Here's how I see it. For us non-professionals, we worry about the amount of blood and the length of time we continue to bleed. I once cut my index finger near the top ( I was in the bathroom cleaning a khukri knife) and it bled all over the sink while I tried to open gauze pads to put on the cut and deal with the blood by running water and using paper towels. I managed to wrap it and I just held it until I got to a clinic. The nurse was the one who took care of me. She basically had me soak/rinse my hand in a basin of hydrogen peroxide and put on the foam and bandaged it. The doctor without even saying "Hello" to me, looked at my finger for 2 seconds and told her to do exactly what she was thinking. After she dressed my finger, she then gave me supplies and instructions on how to redress it myself. I thought oh great, a "do it yourself" kit. If I had a blood clotting agent and the supplies at home I could have done it myself..... but even thought it stopped bleeding on the ride to the clinic, I thought I might require stitches or some medication. Apparently I handled it better than I thought and if I was more knowledgeable I could have taken care of it, but "better to be safe" is what guides most of us.
How about leaving the 1st inplace and toss the 2nd. Apply a new second and adjust where you are putting pressure. I have never thought stacking 5 or 6 bandages to be a good idea. But i do believe removing the first could mess with clotted blood in the wound. Also a fan of the 4 X 4 as the first dressing.
German here, not familiar with US first aid protocols. Am I getting this right, the standard first aid courses teach to keep stacking gauze pads with no other alterations? We do teach stacking bandages here, but by bandages we don't mean gauze pads... My protocol as a first aid instructor currently is (extremity, arterial bleeding): (This applies to driving license applicants, and the bi-yearly legally required courses for at-the-workplace first aid): 1) Apply manual pressure 2) If possible, elevate limb (yes, controversial) 3) Call for help, get someone to get a first aid kit out of a nearby car (if noone cooperates and the bleeding is life-threatening, it is legal to break into a car in this case) 3a) The standard issue first aid kid in a German car includes no israeli bandage or tourniquet, but lots of gauze pads and bandages. 4) Apply a sterile gauze pad firmly 5) Wrap bandage around gauze pad once or twice, then add still-wrapped bandage as pressure padding on top of the gauze pad, then wrap the first bandage around that as well (tightly) 6) If bleeding persists, you may stack another pressure padding on top of the first pressure padding, and apply another bandage even more tightly to press both pressure paddings onto the wound area. The reason not to remove the first pressure bandage is to not loose pressure 7) Failing that, apply even more direct pressure (kneel down if necessary) 8) Taught only in specialized courses for firemen/-women, woodworkers, mechanics etc.: You may apply a tourniquet in addition or instead of stacking pressure bandages. Now that system isn't without fault (it is certainly rather complex if you do not visit the required refresher courses and is not aimed at major trauma scenarios), but that's the only protocol I know which makes you stack anything on a wound. You only stack pressure bandages to increase pressure if a normal bandage wasn't enough. You'd never stack normal bandages. In fact, we make sure the pressure dressing remains wrapped to avoid soaking in blood because we do want to immediately see further bleeding, not hide it inside a soaking, now-soft pressure bandage. It'd be a different matter if we'd pack wounds, but that's only recently been added to EMS protocol here (with all the hysteria around terror attacks and depression-induced shootings), it has never been part of first aid training. I find it fascinating how things are handled differently around the world. The "elevate the injured limb" thing, for instance, is really out of fashion in the US, while in Germany, people are way too afraid of teaching to use tourniquets. Also, haemostatic agents: Pretty popular with Americans, but extremely controversial over here. As a medic, I am currently not allowed to use QuikClot for instance. Even privately, I should not do it because there are hardly any deaths due to external bleeding in my state, but a very high number of clotting-related deaths (mostly your good old pulmonary embolism, stroke, heart attack and such). We are currently buying chinin-based wound packing material, though, so protocol is becoming more forgiving. Not many medics have been taught packing wounds as of yet. And I mean, it's extremely rare. 99% of life-threatening emergencies require a quickly established IV access, good ECG reading, solid CPR and intubation skills, early defibrillation and/or rapid transport. 1% may require difficult to control external bleeding, so I understand why our protocol only added tourniquets a few years ago. We were way too afraid of losing limbs, but current statistics show no problem with tourniquet use.
go waaaaaaaaaaaaaaaaaaay back 20 years and it was apply bandage/clean cloth/something and get the arm wound above the heart. Thus lowering pressure to the wound causing the blood and clots to pool. And stop bleeding. Maintain above heart level until help arrived or you got to the ER.
I have a pretty extensive Trama Kit. My first priority on a serious injury is to stop the blood flow, I myself use Bleedstop, then an Isreal Bandage, then a tourniquet, If need be two tourniquet. The Bleedstop woks well to couragulate the blood and, in the least, slow down the blood flow. You will need to apply direct pressure for about 5 minutes, depending upon the severity of the wound. The Isreal Bandage will soak up quite a bit of blood, and you can apply direct pressure on the wound like a tourniquet. Then, use a ratcheting tourniquet above the wound to further stop the blood flow.
This is where the Swat-T tourniquet (synthetic stretch wrap material)works great, because it can be used to apply the direct pressure needed assist bandages.
Many of my micro trauma kits do not have a full size cat tourniquet I am ordering a bunch of SWAT T s for those kits .. also blood stopper powder hemostatic gauze even an ace bandage
This is the protocol that is in the British First Aid manual. If the first dressing soaks through, apply a second dressing on top. If the second dressing also soaks through, remove both and apply a fresh dressing, ensuring that pressure is applied accurately to the point of bleeding. The manual is the standard text book for all first aid qualifications in the UK. The Oxford Handbook Of Pre-Hospital Care states: "In the event of blood soaking through applied dressings, further applied dressings are unlikely to arrest haemorrhage." It seems that your idea is a good one, as this is what we do this side of the Atlantic.
