Stop Bleeding ⎮ Save Lives

hey guys my name's sam and welcome to pragmatic this week's video we're gonna be talking about treating massive hemorrhage in the civilian environment [Music] as always guys a couple disclaimers before we start the video number one i'm about to bring kind of a gross looking stop the bleed trainer up onto the table so if that's not for you maybe click off this video number two i'm just some guy on the internet make sure you're fact checking everything i say always follow local policies procedures law and training when you're doing care on another human being that being said since the stop the bleed campaign has become much more widespread bleeding control is widely covered under good samaritan laws just make sure you know those laws in your region all right so moving on to the topic of this video right here i've got a nice little stop the bleed trainer this was supplied to me by humanik medical so i really appreciate them uh send this over because it makes the demonstration a little bit easier i really wanted to do this video because in some of my older videos with wound packing tourniquet application my stop the bleed video they're either really academic and really focused or they miss a couple points that people have been asking about in the comments and instead of just typing out replies and corrections to people as they come along this video will address a lot of those misunderstandings uh moving forward so i hope this is a little bit more comprehensive but at the same time isn't going too far in the weeds on any individual topic we care about massive hemorrhage because it is a preventable cause of death which means that there are thousands of people worldwide that die from massive bleeding where they didn't have to if somebody had been trained around them they could have saved a life which is why i am so so passionate about this topic and have multiple videos covering this if you do want some in-depth videos i will leave links below to some of the individual things we're talking about today number two this is not a tactical skill this is not something that's only valid in a war zone yes bullet wounds and knife wounds can all cause arterial hemorrhage that need to be treated but so can chainsaws plate glass windows car accidents motorcycle accidents bear attacks shark attacks i don't know think of a situation you can bleed from a variety of different injury sources not just violence when we are talking massive hemorrhage we are not talking small venous wounds we are talking massive arterial hemorrhage this is bleeding that is spurting to the beat of their heart this is uh bleeding that is pooling under them soaking through multiple layers of clothes this bleeding needs to be addressed really quickly or the patient might die for reference you have about three to four minutes before you bleed out of your femoral artery or your carotid artery so time is of the essence we have to address it quickly on the flip side of that we have venous bleeding which it can look really gruesome you can have massive injuries but not have any arteries affected moving forward we're going to assume all the bleeding on this mannequin is massive arterial hemorrhage we're not going to be discussing minor wound care in this video so let's go on to treatment we've got a couple different devices and products that can help us with this but not all of these are necessary for massive bleeding control if we're not carrying them on our persons now i carry a lot of this stuff but also i understand that that's not what everybody's going to be able to do and that's totally okay there are some workarounds uh i can teach you guys today so first and foremost if it's a massive extremity bleed so anything below the shoulder ideally we would like to put a commercial tourniquet in place this is just a device that goes around the arm you tighten it down and then it has a windlass that gives a 20 to 1 mechanical advantage shuts off that artery and will stop all blood flow distal so farther down the arm or the leg on the patient so this right here is a cat tourniquet this is what a lot of professional services are using you'll notice that it's bright orange and for civilian use i think that's where it's at because it's really easily identifiable now contrary to common uh misconception or what we used to think about tourniquets is that just because you've applied this to somebody does not mean they're automatically losing that extremity as long as they're at definitive care so a hospital with vascular surgery within about four hours they're going to keep that limb and there have been documented cases of limbs being saved far after that four-hour timeline so just know that this is not an immediate limb decision you're not going to just get their arm cut off just because you applied one of these by mistake or wasn't that big of a deal so to apply these we want to apply these three to four inches above the injury site if we can't immediately identify the site of bleeding we can just go high and tight so as high up on the arm as we can tighten it down turn the windlass and get the bleeding to stop so we're going to say it's bleeding from here this is the top of the leg this is the bottom of the leg i'm going to take that tourniquet put it on and it's a little bit hard to do on this table because this mannequin is very sticky and doesn't like to go around with the tourniquet very well we have the tourniquet we're gonna pull this as tight as we can so this first tightening is really important that we just tighten that as much as possible the second step with this is we're going to take it and we're going to turn the windlass until bleeding stops that's