Bleed control - personal program

[roadrunner]

What does the injury list look like that would call for the use of a tourniquet?

How many of y’all carry around AED’s?

Severed femoral artery and that's only if you can get the tourni applied within 30 secs...

 

[roadrunner]

Okay @Marbles. Please explain what made you giggle like a little girl...

 

[Marbles]

Okay @Marbles. Please explain what made you giggle like a little girl...

Average blood flow through the femoral artery is 650 ml/minute +/- 250 ml/minute. A 200 pound adult male will have about 6 liters of blood volume.

Up to 15% volume loss produces few symptoms, so at least one minute of a completely severed femoral will give only a slight elevation in heart rate.

15-30% results in elevated heart rate and respiratory rate and narrowed pulse pressure, but at most a slight decrease in BP. So at least 2 minutes of normal function with a completely severed femoral artery.

30-40% starts to generate a marked drop in blood pressure and changes in mental status. Above 40%hypotension becomes worse, pulse pressure becomes significantly narrowed, and altered mental status becomes worse.

The absolute worst case is probably 3 minutes of function, throw in compression from surrounding tissue and from the likely hematoma, as well as arterial spasm and the slow in bleeding from dropping blood pressure, and that a nicked artery can result in bleeding out and in most cases there will be more time.

Arteries are muscular structures and tend to spasm when severed, the more traumatic the injury, the more likely they are to spasm. It is not unheard of for limbs that are initially ripped off by machinery to produce very little bleeding at first.

Beyond that, injuries to smaller arteries can sometimes best be managed by a torniquet, which compounds the impression of fatalism that you only chose to list the femoral.

 

[roadrunner]

Average blood flow through the femoral artery is 650 ml/minute +/- 250 ml/minute. A 200 pound adult male will have about 6 liters of blood volume.

Up to 15% volume loss produces few symptoms, so at least one minute of a completely severed femoral will give only a slight elevation in heart rate.

15-30% results in elevated heart rate and respiratory rate and narrowed pulse pressure, but at most a slight decrease in BP. So at least 2 minutes of normal function with a completely severed femoral artery.

30-40% starts to generate a marked drop in blood pressure and changes in mental status. Above 40%hypotension becomes worse, pulse pressure becomes significantly narrowed, and altered mental status becomes worse.

The absolute worst case is probably 3 minutes of function, throw in compression from surrounding tissue and from the likely hematoma, as well as arterial spasm and the slow in bleeding from dropping blood pressure, and that a nicked artery can result in bleeding out and in most cases there will be more time.

Arteries are muscular structures and tend to spasm when severed, the more traumatic the injury, the more likely they are to spasm. It is not unheard of for limbs that are initially ripped off by machinery to produce very little bleeding at first.

Beyond that, injuries to smaller arteries can sometimes best be managed by a torniquet, which compounds the impression of fatalism that you only chose to list the femoral.

You forgot to mention how quickly shock can and will take affect on a person self treating a wound all the while digging out their compression bandages and tourniquet to stop or at least slow the bleeding.

Once the mishap occurs, there will be a moment of surprise realizing what happened and that you need to take immediate action.

There will be a time delay that will add on to the total time for volume loss. Your heart rate will be elevated, no matter what. A higher heart rate at the start will exacerbate the issue.

No where did I say the 30 sec was most crucial. You assumed. You assumed that bleed out would occur in that timeframe.

That's the true reality of it. Your response is nothing more than academic and juvenile at best.



And, just for reference for others, this is a copy and paste from a simple internet search on femoral artery damage:

If severed or severely lacerated, the femoral artery can dump enough blood quickly enough to immobilize most people from loss of blood pressure and volume in about 30 seconds.

Modern Suvival - Knife Strikes

 

[Marbles]

You forgot to mention how quickly shock can and will take affect on a person self treating a wound all the while digging out their compression bandages and tourniquet to stop or at least slow the bleeding.

Please define "shock?"

Once the mishap occurs, there will be a moment of surprise realizing what happened and that you need to take immediate action.

I've seen enough people in crappy situation to know that there is a large variance in individual reactions, talk like that is what makes people fall to the ground from non-lethal gunshots.

