BLEEDING

BLEEDING


For a discussion of wound management (cleaning, closing, and dressing), see page 260.


Whenever you are going to be exposed to blood or other potentially infectious body fluids, wear sterile latex rubber gloves from your first-aid kit. If you are allergic to latex, use other nonpermeable gloves (such as nonlatex synthetic).


While it is occasionally visually distressing, bleeding can be one of the easiest problems to manage, because the treatment options are so straightforward. The severity of the injury determines the rate of blood loss and what measures you must take to control the bleeding. Evaluate the following considerations:





TREATMENT FOR BLEEDING


First, remove all clothing covering the wound so that you can see precisely where the bleeding is coming from. Almost all external bleeding stops with firm, direct pressure. This should be applied directly to the wound with the heel of your hand, using the cleanest available thick (four or five thicknesses of a 4 in by 4 in—or 10 cm by 10 cm—sterile gauze pad, for instance) bandage or cloth compress (Figure 31). Maintain pressure for a minimum of 10 minutes, to allow severed vessels to close by spasm (an artery contains small amounts of muscle tissue in its walls) and to allow early blood clot formation. Peeking at the wound under the compress interrupts the process and prolongs active bleeding. The application of cold packs or ice packs over the compress (not under it) may hasten the process by initiating spasm and closure of disrupted blood vessels. It is also useful to have the victim lie down, and to elevate the bleeding part above the level of his heart. A scalp wound tends to bleed freely, and may require prolonged pressure or wound closure for control (see page 65).



If direct pressure to the wound does not stop the bleeding, you must make certain that you are applying the pressure in the correct spot. Check quickly to see that you are pressing precisely over the bleeding point. If you are a fraction of an inch off, you can miss the best compression spot for a torn blood vessel; in this case, simply piling on more bandages may not solve the problem. Once you have repositioned your pressure, wait again for 5 to 10 minutes. If the pressure appears to be working, once the bleeding has substantially subsided you can apply a pressure dressing. Do this by covering the wound with a thick wad of sterile gauze pads or the cleanest dressing available, and wrapping the area firmly with a rolled gauze or elastic bandage. Do not apply the dressing so tightly that circulation beyond it is compromised (as indicated by blue fingertips or toes, or by numbness and tingling). Watch the dressing closely for blood soaking and dripping, which indicate continuous bleeding.


A very useful product for bleeding is a nonmedicated BloodStopper gauze bandage. Another alternative is the medicated QuikClot adsorbent hemostatic gauze (Z-Medica Corporation), which delivers a zeolite-based clotting agent. This product is also available in a mesh 3.5 in by 3.5 in “sponge” configuration as QuikClot Sport (with or without silver as an antibacterial agent). BleedArrest (Hemostasis, LLC) particles and sponges utilize a natural biopolymer to control severe external bleeding. Celox (hemostatic granules) is a new high-performance hemostatic material that has been created to control high-volume arterial bleeding. Composed of a proprietary marine biopolymer (including Chitosan), it is poured as a granular mixture into a bleeding wound, where it helps to facilitate blood clot formation without causing any tissue damage. It is thought to do this by aggregating negatively charged red blood cells, which are attracted to the positively charged granules. According to promotional material distributed by Sam Medical Products, the granules assist a clot to form within minutes without generating any heat, burning sensation, or rigid structure formation within the wound. A gelled mass formed by excess granules protects the clot and is easy to remove.


Chitosan is manufactured by chemical modification of chitin, which is the structural element in the exoskeleton (“external” skeleton) of crustaceans (crabs, shrimp, and so forth). It carries a positive charge, wherein lies its value for this particular application. Chitosan is not known to commonly invoke an allergic reaction, and can be sterilized. Notably, it is present in other products designed to control bleeding from wounds, such as bandages (ChitoFlex Hemostatic Dressing) marketed by HemCon Medical Technologies Inc.


Celox works in hypothermic conditions and also on blood that has been heparinized (e.g., a person being treated with this category of “blood thinner” or, presumably, with enoxaparin [Lovenox]). There is no mention of whether or not it has been or would be expected to be effective if a victim is currently taking warfarin (Coumadin), which is a common anticoagulant.


To apply Celox, one pours the granules from a sterilized, sealed packet (15 grams or 35 grams) into the wound and then holds them in place with a gauze bandage for 5 minutes. A compression bandage, such as an elasticized wrap, is then wrapped over the gauze-covered wound and the victim is brought to medical care.


The following are some important things to be aware of with a serious wound:



Aug 11, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on BLEEDING

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