Hello Iv been using your great videos in my EMT class!! Iv has been an inner-city EMT for 35 years as well as an officer. I'm now an instructor and your videos are a god-sent thanks !! happy thanksgiving to you and yours.
That was just what I was thinking, you beat me to it. It just seems like a practical option to me also to reinforce without disturbing the clot and then change location of pressure.
1. 4x4s with good pressure. 2. Roller gauze, still rolled up, set over the original 4x4s. This leaves a sizable “bump” over the wound area. I take CoBan and do a good pressure wrap, check for a distal pulse and or cap refil. Basically it’s a “mini Izzy bandage”. I’ve used this on pretty bad wounds that could have easily gone to a tourni ex. We had a woman who was serious about killing herself, sliced along the vein, not across. Wrapped it, started an IV (she’d lost a lot of blood) and kept her around 90 sys and she was good to go for a good 20 min transport. Anyway…very effective.
Direct pressure from the start is a winner but just as important, why is the patient still bleeding? Increased BP? Blood thinners? We use an ace wrap or coban to secure dressings when possible and let the patient apply pressure if we have to move on.
2021 and here in the UK. We are now taught to remove the first dressing, check the wound for foreign objects that we may have missed in the first place. Re-assess where the wound is bleeding from and put direct pressure on that point.....so you were correct all along.
As an EMT that was trained in the past few years, and now sometimes acts as an instructor, that's not what I was taught nor is it what I teach. What we generally teach is that after you apply that initial 5x9, you do not remove it. However if it bleeds through add more 5x9s as necessary, and if you can no-longer hold antiquate pressure remove the excess 5x9s (but not the initial one) and add fresh ones if needed. The clot is forming on the initial 5x9 you placed, not anything else. So you should be good to add/remove things as needed so long as you don't remove the 5x9 you placed first.
Similarly, I heard local paramedics say that more and more neurologist and orthopedic surgeons say that it is better to get victims to the ER quicker that spending a lot of time stabilizing. If you spend hours getting someone stabilized in a car, etc. the damage might be worst. What they need is surgery and or medication ASAP.
That's correct. In a serious trauma the vast majority of treatment will be done en route to the E. D. unless an unpreventable element, such as, extraction requires a prolonged scene. In that case you would begin treatment while the extraction is in progress, if possible.
I have simply put a gloved hand with lots of pressure on a wound and controlled bleeding with no bandage. Once its controlled I then apply a bandage with continued pressure.
As noted by others, the UK first aid training agencies have been advising on applying only two dressings, then restarting again (as you suggest) since ~2002; regional variations on first aid advice do occur.
Right on! Adjusting the way pressure is applied makes more sense than stacking bandages. Couple thoughts: 1) If the wound is deep, pack with gauze before placing a pressure bandage; 2) 6" pallet wrap makes a fine compression dressing for holding pressure on a 5"x9". Firmly apply 3-4 layers of wrap over the pad.
MD (to be) here: by taking the 5*9 off, you're not taking out the clots (if it is still bleeding there are no clots) you're however taking away the blood which has most of your clotting factors. Place the 5*9, wrap it real tight with gauze or tape and apply pressure. You want to keep as much blood as possible in the site, so the clotting factors dont get washed away. If you know your anatomy, you could try holding pressure over the artery leading up to the wound. But over all, one 5*9, wrap it, press hard on it. Small nicks and cuts clot immediately because the primary clot (platelets holding together by only moleculed on their membranes) coupled with vaso constriction is enough to close the capillaries since the blood flow is very weak and the space to close off is small. If you got smaller arterioles or venules that are bleeding like in this situation, the primary clot wont cut it, you need a secondary clot, where fibrin is layed all around the site by platelets grabing and tangling more platelets, red blood cells, white blood cells, proteins and everything that comes into contact. It will take longer and you need to slow the bloodflow down as to allow clotting factors to do their work.
Also been thinking that if you have to use a tourniquet, that putting some soft padding like a rag on the opposite side of the artery you want to clamp down might relieve some pressure and cause less chance of amputation while still targeting the artery that is bleeding out.
I knew a guy who got a head injury. At the hosp the Dr commented on nice application of dressing but said next time put it over the wound. Dressing in the right place, preasure in the right place? More preasure or TQ
MR. FLACKO, you are 100% correct. Also, think about capillary action for a second. By adding mas fabric while pressing only creates a WICKING action and will actually DRAW fresh blood outward. Are there any contraindications using coagulants? ........thanks, LPN (Low Paid Nurse)
In my First Aid classes, I always teach to leave the first dressing in place but don't keep "padding".... remove the second if it soaks through, but leave the first in case there is "some" clotting that has started. You are certainly more educated on this area so I will have to consider your option now.
about 4 years ago I had a nasty cut, about 3" (the ones that requires stitches) in my arm and I only got my t-shirt and press firmly about 2 hours and the bleeding stoped, from then I always carry a IFAK near !!!
(1:04) spell check broken? I believe in the traditional information being taught. It is always good to apply pressure. Now what kind of technique is used to apply that pressure is what I think you are questioning, which is correct. We need to start teaching “better” give the students some time (lots of of time) to practice and practice some more. I was proctoring a CPR class and the first thing the new instructor said was that she will try and get the students out early? WHY? They are booked for 3 hours, if they had a conflict they should reschedule, not be penalized with less time to practice.
