easy touse
The recommended means to control
bleeding in a tactical environment.
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Combat ApplicationCombat Application
$ourni&uet $ourni&uet
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4tep 4tep 6lace the"ounded
extremitythrough the loopof the 4elf7adhering 0and
6lacetourni&uet above
the
4tep 24tep 2
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6ull the free7running endof the 4elf7
adhering0and tightand securelyfasten it bac'on itself.
(dhere 4elf7adhering 0andcompletelyaround the limbuntil the clip is
reached.
4tep 84tep 8
Step 4Step 4
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#"ist the9indlass ,od
until thebleeding hasstopped.
Loc' the ,od in
place "ith the9indlass 3lip
4tep 54tep 5
Step 6Step 6
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For small extremities)continue to adherethe 4elf7adhering0and around theextremity and overthe 9indlass ,od.
:rasp the9indlass
4trap) pull ittight) andadhere it tothe velcro onthe 9indlass
3lip.
4tep ;4tep ;
Step 8Step 8
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Combat ApplicationCombat Application
$ourni&uet $ourni&uet
#he 3(# #ourni&uet is no" ready fortransport.
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Combat ApplicationCombat Application
$ourni&uet $ourni&uet
+O#E1
#he friction adaptor
buc'le is notnecessary forproper 3.(.#.application to an
arm. t -<4# beused "ith t"ohands "henapplying to a leg.
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Combat ApplicationCombat Application
$ourni&uet $ourni&uet
Large Extremity ApplicationLarge Extremity Application
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Large Extremity ApplicationLarge Extremity ApplicationCombat ApplicationCombat Application
$ourni&uet $ourni&uet
#o use) "rapthe 4elf7adhering 0and
through thefrictionadaptorbuc'le.
Large Extremity ApplicationLarge Extremity Application
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Large Extremity ApplicationLarge Extremity ApplicationCombat ApplicationCombat Application
$ourni&uet $ourni&uet
#his preventsthe 4elf7adhering 0andfrom looseningduring
transport.
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$he "pecial Operations(orces $actical $ourni&uet
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$ourni&uet $ourni&uet
►Forceful, arterial (leedingForceful, arterial (leeding
*a%putation+ %a re1uire earl*a%putation+ %a re1uire earl
use of a tourni1uet/use of a tourni1uet/
►#' 6'T WASTE TIME atte%pting a#' 6'T WASTE TIME atte%pting a
pressure dressing in these casespressure dressing in these cases
A l i dA l i d
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Apply an mprovised Apply an mprovised
$ourni&uet $ourni&uet
►7se an %aterial to %a$e an7se an %aterial to %a$e an
i%pro-ised tourni1uet3i%pro-ised tourni1uet3
►Cra-ats, grenade ring, rigid o(2ectCra-ats, grenade ring, rigid o(2ect
such as a strong stic$, tape, &ipsuch as a strong stic$, tape, &ip
ties, riggers (elt, etc/ties, riggers (elt, etc/
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Apply a $ourni&uet Apply a $ourni&uet
► 6e-er co-er a tourni1uet6e-er co-er a tourni1uet
► 8T9 on casualt8s forehead or so%e"here8T9 on casualt8s forehead or so%e"here*Sharpie pen+/*Sharpie pen+/
►
In co%(at "hen the tactical situationIn co%(at "hen the tactical situationallo"s, loosening a tourni1uet isallo"s, loosening a tourni1uet is
appropriate/appropriate/
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$ourni&uet 'emoval $ourni&uet 'emoval
► When loosening a tourni1uet do not re%o-e itWhen loosening a tourni1uet do not re%o-e itfro% the li%(/fro% the li%(/
► If the tourni1uet has (een in place for : ;If the tourni1uet has (een in place for : ;
hours do not re%o-e/hours do not re%o-e/
► If !uid resuscitation is re1uired it should (eIf !uid resuscitation is re1uired it should (eacco%plished (efore the tourni1uet isacco%plished (efore the tourni1uet is
re%o-ed/re%o-ed/
► Tourni1uets are -er painful, pro-ide pain Tourni1uets are -er painful, pro-ide pain%eds as needed/%eds as needed/
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$ourni&uet 'emoval $ourni&uet 'emoval
►'nce the tactical situation allo"s,'nce the tactical situation allo"s,
tourni1uets should (e loosened andtourni1uets should (e loosened and
other %ethods to stop (leeding appliedother %ethods to stop (leeding applied
►#irect pressure4pressure dressing#irect pressure4pressure dressing
►)e%Con Chitosan Bandage)e%Con Chitosan Bandage
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$ourni&uet 'emoval $ourni&uet 'emoval
► If tourni1uet has (een in place for onl <4=If tourni1uet has (een in place for onl <4=
hours, loosening and other %ethods tohours, loosening and other %ethods to
control he%orrhage can sal-age li%(s/control he%orrhage can sal-age li%(s/
► Re%e%(er3 if una(le to control he%orrhageRe%e%(er3 if una(le to control he%orrhage
( other %eans re4tighten the tourni1uet/( other %eans re4tighten the tourni1uet/
► It is (etter to sacri0ce the li%( than to loseIt is (etter to sacri0ce the li%( than to lose
a life to he%orrhage/a life to he%orrhage/
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Amputation Amputation