usually going to be one to two times and it is painful coach your patient tell them hey this is going to hurt but we're going to get through it you'll talk to them make sure you're explaining what's going on as you do it so we're going to tighten that until bleeding stops bleeding is completely stopped from this i'm going to take the tail of this tourniquet here we're going to tuck it through this strip here some people do this before some people do it after i like just tucking it in there because it holds the windlass tight and then i know this isn't going to get pulled out take the time strip and pull it across just like that you can write the time of application because that is important to the receiving facility that being said if you don't have a pen or a sharpie or anything to write down on it that's no problem it'll be okay the patient will be okay they'll be able to estimate about when it was applied so that's really all there is to this tourniquet now a couple misconceptions we never want to take this off once we've applied a tourniquet we're not going to loosen it every 15 minutes that's old news we're also not going to second guess ourselves and pull it off this might feel like an extreme measure but honestly i would much rather you do this in somebody that might not need it and is borderline then not do this on somebody that absolutely needs it so that's the basics of the cat tourniquet application there's a lot of different brands out there this is probably just the most common try to make sure that their committee for tactical combat casualty care uh recommended those are tourniquets that have been extensively tested by the military and other units and are known to be really high quality products so you're saying now well sam hey i don't have access to a commercial grade tourniquet can i make one and the answer to that is relatively complicated first and foremost i would not recommend doing a makeshift tourniquet if you're not really really trained up on it mainly because there's been studies that have shown that makeshift tourniquets are over 85 percent ineffective that's a huge failure rate for tourniquets that's why the stop the bleed campaign recommends packing wounds regardless of location if you don't have access to a commercial grade tourniquet now if you were to make a tourniquet yourself you're not going to use shoelaces you're not going to use anything really small you want at least an inch diameter preferably an inch and a half so a shirt widened out will work okay you can tie a knot over it and then you can stick something in it and make the windlass and then tie it again but honestly that takes a lot of time where that wound probably could have been been controlled much more effectively with wound packing so that's a good segue into the next part of this and that's wound packing so when we have an injury that is either in a junctional site that's the base of the neck that's the armpit or the groin or we don't have access to a commercial tourniquet and that wound is anywhere on the extremity or in one of these junctional sites we can pack it now we can use a number of different things the gold standard is going to be some kind of hemostatic agent such as quick clot now this is a gauze that basically is permeated with a material that helps promote clotting so this is the gold standard these are also really expensive though so i think this packet right now is going for i want to say like 55 to 60 dollars for one of these it's got like a five-year shelf life so they last quite a long time but not for everybody not something everybody's going to have access to the next step down from that we have just plain s rolled gauze so this does not have hemostatic agent but it's a very similar gauze material as this and what i'll tell you is that between these two keep on picking this up putting it down these have no difference in survivability as far as been has been demonstrated in the laboratory so when they've done studies on packing with normal gauze and packing with hemostatic agents while this stops the bleeding slightly faster this isn't going to leave your patients any worse off in the long run so honestly i pack these in all my kits i also pack this but i have no qualms about using just regular gnar packing gauze and for reference this costs about i don't know two dollars or so i'll leave links down below to these products if you want to look at anything pick anything up um i'm just trying to give you the most options possible so the third thing you can use and what most of us probably have on us unless you're you know a nudist colony in italy or something like that is a t-shirt so t-shirt is a pretty tight-knit fabric and you can stuff that into the wound pretty easily it's going to be almost as effective as one of these so we all have something we could do in these situations but for demonstration purposes because nobody wants to see this dad bod i'm going to go and pack with this as we're talking about it so the concept of wound packing basically is that with a wound especially like this if i just took pressure and i put it on top of there there is still a huge wound cavity in there and it can continue to bleed and bleed and bleed internally we're just making it look pretty by putting pressure on the outside what we really need to do is we need to get pressure down into the wound right against the bleeding artery and that's going to give us the best chance of stopping that that bleed so this is a good lesson for checking your gear and being familiar with what you have i'd recommend buying two of everything so you can practice with one this gauze here is in a second package now it's pretty easy to open