I have never heard of stacking 5x9's at all in a heavy bleed. The 5x9 is not there as a patch such as on a flat tire. It is a semi sterile surface that is absorbent. The pressure is to stop the bleeding while the 5x9 provides a more sterile cover than your bare hand and to reduce blood running all over. If the pressure is not handling the bleeding and the bleeding is excessive it is time to move to something else. You could put a 4" thick folded towel and it will just absorb blood and stop no bleeding at all. It's all about pressure, cleanliness and reduction of infection via the 5x9 instead of the 5x9 being a non-permeable membrane.
The other problem is, if you don't approximate the wound edges, additional pressure can actually cause the wound to stay open. Removing the initial bandages, readjusting making sure the wound edges are approximated as best as you can and then apply direct pressure or a pressure bandage can make a big difference.
Yeah. Stacking is, imho, kinda silly if it keeps bleeding; if the wound looks that bad, and superior medical assistance isn't close by (say five or ten minutes away, max), I'm going to pack that wound with either celox ribbon (by preference) or granules, THEN apply the 5x9.
In the vast majority of cases where one might need to address a serious wound in the field, there is just one such wound, and most of the time, once you've got the bandage on, you can afford a few extra minutes at that point. How about assisting the bandage by applying hand pressure over the bandage. Clotting can be relatively quick if the clot itself isn't disturbed by blood flow. So put the heel of your palm over the wound after you bandage it and apply sufficient pressure manually. It's a rare wound indeed that will still be bleeding after a few minutes of that.
What if instead we apply the bandage and just wrapped it tightly with a roller bandage or an ace wrap (but not too tight) to maintain constant pressure on the wound? would that work?
@Bryan Choo It would be less effective than direct pressure. The roller bandage will be applying pressure equally, all around where it is wrapped. Any additional pressure beyond the tight wrapping to the wound will be solely due to the thickness of the wound dressing. For some wounds, adding sufficient additional pressure from tight wrapping might well be tantamount to the effect of a tourniquet. Tourniquets should be the last resort choice, the choice when nothing else will do either due to wound severity or urgency of time constraint. There are huge downsides in terms of after effects however from that kind of generalized pressure reducing or eliminating blood flow past that point. Hand pressure to assist wound clotting avoids the tourniquet problem. Moreover, while a tight wrapping may well do the job, it continues it's tightness well beyond the point from when it is still needed, unlike hand pressure, where a human brain is in the loop. One thing I could suggest if you don't want to spend minutes pampering a wound but also don't want to wrap too tightly, is to heighten the packing above the wound right at the start. Apply a sterile pad to the wound, then put a gauze roll, 'unrolled', directly atop that positioned to maximally cover the shape of the wound, then gauze wrap (using a second roll) the pile. The unrolled gauze will create that localized pressure. It won't be as much pressure as direct hand pressure, but it will be sufficient for most.
I have no experience (only what I gather on channels and fb pages like this), but that will probably work way better than just stacking. I remember discussion about wound packing and the summary was that if it fails and blood is still leaking, don't add more gauze, but remove everything and put new hemostats as most likely it was in the wrong place and doing its job in the first place.
In my case they taught us to leave the initial gauze on, but any subsequent gauze that's bled through could be replaced. It sounds like they may have said to apply extra gauze if it bled through, but never really clarified further than that for you.
Who would tell you to just stack bandages on top of one another and everything will be okay? Apply pressure to the arteria brachialis, apply one bandage with good pressure and you're good to go in a minute or so. Increasing the direct pressure on the wound will not necessarily help any further instead stop the blood flow by increasing the pressure on your upper arm (should be enough using your hands no tourniquet)...
I worked EMS for years and always thought this seemed stupid...if it's bleeding so much that you need more bandages, there is clearly no clotting to disrupt...I usually went for a FRESH bandage and some form of additional pressure 'upstream', often manually, all while doing my best to calm the patient and get their heart rate down. I found calming to be incredibly effective when possible.
When do you use a petroleum gauze, only on burns or also cuts like what he's describing? Would you put on a bullet hole(dosent bullet burn skin?) that's somewhere where is not gushing blood?
How about a Israeli bandage or North American rescue 6”? Then we can really get some pressure on the wound and maybe not have to hold it so we can continue on with patient assessment? .02
You could even do 5x9 with an ACE wrap (trick of the trade from working at a "frugal" EMS system). Israeli bandage = $10+ ... NAR trauma dressing = $11+ ... 5x9 + 4" ACE = < $5 (and they are multi-use)
On smaller wounds up to an inch and maybe a 1/3 inch deep I have always found dryer bandages stop the bleeding faster. I haven't had much experience with fresh wounds much larger, so I don't know if that would transfer over. But what your saying makes sense. I would also think that pressure should be closing the wound as well it at all possible.
I have been an emt in florida for 19 years i have always hated the keep adding bandage idea. I think its s great thought to readjust the pressure point. I have seen the thick pad over a wound with no help as well lol.... P.s. love your vids.....
