Wound packing: indications and contraindications?
Indications: -life threatening external hemorrhage not amenable to Tq(or it failed)
-tactical field care
Contraindications: -non-life threatening hemorrhage -external hem. controlled with direct pressure -abdo/thoracic/cranial cavity
How long to apply pressure to combat gauze?
5 min. for hemostatic
10 minutes for non-hemostatic
How long is the pelvic binder meant to be on for?
4 hours. Only remove at definitive care facility.
At 12 hours release pressure and check skin. Change every 24hrs or when soiled per equipment availability.
Which skills do you figure 8 tie feet?
Pelvic binder and junctional tq. Add padding for pt comfort.
Massive epistaxis: indications and contraindications?
Indications: -massive epistaxis not controlled with pressure to nares below bridge
Contraindications: -non-massive epistaxis -basal skull fracture(trauma caused-moving facial bones, forte fracture, battle sign , raccoon eyes)
Tq: indications and contraindications?
Indications: -life threatening external hemorrhage amenable to Tq -amputation -newly identified or previously uncontrolled hemorrhage(note: SOFTTW or EMT preferred)
Contraindications: -non-life threatening external hemorrhage
Where to place Tq?
-2/3 fingers above wound -not on joint -5cm above medial femoral condyle to avoid adductor hiatus
In CUF: on clothes high and tight
Describe Tq application in CUF?
Occlude major artery with knee, put tq high and tight over clothes. If not obvious where, wet check: inguinal, legs, neck, auxiliary, arms
When to assess tq?
Constantly for first 10 minutes(muscle relaxation etc), during and after pt movement, when the pt was left unmonitored
Pelvic binder: indications and contraindications?
Indications: -penetrating/blunt pelvic trauma -unexplained hypotension in suspected blunt trauma -blast with lower limb amputation -pain/tenderness in pelvic region
(Note: done prior to moving pt, max roll 15’)
Contraindications: none
Describe the different Tqs: EMT, CAT, SOFTTW, Sam junctional, TPod
EMT: pneumatic band, preferred
CAT: basic pinchy one, plastic rod
SOFTTW: traingle lock, metal rod
Sam junctional: for inguinal, 2 inflatable target compression devices(tcd)
Tpod: pelvic binder
What are the shock classes?
1: <750ml <100bpm slightly anxious
2. 750-1500mL anxious
3. 1500-2000mL confused
4. >2000mL >140bpm lethargic
New techniques for other bleeds.
How can you stop an abdo bleed? Epistaxis?
Neck?
If can visualize, pinch off abdo bleeder with combat gauze.
Nasal tampon for epistaxis: soak in water for 30sec, insert, inflate, pt sit for 15-20min, remove 24-72 hours.
Neck can use 10cc foley insert into artery and inflate, knot end and secure.