we can just take that red tab right there and start pulling it out it's pretty nice but if you weren't aware of this opening mechanism and you're under stress it might cause you some issues so we have a massively bleeding wound and we'll use this guy here as my demo point i'll turn this around so you guys can see it on both cameras what i need to do first is i want to get the major uh coagulating blood in there out of there i don't want to bust any clots over the wound but if i have like just a pool of blood i'm going to do a quick sweep to try to get that out of there because i don't want to completely saturate this gauze the second i put it in there now the next thing i'm going to do is i like taking the end of this and making just a little ball like kind of a compressed ball and i want to try to find exactly where the artery is that's bleeding my goal isn't just to pack indiscriminately into this wound my goal is to get this right up against that artery to provide that pressure so i'm going to take this and i'm going to find that artery i'm going to put this right up against there and then i'm going to exchange fingers so i'm not just going to let go i'm going to take this i'm going to go one after the other and exchange as we go this guy's going to unreal sometimes if it's a roll you can just throw it over your shoulder tuck it down your shirt either one will work and we're going to maintain that pinpoint pressure now i can't stress this enough the point of this is not diffuse pressure this is not going to stop the bleeding we need to have very direct pressure on that artery and we're going to pack this as much as possible to get as much surface area of gauze in there and we're just going to hold that now if this was a quick clock gauze if we started to see this bleeding through i would take this whole thing i'd pull it out i take the other end of the quick clock gauze put it back in and the theory behind that is that you're getting more of the uh hemostatic agent closer to that artery you're kind of replacing it with this gauze the teaching is just pile more and more gauze on top of it that being said there does come a point where you might have to replace this gauze just know that the formal education is that you keep on packing gauze on top of it so i've got that wound packed now what now i'm going to sit here and i'm going to hold this as long as possible i don't want to wrap it i don't want to release this i don't want to give this to somebody else i want to maintain manual pressure because manual pressure is going to be the most effective thing for this patient if we're in an environment that's maybe not permissive we have to move maybe it is an active shooter situation or we're in traffic we can take a compression wrap and wrap it around the wound just know that's not going to hold the pinpoint pressure you have and you should be holding this for at least five minutes if not longer honestly if this was me and this was say a motorcyclist that crashed on the side of the road and i'm packing a puncture wound i'm gonna hold this until i physically hand off this pressure to the emt or paramedic that's responding to it so that is packing this wound just like this now let's talk about it on some other types of wounds so the most different type of wound on this guy is this bullet hole now a lot of questions have come up on hey what if it's a through and through and i'm just packing it's coming out the other end and we just end up like flossing the patient's wound that's not super realistic because oftentimes wound channels will take weird paths throughout the body number two the goal is not just packing down into this hole indiscriminately the goal is to pack this against the artery so if you have a through and through and you're like see in daylight on the other side all you're going to do is you're going to take this you're going to find the artery and pack it up against the artery instead of just packing it through the wound so this one's actually a pretty small wound uh but if you you can't feel it but if you put your finger in there you can feel it's a pretty large wound channel which can happen with bullets so i take this down i do the same thing i find the artery on the wall and then once again i'm just going to replace my fingers with the gauze i want to keep that pressure as tight as possible and this one's not going to take quite as much gauze just because it's a much smaller wound that's okay if you filled it up and you can maintain the pressure just like this that's great there's no problem with that whatsoever the next thing somebody's going to say become it comes up on all these videos is some well-meaning person likes to give advice and say oh look at that that's the same shape as a tampon now for regular watches of this channel you know a couple weeks ago i did a myth and facts video and we talked about tampons and there were a surprising number of angry people in the comments telling me i saw tampons work now i hate to break it to you but nobody has ever seen a tampon single-handedly stop an arterial hemorrhage they don't work like that this is not a device for bullet holes or major bleeding control this is for menstrual cycles and i suppose some people out there want to use it for a nose bleed i choose not to do that uh for my patients we use rhino rockets if we have to put something up in their nose otherwise we just pinch the nose and we're good to go there now people that say they've seen this work have not seen this performed on an arterial hemorrhage they've seen this performed on a gruesome looking venous hemorrhage and they come out here and they claim that it saved somebody's life i guarantee you it