Not just that skinny medic , also the fact that air is is whats gonna dry out the flowing blood, so the more you put stuff on the less breathable it becomes causing less air to get to the wound to dry it out.if you can cinch the cut up somehow and put a single 5x9 folded over on it and tape it down tight or hold it firm has to be better then putting on lots of 5x9's. you need to get air to the wound while at the same time preventing it from bleeding to much by use of pressure. I think the bandage in most non lethal cases is just to keep it from getting infected and being able to just tape it it on and continue with ur day without having to hold ur hand down. but lets say u have one 5x9 that gets drenched , i think the negative effect of that is having more of a pool and less air getting through,but if keeps bleeding out like that then yeah the problem is putting more pressure on and not wanting to remove the first bandage because of whatever scabs" may have been forming will get ripped off, but if its been no time at all and its hella' bleeding then yeah more pressure and u can remove the old bandage and put on a new one double layered or triple layered because it hasnt been enough time to scab over internally or externally. You have to gauge the cut and try to get the right amount of bandage on the first time. I agree with you that its more about pressure .I never thought of how putting more on would make it less able to be clamped down but thats true. But yeah if its been on for a while you dont want to remove it but in some cases u might .Some cases adding more is better m so,me removal and pressure adjustment. THey should make a sterile see through tape that dissolves after contact with blood in a few days. Thatd be a quick stitch that removes itself
I have NEVER been taught to keep applying more & more dressings. 1 trauma pad with direct pressure. If it doesn't work, get someone to apply direct pressure while you go for the brachial/femoral artery and use indirect pressure. If blood still soaking through at that point, you should be already booking it to the hospital!
i agree with changing location of pressure ive always questions when dealing with bleeds like that why cant we treat it like a tourniquet required injury and apply pressure above the wound while still applying secondary pressure directly to the wound
Thank you man at least one person who learned it like I did. You have a nasty wound on your arm. Go and squeeze the upper arm in order to tighten the arteria brachialis and slow the blood flow, then apply your pressure bandage and you should almost always be good to go in like a minute
Blood in the veins is moving from the limb towards the heart. So for this idea to work on a venous bleed, you would need to apply pressure distal to the wound to prevent blood flow.
@@objectiverunamok8918 you would not have such massively bleeding wounds if only the veins are affected except for some extreme cases of anticoagulations. And because the bloodflow in the veins is regulated passively by the arteries next to them, proximal pressure is highly effective anyways.
What you say makes sense to me. It has always seemed to me that after a point you're just extracting blood by capillary action when you apply more fibers.
I always learned that if the bleeding doesn't stop with direct pressure at the site of the injury, to then apply pressure to the major artery proximal to the wound. But I have no real life experience.
I've worked under 5 seperate EMS protocol systems. All of them regarded pressure points as an ineffective technique. But I haven't worked as a paramedic for over 10 years.
I honestly understand your idea and yes there is a point in game plan change. However, I do believe if we can slow the blood flow through multiple layers while applying direct pressure we can help the clotting under the first layer do its job better. If the clotting under the first layer had begun to start to work removing that layer brings us back to square one.
I managed to stop a bleed by strait up pinching a vane that i nicked . Ye a small bit of gauze over it . When I got to the ER they took it off and it squirted they asked how much blood I had lost and when I said none they brought blood anyway. My reaction time was fast enough that I got the vane before it filled the wound with enough blood to leak . 3 drops of blood on the floor and a bit on the table and in my mom's car as she rushed me off . But when they closed of the blood vessel in the operating room I lost alot of blood. So the fact that I am thin enough to be able to pinch off my vanes because they basically on the outside of my arm like noodles glued to a sausage 😂. I pinched my skin purple and there was a bruse higher up my arm where I pinched and the next day my right hand was more painful than the one I cut open because of the constant muscle tension of sitting and holding what was basically a slit vane for 4 hours in an emergency room. Should have let go would have had service faster😅 😂😂 but had I placed something over it I would not have been able to hold it like that . I was told that I was actually very lucky I managed to stop it that quickly. Was the one on the side of the left hand taking blood from the thumb index and middle finger. It runs over tendon on the back of the hand that moves the thumb . Hope that describes the image better.
Silly question, but if you've filled the 2nd 5x9, why not remove the 2nd one, adjust position, and apply a new 2nd, instead of "building the mattress?"
My training from Cub Scouts through EMT school was first bandage stays, the second one gets replaced if it bleeds through. Also if it's still bleeding more pressure.
Maybe I'm stupid, but I have always felt that the ultimate goal was to keep as much of the red stuff inside the "people tank" as possible. I too have seen an arm or lower leg wound with six or eight inches of pads stacked like hotcakes and then wrapped in place with stretch gauze. Considering that each 5x9 soaks up about 4-6 oz of blood, stacking five of them up means you've just wicked about a pint and a half of blood into the bandages. As you say, the whole exercise revolves around getting clots to form at the wound -- not four, five, six pads away. I would think a gash that's bleeding that bad needs to be flushed, butterflied together, slap a 5x9 across the top, then put the waxy wrapper from the pad down as a backer, and if pressure on that doesn't cut it, it's time for either a tourniquet or at least a snug ace bandage wrap. In any event, no matter what preps happen, try to keep that first pad in place. Glad you keep training us, and also glad you keep thinking beyond the "abc's" of first aid.
Wouldn't the only problem come from removing the first bandage? So it seems it wouldnt disrupt any clotting to remove the second bandage and leave the first one
THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS (ACEP)...Two dressings, replace both if still bleed through. TCCC....combat gauze...3 mins....then replace if still bleed.
Interesting video. I think most of have used multiple 4x4s on a wound, can't imagine using that many 5x9 or ABD on a wound. I can see your point. As others have said maybe an ABD wrapped with Kling or ACE for compression.
I agree. When using the emergency roll of TP and duct tape at the job site you get a good wad, hold pressure then after a song or smoke pitch it out the window, put second wad on wound and tape in place. If it runs out the duct tape or you can't get it to stick due to river of blood you have to tell your boss, which might be worse then going to the doctor. Just saying ;)
Would it be ok to stack a couple and then wrap it with an ace bandage? I would think that would be the best way to apply even pressure to stop the bleeding. Also would free up your hands to asses/treat other possible wounds.