There will be a time delay that will add on to the total time for volume loss. Your heart rate will be elevated, no matter what. A higher heart rate at the start will exacerbate the issue.

As elevated heart rate in such a situation is a function of catecholamines, please define their effect on peripheral circulation and arterial tone? Have you ever personally seen how strong an effect endogenous catechols can have on a person in circulatory collapse? Ever held your fingers jammed up against an injured artery until your hands and forearms cramp?

 

[Marbles]

And the 2nd gen antihistamines we should carry. Please

Sorry I though I answered that.

Zyrtec (cetirizine). As an Rx (so this is a statement, not a recommendation) it can be used safely at 4x the normal daily dose (two 20 mg doses) for hives.

Zyrtec is available over the counter, the dosing discussed is Rx as it is not in accordance with the label.

 

[fngTony]

Let’s not ruin a good topic with being disrespectful.

 

[fwafwow]

Sorry I though I answered that.

Zyrtec is available over the counter, the dosing discussed is Rx as it is not in accordance with the label.

You did. I’m sorry. I totally spaced and overlooked your first post on the topic. I used to carry an epi pen, but it expired. I may get another but will also swap out the Benadryl for Zyrtec.

I think I saw the post by @Maverick1 and just got sidetracked. Still waiting on that elucidation

 

[fwafwow]

Still waiting

 

[yfarm]

I have only once in my life applied a tourniquet to control arterial bleeding and it was on a Lab my wife said I loved more than her, lacerated a front leg artery stepping into a mason jar at a dead run after a deer. I applied to reduce the mess in my car taking him to the vet. I have cut hundreds of arteries using 12ga mechanical suction biopsy devices in places in the body where your choices are compression or embolization. As my surgeon friends say compression, bleeding will eventually stop. One patient it took 8 hrs and I was thinking about embolization. Personally as Marbles said, I think Elastoplast is more important than a tourniquet for the injuries a hunter will see. Car accidents and battlefield we are not talking about. Zyrtec and Diamox also will be used more than a tourniquet.

 

[Jmort1754]

I don't think a tourniquet is a bad idea to have but in reality there is a list of other things I would have first.

 

[Fatcamp]

I have only once in my life applied a tourniquet to control arterial bleeding and it was on a Lab my wife said I loved more than her, lacerated a front leg artery stepping into a mason jar at a dead run after a deer. I applied to reduce the mess in my car taking him to the vet. I have cut hundreds of arteries using 12ga mechanical suction biopsy devices in places in the body where your choices are compression or embolization. As my surgeon friends say compression, bleeding will eventually stop. One patient it took 8 hrs and I was thinking about embolization. Personally as Marbles said, I think Elastoplast is more important than a tourniquet for the injuries a hunter will see. Car accidents and battlefield we are not talking about. Zyrtec and Diamox also will be used more than a tourniquet.

My tourniquets are in trauma kits kept in my boat and car. I do have a CAT in my emergency pack kit as well.

I'm well aware that I'm more apt to use these tools when not hunting, but feel like I would be tempting fate not to have one at all times.

Oddly enough one of our trauma surgeons at my hospital almost died from a bike wreck and a TQ saved his life. He now does presentations during Sturgis to help educate others. And still rides.

 

[yfarm]

Used a shoestring for my dog with a pencil.
My dogs have required more care while hunting than any human I’ve hunted with. For my labs my most frequently used item was ocular anesthetic drops with tweezers to pull out the nictating membrane to flush grass seeds out.
On another note, I have dealt with far more hook injuries far offshore than hunting injuries. Removing 6-9/0 hooks thrown by fish, keep lidocaine,syringes,needles and dermabond in the boat. Ice can be used as an anesthetic allowing hook removal with a bolt cutter. Clean and seal the entrance and exit and go back to fishing.

 

[Mangata]

Just a pearl for this thread.

Appreciate and support folks being ready to save theirs, partners, and strangers in the setting of traumatic hemorrhage.

