Originally Posted By: Pete
here's one thing ... and I want to get the opinion especially of the paramedics on this forum.

for a case of serious (or critical) bledding from an extremity I am considering the following technique.

1. While one person gets gear ready (bandages, celox dressings, water for irrigation), a second person applies immediate pressure at the site of the wound.

2. when ready to go, someone takes a piece of surgical tubing and wraps it around the uppermost part of the extremity with some tightness. not enough to be a tourniqet, but enough to reduce blood pressure in the extremity.

3. with blood flow temporarily reduced ... wound is uncovered, irrigated to clean out foreign matter, new bandages applied, pressure applied again on new banadages. goal of this step - 60 secs maximum time.

4. surgical tubing is removed and pressure is maintained on the wound site.

the idea of this technique is to temporarily reduce blood flow to allow quick cleaning and better application of proper bandages. the aim is to be smooth and fast, so blood pressure to the extremity is only reduced for a short time.

and by the way, you could essentially do the same thing if you used a blood pressure cuff on the extremity (and pumped it up) to reduce blood flow. just don't pump it to the point where it gets to systolic pressure - allow some blood to keep flowing.

thoughts??

Pete2
Boy, this is a mixed one. First, surgical tubing probably won't be tight enough for a true arterial bleed. Arteries tend to be deep, veins shallow. So, if it's veinous, your tubing is going to make the bleeding worse, because you block the "uphill" flow. Kind of like when you give blood, and they wrap tubing around your bicep to bulge out your elbow veins. A BP cuff would be better, but to truly stop bleeding, you NEED to overcome systolic blood pressure.

Second, I wouldn't ever do this under rare circumstances.

I think most folks reading this are confusing 2 concepts: bleeding control, and infection control. Guess which comes first?

AFTER the bleeding has stopped, THEN start the infection control. Stop the bleeding however you have to - gauze, TQ, celox, finger on a blood vessel ... the hold it for a while. If it's critical bleeding, you might not be able to stop it, in which case the person dies. But, after 10-15 minutes of serious, HARD direct pressure, most bleeding will stop. Wait a while, an hour or 2, before even thinking of infection control. Honestly, if you're within 24 hours of a medical center, I would barely consider going back there. If it's difficult to control once, it's going to be hard to control a second time.

Sometimes, you don't just do something - you stand there.