After the bleeding has stoped do we remove the gauze irrigate and clean wound and reapply new gauze and wrap it with cling, ace bandage, compression bandage, or self-adherent bandages.
Would it make sense to place the first dressing, if it bleeds through add a second. If it bleeds through the second bandage, remove just the second bandage and apply a third bandage over the top of the first and throw away the second? This is assuming that you can remove the second bandage without pulling the first one off with it.
I would say if you have to put a 3rd or 4th ABD pad on and there is still more blood, there is not any clotting going on and you should pull it all off and put on a Blood Clotting sponge or another type of blood clotting tool.
I ve watched Rns in the ED throw saturated 2x2s after saturated 2x2 in the floor after DCing an iv. Seriously. I counted 8 one time before she went to find more tape and never came back.
cuddlefish longbottomtonshireville In low light class, instructor said his partner shot dude 10 times in chest, dude got away and was found dead in er waiting room, sometimes the rns overlook stuff, 😁
The clot will be where the wound is, mayyyybe a little into the first pad. Why not just keep the first pad on to "protect the clot", and then just replace the second one when it's saturated?
Going back to basics. Although the idea of replacing. The first 2 pads that are ineffective is a duh moment. Nicely done But just like In Boy Scouts. Direct pressure. Elevation. Pressure point the. Tourniquet. In that order. Unless it's obviously an arterial bleed aka partial or complete amputation or deep penetrating wound. Aka gsw, stab etc. The basics are called just that because well they work.
The bleed through to the 2nd and 3rd bandage, how much of it is just absorbtion from the saturation of the 1st bandage? A good percentage I think. Your thought is spot on. The more bandage you apply to a cut the more dissipated the pressure as it will spread out to a wider area causing less pressure on the focal point. Good vid SM. 👍
I'm just seeing this and have a question...if I am treating a patient with a constant bleed, and they bleed through all my dressings, could I try a Hemostatic agent...or is that for an arterial bleed only? Meaning, if I have applied multiple trauma dressings and they bleed through, when I undress to reapply, why wouldn't I try a different approach altogether? Let me just say before someone blasts me...I haven't done active patient care since I was medically retired from the Marines almost 20 years ago...so I am a little behind in my CE's and Blocks LMAO. Thanks for the mental exercise. Semper Fi
Here's how I see it. For us non-professionals, we worry about the amount of blood and the length of time we continue to bleed. I once cut my index finger near the top ( I was in the bathroom cleaning a khukri knife) and it bled all over the sink while I tried to open gauze pads to put on the cut and deal with the blood by running water and using paper towels. I managed to wrap it and I just held it until I got to a clinic.
The nurse was the one who took care of me. She basically had me soak/rinse my hand in a basin of hydrogen peroxide and put on the foam and bandaged it. The doctor without even saying "Hello" to me, looked at my finger for 2 seconds and told her to do exactly what she was thinking. After she dressed my finger, she then gave me supplies and instructions on how to redress it myself. I thought oh great, a "do it yourself" kit.
If I had a blood clotting agent and the supplies at home I could have done it myself..... but even thought it stopped bleeding on the ride to the clinic, I thought I might require stitches or some medication. Apparently I handled it better than I thought and if I was more knowledgeable I could have taken care of it, but "better to be safe" is what guides most of us.
How about leaving the 1st inplace and toss the 2nd. Apply a new second and adjust where you are putting pressure. I have never thought stacking 5 or 6 bandages to be a good idea. But i do believe removing the first could mess with clotted blood in the wound. Also a fan of the 4 X 4 as the first dressing.
100% agree, the clots are forming below the first bandage, the second doesn't have any helpful clots.
@@lobisw true but if ur going to lift bandage maybe it’s very suttl but could still interrupt the cot so might as well toss and re-evaluate
German here, not familiar with US first aid protocols.
Am I getting this right, the standard first aid courses teach to keep stacking gauze pads with no other alterations?
We do teach stacking bandages here, but by bandages we don't mean gauze pads...
My protocol as a first aid instructor currently is (extremity, arterial bleeding):
(This applies to driving license applicants, and the bi-yearly legally required courses for at-the-workplace first aid):
1) Apply manual pressure
2) If possible, elevate limb (yes, controversial)
3) Call for help, get someone to get a first aid kit out of a nearby car (if noone cooperates and the bleeding is life-threatening, it is legal to break into a car in this case)
3a) The standard issue first aid kid in a German car includes no israeli bandage or tourniquet, but lots of gauze pads and bandages.
4) Apply a sterile gauze pad firmly
5) Wrap bandage around gauze pad once or twice, then add still-wrapped bandage as pressure padding on top of the gauze pad, then wrap the first bandage around that as well (tightly)
6) If bleeding persists, you may stack another pressure padding on top of the first pressure padding, and apply another bandage even more tightly to press both pressure paddings onto the wound area. The reason not to remove the first pressure bandage is to not loose pressure
7) Failing that, apply even more direct pressure (kneel down if necessary)
8) Taught only in specialized courses for firemen/-women, woodworkers, mechanics etc.: You may apply a tourniquet in addition or instead of stacking pressure bandages.
Now that system isn't without fault (it is certainly rather complex if you do not visit the required refresher courses and is not aimed at major trauma scenarios), but that's the only protocol I know which makes you stack anything on a wound. You only stack pressure bandages to increase pressure if a normal bandage wasn't enough. You'd never stack normal bandages. In fact, we make sure the pressure dressing remains wrapped to avoid soaking in blood because we do want to immediately see further bleeding, not hide it inside a soaking, now-soft pressure bandage. It'd be a different matter if we'd pack wounds, but that's only recently been added to EMS protocol here (with all the hysteria around terror attacks and depression-induced shootings), it has never been part of first aid training.