To gain hemostasis in a local wound you should use a fingertip sized dressing and one to two fingers of serious direct pressure to the immediate area of hemorrhage. The more dressing overlying the wound will decrease your ability to apply direct pressure to the site of bleeding for hemostasis. May decrease your need to deploy tourniquet and risk limb ischemia.

I can tell you that I have seen uncontrolled bleeding from poor local wound technique ( ie a big wad of clothing or paper towels applied to wound) much more than wounds requiring tourniquets.

 

[fwafwow]

I came across my own thread and it's a good reminder that it's time for me to review my kits, both to see what may have expired, and to make sure I'm familiar with what I have (and where).

As my surgeon friends say compression, bleeding will eventually stop. One patient it took 8 hrs and I was thinking about embolization. Personally as Marbles said, I think Elastoplast is more important than a tourniquet for the injuries a hunter will see.

All true, and why training is just as, if not more, important than what's in the kit.

Car accidents and battlefield we are not talking about. Zyrtec and Diamox also will be used more than a tourniquet.

None of these are mutually exclusive, but for me "bleed control" is a different set of items, and planning/training, than the meds. And I do have a more substantial kit in my cars, in part due to what injuries can occur, and because I'm not having to carry it.

I don't think a tourniquet is a bad idea to have but in reality there is a list of other things I would have first.

Totally agree. And I've recently been more likely to carry just some s-rolled gauze in my pocket (at least when I'm just around town).

My tourniquets are in trauma kits kept in my boat and car. I do have a CAT in my emergency pack kit as well.

I'm well aware that I'm more apt to use these tools when not hunting, but feel like I would be tempting fate not to have one at all times.

Oddly enough one of our trauma surgeons at my hospital almost died from a bike wreck and a TQ saved his life. He now does presentations during Sturgis to help educate others. And still rides.

That's the way I see it - very little downside to having what you need and never needing it. I do use it as a way to broach with friends the topic of bleeding control training. I know they will never buy or carry a TQ, but they might learn how to apply pressure, pack a wound, etc., as opposed to just watching someone bleed.

Used a shoestring for my dog with a pencil.

I could have sworn this was the only thing you posted, hence the emoji I used. I realize it was "just" your dog, but my emjoji was a lazy way of replying instead of pointing out that a shoestring (or paracord, etc.) might help if you have nothing else available, but it's less than ideal and can cause it's own damage - especially if it's applied when just compression could have worked - like @Mangata points out below.

Just a pearl for this thread.

Appreciate and support folks being ready to save theirs, partners, and strangers in the setting of traumatic hemorrhage.

To gain hemostasis in a local wound you should use a fingertip sized dressing and one to two fingers of serious direct pressure to the immediate area of hemorrhage. The more dressing overlying the wound will decrease your ability to apply direct pressure to the site of bleeding for hemostasis. May decrease your need to deploy tourniquet and risk limb ischemia.

I can tell you that I have seen uncontrolled bleeding from poor local wound technique ( ie a big wad of clothing or paper towels applied to wound) much more than wounds requiring tourniquets.

^^^ This. (I'm not expert on bleeding control, but I did stay at a Holiday Inn Express.) Of the many posts about TQs (quite a few of which are mine), I'd hate to think that people would carry and use a TQ but not realize that getting your hands (and fingers) bloody is the right prior step to stopping the bleeding. It seems so obvious, but I think of how many times I used to not do that for my own cuts, as I was staring at the blood, or washing it under water - instead of immediately applying pressure.

 

[Fatcamp]

I came across my own thread and it's a good reminder that it's time for me to review my kits, both to see what may have expired, and to make sure I'm familiar with what I have (and where).

All true, and why training is just as, if not more, important than what's in the kit.

None of these are mutually exclusive, but for me "bleed control" is a different set of items, and planning/training, than the meds. And I do have a more substantial kit in my cars, in part due to what injuries can occur, and because I'm not having to carry it.

Totally agree. And I've recently been more likely to carry just some s-rolled gauze in my pocket (at least when I'm just around town).

That's the way I see it - very little downside to having what you need and never needing it. I do use it as a way to broach with friends the topic of bleeding control training. I know they will never buy or carry a TQ, but they might learn how to apply pressure, pack a wound, etc., as opposed to just watching someone bleed.

