HEMORRHAGE

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EXERCISES
EXERCISE:
MYTH #1: DIRECT PRESSURE WILL CONTROL BLEEDING.

FILL THE GAPS WITH THE MISSING WORDS BELOW

Hemorrhage control techniques digital pressure control bleeding

• Direct pressure is the primary technique EMS uses to (1)__control bleeding, but this technique will only work if focused (2)
digital pressure is placed on the source of bleeding. Placing an entire palm over the bleeding is often unsuccessful because
pressure is diffused over a wide surface area. By reducing the diameter of the surface through which force is applied from 10
cm (palm) to 2 cm (finger), surface area is reduced 25 times and applied pressure goes up by the same ratio.
• Some knowledge of anatomy is required for the fingers to press the source bleeding from deep wounds against the
underlying structures. Effective digital pressure is difficult to maintain for more than a few minutes (the muscles of the
fingers tire). (3) Hemorrhage control via direct pressure is extremely challenging during transport due to constant
movement of the patient and provider.
• Other hemorrhage control (4) _____ techniques ________are required to transport a bleeding patient and to free the hands
so that other priorities can be dealt with.
MYTH #2: PRESSURE DRESSINGS ENHANCE HEMORRHAGE
CONTROL. PERSISTENT BLEEDING IS MANAGED BY THE
APPLICATION OF ADDITIONAL DRESSINGS.

• This approach to hemorrhage control is still written and stressed in many modern EMS textbooks.4 However, if persistent
bleeding saturates a pressure dressing, then the pressure isn’t focused on the source of bleeding. Pressure dressing should apply
pressure directly to the site of vascular injury. The application of additional layers of dry dressing results in a more diffuse, and
therefore less effective, pressure atop the existing nonfunctional one.
• This continued addition of dry dressing only results in soaking up more blood. The sponge-like effect draws blood from the
wound, and ultimately wicks away clotting factors from the site of the vascular injury. Additionally, small motions that naturally
occur between the patient and dressing disrupt the clot that may be forming in the gauze matrix and wound. Blood, and the
resulting hematoma responsible for sealing the damaged vessel, is better left inside the body and not outside.
• Effective hemorrhage control requires the clotting process take place at the site of endothelial damage. While dressing may assist
in keeping the forming hematoma in contact with the vessel, the absorptive nature of these products, the diffusion of pressure and
the challenges of maintaining the fabric matrix immobile during patient movement make this approach fraught with opportunities
for unrecognized failure (the dressing prevents visualization of bleeding from the wound until a significant amount of blood has
soaked through).
• The use of elastic bandaging and dressings can create effective pressure by wrapping, but this is practical only on the arms and
legs. Circumferential wrapping is difficult across other areas of the body such as the scalp, neck, truncal areas, axilla and groin
because of the anatomy, and results in greater difficulty generating effective pressure.
• The bottom line is that some minor- to moderate-bleeding wounds on the extremities can be adequately controlled with pressure
dressings, but it’s mostly an exercise in futility to attempt direct pressure alone elsewhere
 EXERCISE
MYTH #2: PRESSURE DRESSINGS ENHANCE HEMORRHAGE
CONTROL. PERSISTENT BLEEDING IS MANAGED BY THE
APPLICATION OF ADDITIONAL DRESSINGS.

WRITE TRUE OR FALSE TO THE FOLLOWING INFORMATION: TRUE / FALSE

1. Pressure dressing should apply pressure directly to the site of vascular injury. _______true____
2. The application of additional layers of wet dressing results in a less diffuse, and therefore more effective technique __TRUE
_________
3. Blood, and the resulting hematoma responsible for sealing the damaged vessel, is better left inside the body and not outside.
___FALSE________
4. The dressing prevents visualization of bleeding from the wound until a significant amount of blood has soaked through.
____FALSE_______
5. The use of elastic bandaging and dressings can create effective pressure by wrapping, but this is practical only on the neck and groin.
______FALSE______
 EXERCISE
MYTH #3: TOURNIQUETS WILL CONTROL ALL EXTREMITY BLEEDING.
MATCH THE IMAGES BELOW WITH THEIR CORRECT DESCRIPTION

c. Difficult-to-control
bleeding
a. Strap tourniquets often requires the use of two
commercial tourniquets to
compress large thigh muscles.

b. A properly tightened tourniquet d. Bleeding wounds need to

must occlude arterial flow and will be carefully monitored for
produce extreme pain in the
rebleeding.
extremities.
 EXERCISE
MYTH #4: APPLICATION OF HEMOSTATIC AGENTS TO BLEEDING
WOUNDS WILL CONTROL ALL EXTERNAL BLEEDING

Put in order the paragraphs to organize a CORRECT APLLICATION OF

HEMOSTATIC AGENTS process

Hemostatic agents need Proper technique pushes

The technique for Hemostatic impregnated to be packed into a the hemostatic agent to
packing the wound is gauze does enhance bleeding
control, but some studies have
wound against the the bottom of the wound Place on top
critically important injured vessel and and is successively
and should ideally be
suggested that the addition of
the hemostatic agent enhances effective compression packed in with a single of a bleeding
taught in a live tissue maintained for at least finger to maintain
the effect of the gauze by
effective pressure on the wound.
training environment. about 15%.7–9
three minutes . bleeding source.