I find it fascinating how things are handled differently around the world. The "elevate the injured limb" thing, for instance, is really out of fashion in the US, while in Germany, people are way too afraid of teaching to use tourniquets. Also, haemostatic agents: Pretty popular with Americans, but extremely controversial over here. As a medic, I am currently not allowed to use QuikClot for instance. Even privately, I should not do it because there are hardly any deaths due to external bleeding in my state, but a very high number of clotting-related deaths (mostly your good old pulmonary embolism, stroke, heart attack and such). We are currently buying chinin-based wound packing material, though, so protocol is becoming more forgiving. Not many medics have been taught packing wounds as of yet. And I mean, it's extremely rare. 99% of life-threatening emergencies require a quickly established IV access, good ECG reading, solid CPR and intubation skills, early defibrillation and/or rapid transport. 1% may require difficult to control external bleeding, so I understand why our protocol only added tourniquets a few years ago. We were way too afraid of losing limbs, but current statistics show no problem with tourniquet use.
go waaaaaaaaaaaaaaaaaaay back 20 years and it was apply bandage/clean cloth/something and get the arm wound above the heart. Thus lowering pressure to the wound causing the blood and clots to pool. And stop bleeding. Maintain above heart level until help arrived or you got to the ER.
I have a pretty extensive Trama Kit. My first priority on a serious injury is to stop the blood flow, I myself use Bleedstop, then an Isreal Bandage, then a tourniquet, If need be two tourniquet.
The Bleedstop woks well to couragulate the blood and, in the least, slow down the blood flow. You will need to apply direct pressure for about 5 minutes, depending upon the severity of the wound.
The Isreal Bandage will soak up quite a bit of blood, and you can apply direct pressure on the wound like a tourniquet. Then, use a ratcheting tourniquet above the wound to further stop the blood flow.
This is where the Swat-T tourniquet (synthetic stretch wrap material)works great, because it can be used to apply the direct pressure needed assist bandages.
Many of my micro trauma kits do not have a full size cat tourniquet I am ordering a bunch of SWAT T s for those kits .. also blood stopper powder hemostatic gauze even an ace bandage
This is the protocol that is in the British First Aid manual. If the first dressing soaks through, apply a second dressing on top. If the second dressing also soaks through, remove both and apply a fresh dressing, ensuring that pressure is applied accurately to the point of bleeding. The manual is the standard text book for all first aid qualifications in the UK. The Oxford Handbook Of Pre-Hospital Care states: "In the event of blood soaking through applied dressings, further applied dressings are unlikely to arrest haemorrhage." It seems that your idea is a good one, as this is what we do this side of the Atlantic.
What does it say about tourniquets?
Touniquets and haemostatics are now part of the basic occupational First Aid certificate course in the UK.
Hello Iv been using your great videos in my EMT class!! Iv has been an inner-city EMT for 35 years as well as an officer. I'm now an instructor and your videos are a god-sent thanks !! happy thanksgiving to you and yours.
We just love your channel! God bless you
What about removing the second 5X9 adding a new one and then changing your pressure point.. that way you're not interferring with any clotting...
That was just what I was thinking, you beat me to it. It just seems like a practical option to me also to reinforce without disturbing the clot and then change location of pressure.
Seriously? That's the way I do. But I also usually don't have trouble stopping a bleed
1. 4x4s with good pressure. 2. Roller gauze, still rolled up, set over the original 4x4s. This leaves a sizable “bump” over the wound area. I take CoBan and do a good pressure wrap, check for a distal pulse and or cap refil. Basically it’s a “mini Izzy bandage”. I’ve used this on pretty bad wounds that could have easily gone to a tourni ex. We had a woman who was serious about killing herself, sliced along the vein, not across. Wrapped it, started an IV (she’d lost a lot of blood) and kept her around 90 sys and she was good to go for a good 20 min transport. Anyway…very effective.
We've always taught in the army to apply a pressure dressing if a field dressing fails
The Immortal.....good to hear from you.
Wolverine Prepper
Good to hear from you too!
Hope all is well buddy.
And with the new (current) elastic combat bandage that is much easier to do.
Yep, but if you don't have an Israeli or the equivalent, you have to make it up as you go along.
I’ve had really good results with two layers and a BP cuff (on limbs, obviously). Even, quantifiable pressure and hands free.
The bp cuff is a good idea
Direct pressure from the start is a winner but just as important, why is the patient still bleeding? Increased BP? Blood thinners? We use an ace wrap or coban to secure dressings when possible and let the patient apply pressure if we have to move on.
2021 and here in the UK. We are now taught to remove the first dressing, check the wound for foreign objects that we may have missed in the first place. Re-assess where the wound is bleeding from and put direct pressure on that point.....so you were correct all along.
As an EMT that was trained in the past few years, and now sometimes acts as an instructor, that's not what I was taught nor is it what I teach. What we generally teach is that after you apply that initial 5x9, you do not remove it. However if it bleeds through add more 5x9s as necessary, and if you can no-longer hold antiquate pressure remove the excess 5x9s (but not the initial one) and add fresh ones if needed.
The clot is forming on the initial 5x9 you placed, not anything else. So you should be good to add/remove things as needed so long as you don't remove the 5x9 you placed first.
Excellent points. We always used to teach in SERE that if direct pressure wasn’t working to try that in conjunction with a constriction band.
Similarly, I heard local paramedics say that more and more neurologist and orthopedic surgeons say that it is better to get victims to the ER quicker that spending a lot of time stabilizing. If you spend hours getting someone stabilized in a car, etc. the damage might be worst. What they need is surgery and or medication ASAP.