I could have sworn this was the only thing you posted, hence the emoji I used. I realize it was "just" your dog, but my emjoji was a lazy way of replying instead of pointing out that a shoestring (or paracord, etc.) might help if you have nothing else available, but it's less than ideal and can cause it's own damage - especially if it's applied when just compression could have worked - like @Mangata points out below.


^^^ This. (I'm not expert on bleeding control, but I did stay at a Holiday Inn Express.) Of the many posts about TQs (quite a few of which are mine), I'd hate to think that people would carry and use a TQ but not realize that getting your hands (and fingers) bloody is the right prior step to stopping the bleeding. It seems so obvious, but I think of how many times I used to not do that for my own cuts, as I was staring at the blood, or washing it under water - instead of immediately applying pressure.

I believe it was one of your threads that caused me to change up the stuff I carry. The two kits I carry are different. One is pretty comprehensive and has some meds and a bunch of miscellaneous stuff. The other is straight bleeding control. Multiple tourniquets and bandages, enough for several people to work and be cared for. I have that with me every day, except for today of course because I move it to the truck last night.

And after an unsuccessful CPR event at a boat ramp last summer both have pretty solid options to provide breaths while protecting the caregiver.

 

[yfarm]

I used a shoestring and a pencil as it was what was available at hand. Am familiar with limb perfusion requirements. This is similar to the other posts from trained individuals carrying duct tape and bandaids. I would rather have highly trained individuals improvise than an untrained person with a truckload of supplies ie finger tip compression and a tiny bandage.
Relative to the dog, upon arrival to the vet, he ligated the vessel with a single suture and then closed the wound.
Another anecdote, have used super glue when dermabond was not available in a first aid situation. Much prefer over bandages in wet environments as it seals the injury from further contamination. The goal is to close the wound after cleaning requiring approximation of the wound margins. Friend did not understand that concept and liberally applied to the open tissues. Sealed wound which then healed by granulating in which is not the desired process.

 

[TaperPin]

This is somewhat off topic, but I thought it was really interesting. The military planning for any peer to peer conflict going forward (like Taiwan) assumes paramedics won’t have access to medivac helicopters because they are such easy targets, so the injured have to go overland. Paramedics will have more advanced procedures to do in the field, drone blood drop offs and more transfusions body to body. A quote from a parametric I heard was this is a good time to get out because it would be a high casualty mess.

 

[fwafwow]

I used a shoestring and a pencil as it was what was available at hand. Am familiar with limb perfusion requirements. This is similar to the other posts from trained individuals carrying duct tape and bandaids. I would rather have highly trained individuals improvise than an untrained person with a truckload of supplies ie finger tip compression and a tiny bandage.
Relative to the dog, upon arrival to the vet, he ligated the vessel with a single suture and then closed the wound.
Another anecdote, have used super glue when dermabond was not available in a first aid situation. Much prefer over bandages in wet environments as it seals the injury from further contamination. The goal is to close the wound after cleaning requiring approximation of the wound margins. Friend did not understand that concept and liberally applied to the open tissues. Sealed wound which then healed by granulating in which is not the desired process.

I wasn't intending to insult your background, training or knowledge. There are just some who have posted roughly the equivalent of "I don't need to pack a TQ, as I can always just use x, y or z." The one video that I found (and may have posted) that caught my attention on this "plan to improvise" approach (again, not saying it's yours) is how it can be tough to secure an improvised TQ, especially if you need your hands for something else.

 

[yfarm]

This is somewhat off topic, but I thought it was really interesting. The military planning for any peer to peer conflict going forward (like Taiwan) assumes paramedics won’t have access to medivac helicopters because they are such easy targets, so the injured have to go overland. Paramedics will have more advanced procedures to do in the field, drone blood drop offs and more transfusions body to body. A quote from a parametric I heard was this is a good time to get out because it would be a high casualty mess.

Brings to mind the stories about wounded air evacs from Dien Bien Phu where the opposition used the red crosses as aiming points for heavy 50s