didn't so with this tampon okay great we inserted that into the wound now i had probably i don't know about this much fabric in that wound and this tourniquet one it doesn't actually provide pressure to it it just absorbs blood and the point of this is not absorption number two the amount of fabric in here is minuscule compared to i said that weird minuscule compared to the amount of surface area that this gauze has so let's see if i can unwrap this really quick this is how much cotton is in a tampon that's expanded i put about this much gauze in there that is a massive amount more gauze in there than the tampon is so this square footage or square inches is the name of the game we need to be packing with gauze or our t-shirt not with tampons there's really no reason to use tampons for massive bleeding all right okay there are two other things i want to address in today's video number one is bleeding from sites that are not your extremities or junctional sites so it stands to reason that if somebody's shooting or you're in an accident there is a chance that you're bleeding from the abdomen from the chest or from the head and i hate to break it to you but a lot of those places are not amenable to tourniquet application or wound packing while in the or you do see people wound packing the abdomen you need a massive amount of gauze to do that and you need very specific training to do that right so it is not recommended that you pack the abdomen with anything some people say placing a chest seal on there at least that's going to take some of the infection out but ultimately they need an operating room and none of your interventions are going to really help that person all that much and you're saying well sam what about bleeding and what we can do we're talking about preventable causes of death and preventable causes of ma of death from massive hemorrhage come from your junctional sites now the chest is another thing if somebody's shot in the chest we can't pat gauze into the chest cavity unfortunately so the best thing we can do is apply chest seal if it is uh in their thoracic cage but ultimately once again they need a surgeon and they need blood products if they're bleeding profusely from those sites on the head one thing you'll note on the head is that it's very very vascular so somebody will get a relatively small cut and it will look like they just got ax murdered by you know who knows who basically in those situations what's great about that if it's not penetrating through the skull and it's just a superficial wound you can take direct pressure put it on that and it's going to do wonders for that patient it's going to stop the bleeding a lot because you have a very good backdrop in the skull to hold that pressure tight i did have one situation uh when i was in emt early on in my career where somebody got smashed in the face by a bottle and they had an artery in their nose that was spurting blood it was a small artery and it was just you know every time their heartbeat they spurt a little bit more blood and i had every piece of gauze known to man over this person's face really what happened was i rolled into the er the trauma doc came over and he put one finger on the artery and it stopped bleeding right away when all of my gauze didn't do anything so that's a great lesson in pinpoint pressure just be aware that in the head it is very vascular and you can usually control the bleeding with means it should be common sense but i'm going to say it anyways don't pack into an open head wound if you see brain or you think it's going past the skull maybe don't put gauze into there the last thing i want to address in this video is proper personal protective equipment so in a professional setting we are always putting on gloves before we touch our patients we're not going to be touching blood with our bare hands if we can at all help it however in the civilian world a lot of people are afraid to act because they're afraid of bloodborne illnesses great news on that front is that your skin if it is intact without open cuts or sores is a great barrier against blood-borne diseases so you are pretty safe going in and treating a patient with bare hands this wound is already going to get infected they're already going to get antibiotics before they go into the or suite so that is not your prime primary concern and even if it was the gloves we wear on the ambulance or the helicopter or any professional responder they're not sterile gloves so they're not really preventing infection either so don't be afraid to act if you do have open cuts on your hands that's a little bit of a different story and there is a risk to that however the chance of transmission is still relatively low so while i'd always recommend you having gloves if you see somebody with a massive hemorrhage and you're comfortable with it i would recommend just going in controlling bleeding with your hands i'll be honest with you i get blood on my hands and my arms all the time at work and we wash it off we're careful with it but it doesn't even count as an exposure that's reportable so that's all i have for this video guys i hope you enjoyed it i hope you learned something if you have anything to add or any questions leave them in the comments down below and i will see you next week [Music] you

Channel: PrepMedic

Views: 974,697

Keywords: stop the bleed, bleeding control, stop bleeding, first aid, 911, paramedic, medic, swat, emt, ems, emergency, protection, ambulance, first aid kit, Emergency medicin, be prepared, prepper, medical, medical care, care under fire

Id: qhOyXTm9XwY

Length: 21min 16sec (1276 seconds)

Published: Sun Aug 07 2022

Reddit Comments

[u/iClaudine]

Great share.