That's correct. In a serious trauma the vast majority of treatment will be done en route to the E. D. unless an unpreventable element, such as, extraction requires a prolonged scene. In that case you would begin treatment while the extraction is in progress, if possible.
I have simply put a gloved hand with lots of pressure on a wound and controlled bleeding with no bandage. Once its controlled I then apply a bandage with continued pressure.
As noted by others, the UK first aid training agencies have been advising on applying only two dressings, then restarting again (as you suggest) since ~2002; regional variations on first aid advice do occur.
Right on! Adjusting the way pressure is applied makes more sense than stacking bandages. Couple thoughts: 1) If the wound is deep, pack with gauze before placing a pressure bandage; 2) 6" pallet wrap makes a fine compression dressing for holding pressure on a 5"x9". Firmly apply 3-4 layers of wrap over the pad.
I am in Canada, we were taught if it bleeds through 2 to use a tourniquet, leaving the two in place
MD (to be) here: by taking the 5*9 off, you're not taking out the clots (if it is still bleeding there are no clots) you're however taking away the blood which has most of your clotting factors.
Place the 5*9, wrap it real tight with gauze or tape and apply pressure. You want to keep as much blood as possible in the site, so the clotting factors dont get washed away. If you know your anatomy, you could try holding pressure over the artery leading up to the wound. But over all, one 5*9, wrap it, press hard on it. Small nicks and cuts clot immediately because the primary clot (platelets holding together by only moleculed on their membranes) coupled with vaso constriction is enough to close the capillaries since the blood flow is very weak and the space to close off is small.
If you got smaller arterioles or venules that are bleeding like in this situation, the primary clot wont cut it, you need a secondary clot, where fibrin is layed all around the site by platelets grabing and tangling more platelets, red blood cells, white blood cells, proteins and everything that comes into contact. It will take longer and you need to slow the bloodflow down as to allow clotting factors to do their work.
I carry blood stopper powder.. pour on the powder put the pad and wrap a tight ace bandage around
Also been thinking that if you have to use a tourniquet, that putting some soft padding like a rag on the opposite side of the artery you want to clamp down might relieve some pressure and cause less chance of amputation while still targeting the artery that is bleeding out.
I knew a guy who got a head injury. At the hosp the Dr commented on nice application of dressing but said next time put it over the wound. Dressing in the right place, preasure in the right place? More preasure or TQ
MR. FLACKO, you are 100% correct. Also, think about capillary action for a second. By adding mas fabric while pressing only creates a WICKING action and will actually DRAW fresh blood outward. Are there any contraindications using coagulants?
........thanks, LPN (Low Paid Nurse)
In my First Aid classes, I always teach to leave the first dressing in place but don't keep "padding".... remove the second if it soaks through, but leave the first in case there is "some" clotting that has started. You are certainly more educated on this area so I will have to consider your option now.
about 4 years ago I had a nasty cut, about 3" (the ones that requires stitches) in my arm and I only got my t-shirt and press firmly about 2 hours and the bleeding stoped, from then I always carry a IFAK near !!!
If I recall correctly, I was taught in the Army that if the first or second bandage didn't do it, apply pressure dressings
i would put 1 or 2 5x9 then wrap it with thick medical tape for pressure.
(1:04) spell check broken? I believe in the traditional information being taught. It is always good to apply pressure. Now what kind of technique is used to apply that pressure is what I think you are questioning, which is correct. We need to start teaching “better” give the students some time (lots of of time) to practice and practice some more. I was proctoring a CPR class and the first thing the new instructor said was that she will try and get the students out early? WHY? They are booked for 3 hours, if they had a conflict they should reschedule, not be penalized with less time to practice.
I have never heard of stacking 5x9's at all in a heavy bleed. The 5x9 is not there as a patch such as on a flat tire. It is a semi sterile surface that is absorbent. The pressure is to stop the bleeding while the 5x9 provides a more sterile cover than your bare hand and to reduce blood running all over. If the pressure is not handling the bleeding and the bleeding is excessive it is time to move to something else. You could put a 4" thick folded towel and it will just absorb blood and stop no bleeding at all. It's all about pressure, cleanliness and reduction of infection via the 5x9 instead of the 5x9 being a non-permeable membrane.
Uk police training says to try 2 pressure dressings and if they fail then tourniquet.
The other problem is, if you don't approximate the wound edges, additional pressure can actually cause the wound to stay open. Removing the initial bandages, readjusting making sure the wound edges are approximated as best as you can and then apply direct pressure or a pressure bandage can make a big difference.
Yeah. Stacking is, imho, kinda silly if it keeps bleeding; if the wound looks that bad, and superior medical assistance isn't close by (say five or ten minutes away, max), I'm going to pack that wound with either celox ribbon (by preference) or granules, THEN apply the 5x9.
Once it bleeds profusely through the second gauze I would fold one in half and tape for added pressure directly over the wound site.
In the vast majority of cases where one might need to address a serious wound in the field, there is just one such wound, and most of the time, once you've got the bandage on, you can afford a few extra minutes at that point. How about assisting the bandage by applying hand pressure over the bandage. Clotting can be relatively quick if the clot itself isn't disturbed by blood flow. So put the heel of your palm over the wound after you bandage it and apply sufficient pressure manually. It's a rare wound indeed that will still be bleeding after a few minutes of that.
What if instead we apply the bandage and just wrapped it tightly with a roller bandage or an ace wrap (but not too tight) to maintain constant pressure on the wound? would that work?