►Apply pressure dressing to cover end of theApply pressure dressing to cover end of the
stump(stump(
►)erlix and !in Ace wrap for effective pressure)erlix and !in Ace wrap for effective pressuredressing(dressing(
►Rinse amputated part free of debrisRinse amputated part free of debris
►*rap loosely in saline+moistened sterile gaue*rap loosely in saline+moistened sterile gaue
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Preservation o#Preservation o#
Amputation Parts Amputation Parts► -eal amputated part in a plastic bag or cravat-eal amputated part in a plastic bag or cravat
► 'lace in a cool container, do not freee'lace in a cool container, do not freee
► Never Never place amputated part in waterplace amputated part in water
► Never Never place amputated part directly on iceplace amputated part directly on ice
► Never Never use dry ice to cool an amputated partuse dry ice to cool an amputated part
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%ressing an Amputation%ressing an Amputation
►.lace a dressing *soft 5 a(sor(ent+.lace a dressing *soft 5 a(sor(ent+o-er the end of the stu%po-er the end of the stu%p
►Secure the dressing "ith (andagesSecure the dressing "ith (andages
►
.re-ents conta%ination
.re-ents conta%ination
►.rotects fro% additional in2ur.rotects fro% additional in2ur
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Ace Wrap)*erlix Ace Wrap)*erlix
►.ac$ large "ounds "ith >erli gau&e.ac$ large "ounds "ith >erli gau&eand "rap "ith an Ace Wrapand "rap "ith an Ace Wrap
►Secure end of Ace Wrap -ia t"o %eans3Secure end of Ace Wrap -ia t"o %eans3 Circu%ferential tapeCircu%ferential tape
Cut <?@ do"n center of Ace Wrap and tieCut <?@ do"n center of Ace Wrap and tie
►Chec$ distal pulse after application toChec$ distal pulse after application toan etre%itan etre%it
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+uic,Clot +uic,Clot
H C ChitHemCon Chitosan
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HemCon ChitosanHemCon Chitosan
%ressing%ressing
Chit H t tiChit H t ti
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Chitosan HemostaticChitosan Hemostatic
%ressing%ressing
)old the foil o-er4)old the foil o-er4pouch so thatpouch so thatinstructions can (einstructions can (eread/ Identifread/ Identifunsealed edges at theunsealed edges at thetop of the o-er4pouchtop of the o-er4pouch
.eel open o-er4pouch ( pulling.eel open o-er4pouch ( pullingthe unsealed edges apartthe unsealed edges apart
Chit H t tiChitosan Hemostatic
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Chitosan HemostaticChitosan Hemostatic
%ressing%ressing
Trap dressing betweenTrap dressing between
bottom foil and non-bottom foil and non-
absorbable green/blackabsorbable green/black
polyester backing withpolyester backing with
your hand and thumb your hand and thumb
Hold dressing by theHold dressing by thenon-absorbablenon-absorbable
polyester backing andpolyester backing and
discard the foil over-discard the foil over-
pouch Hands must bepouch Hands must be
Chit H t tiChitosan Hemostatic
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Chitosan HemostaticChitosan Hemostatic
%ressing%ressing
Chit H t tiChitosan Hemostatic
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Chitosan HemostaticChitosan Hemostatic
%ressing%ressing
► .lace the light colored sponge portion of.lace the light colored sponge portion ofthe dressing directl to the "ound areathe dressing directl to the "ound area"ith the %ost se-ere (leeding/ Appl"ith the %ost se-ere (leeding/ Applpressure for = %inutes or until the dressingpressure for = %inutes or until the dressing
adheres and (leeding stops/ 'nce appliedadheres and (leeding stops/ 'nce appliedand in contact "ith the (lood and otherand in contact "ith the (lood and other!uids, the dressing cannot (e repositioned/!uids, the dressing cannot (e repositioned/
► A ne" dressing should (e applied to otherA ne" dressing should (e applied to othereposed (leeding sites Each ne" dressingeposed (leeding sites Each ne" dressing%ust (e in contact "ith tissue "here%ust (e in contact "ith tissue "here(leeding is hea-iest/ Care %ust (e ta$en to(leeding is hea-iest/ Care %ust (e ta$en toa-oid contact "ith the patients ees/a-oid contact "ith the patients ees/
Chitosan HemostaticChitosan Hemostatic
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Chitosan HemostaticChitosan Hemostatic
%ressing%ressing
► If dressing is not eecti-e in stoppingIf dressing is not eecti-e in stopping(leeding after %inutes, re%o-e original(leeding after %inutes, re%o-e originaland appl a ne" dressing/ Additionaland appl a ne" dressing/ Additionaldressings cannot (e applied o-erdressings cannot (e applied o-erineecti-e dressingineecti-e dressing
► Appl a (attle dressing5(andage toAppl a (attle dressing5(andage tosecure he%ostatic dressing in placesecure he%ostatic dressing in place
► )e%ostatic dressings should onl (e)e%ostatic dressings should onl (ere%o-ed ( responsi(le persons afterre%o-ed ( responsi(le persons after
e-acuation to the net le-el of caree-acuation to the net le-el of care
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Female ra&i patient
Iraqi National;
No Bleeding;
Survived