@Bryan Choo
It would be less effective than direct pressure. The roller bandage will be applying pressure equally, all around where it is wrapped. Any additional pressure beyond the tight wrapping to the wound will be solely due to the thickness of the wound dressing. For some wounds, adding sufficient additional pressure from tight wrapping might well be tantamount to the effect of a tourniquet. Tourniquets should be the last resort choice, the choice when nothing else will do either due to wound severity or urgency of time constraint. There are huge downsides in terms of after effects however from that kind of generalized pressure reducing or eliminating blood flow past that point.
Hand pressure to assist wound clotting avoids the tourniquet problem. Moreover, while a tight wrapping may well do the job, it continues it's tightness well beyond the point from when it is still needed, unlike hand pressure, where a human brain is in the loop.
One thing I could suggest if you don't want to spend minutes pampering a wound but also don't want to wrap too tightly, is to heighten the packing above the wound right at the start. Apply a sterile pad to the wound, then put a gauze roll, 'unrolled', directly atop that positioned to maximally cover the shape of the wound, then gauze wrap (using a second roll) the pile. The unrolled gauze will create that localized pressure. It won't be as much pressure as direct hand pressure, but it will be sufficient for most.
Direct pressure is the standard technique for bleeding wounds and that is what he is talking about in this video.
@@bryanchoo4598 sometimes it works and sometimes it doesnt.
Smaller pressure bandage? Like the 4in one from NAR? I’ve used that one time and it worked pretty well.
I have no experience (only what I gather on channels and fb pages like this), but that will probably work way better than just stacking. I remember discussion about wound packing and the summary was that if it fails and blood is still leaking, don't add more gauze, but remove everything and put new hemostats as most likely it was in the wrong place and doing its job in the first place.
In my case they taught us to leave the initial gauze on, but any subsequent gauze that's bled through could be replaced. It sounds like they may have said to apply extra gauze if it bled through, but never really clarified further than that for you.
Who would tell you to just stack bandages on top of one another and everything will be okay? Apply pressure to the arteria brachialis, apply one bandage with good pressure and you're good to go in a minute or so. Increasing the direct pressure on the wound will not necessarily help any further instead stop the blood flow by increasing the pressure on your upper arm (should be enough using your hands no tourniquet)...
I worked EMS for years and always thought this seemed stupid...if it's bleeding so much that you need more bandages, there is clearly no clotting to disrupt...I usually went for a FRESH bandage and some form of additional pressure 'upstream', often manually, all while doing my best to calm the patient and get their heart rate down. I found calming to be incredibly effective when possible.
When do you use a petroleum gauze, only on burns or also cuts like what he's describing? Would you put on a bullet hole(dosent bullet burn skin?) that's somewhere where is not gushing blood?
I agree w/u, the 2nd one is for cleaning up. Thx for the info.
Well said! Multiple pads give the *illusion* of bleeding control, but in fact the person is bleeding out slowly & neatly into the multiple pads.
How about a Israeli bandage or North American rescue 6”? Then we can really get some pressure on the wound and maybe not have to hold it so we can continue on with patient assessment? .02
Agreed and add some combat gauze or a combat sponge or something with a homeostatic agent in it.
Sounds logical
My first thought was Israeli bandage as well.
You could even do 5x9 with an ACE wrap (trick of the trade from working at a "frugal" EMS system). Israeli bandage = $10+ ... NAR trauma dressing = $11+ ... 5x9 + 4" ACE = < $5 (and they are multi-use)
On smaller wounds up to an inch and maybe a 1/3 inch deep I have always found dryer bandages stop the bleeding faster. I haven't had much experience with fresh wounds much larger, so I don't know if that would transfer over. But what your saying makes sense. I would also think that pressure should be closing the wound as well it at all possible.
I have been an emt in florida for 19 years i have always hated the keep adding bandage idea. I think its s great thought to readjust the pressure point. I have seen the thick pad over a wound with no help as well lol....
P.s. love your vids.....
Interestion point....intrease the direct in addition ELEVATION ABOVE THE HEART is also benifishal to slow the blood flow
Not just that skinny medic , also the fact that air is is whats gonna dry out the flowing blood, so the more you put stuff on the less breathable it becomes causing less air to get to the wound to dry it out.if you can cinch the cut up somehow and put a single 5x9 folded over on it and tape it down tight or hold it firm has to be better then putting on lots of 5x9's. you need to get air to the wound while at the same time preventing it from bleeding to much by use of pressure. I think the bandage in most non lethal cases is just to keep it from getting infected and being able to just tape it it on and continue with ur day without having to hold ur hand down. but lets say u have one 5x9 that gets drenched , i think the negative effect of that is having more of a pool and less air getting through,but if keeps bleeding out like that then yeah the problem is putting more pressure on and not wanting to remove the first bandage because of whatever scabs" may have been forming will get ripped off, but if its been no time at all and its hella' bleeding then yeah more pressure and u can remove the old bandage and put on a new one double layered or triple layered because it hasnt been enough time to scab over internally or externally. You have to gauge the cut and try to get the right amount of bandage on the first time. I agree with you that its more about pressure .I never thought of how putting more on would make it less able to be clamped down but thats true. But yeah if its been on for a while you dont want to remove it but in some cases u might .Some cases adding more is better m so,me removal and pressure adjustment. THey should make a sterile see through tape that dissolves after contact with blood in a few days. Thatd be a quick stitch that removes itself
Can you use something to show how much pressure is applied to a wound when using one, two and three pads? A scale?
???
How about a 5x9 and then a swat t or israeli bandage to apply the pressure.
Good point, SM! Makes sense. Couldn't be much clotting if it's still bleeding.
Why not directly applying a pressure bandage on the wound?
I have NEVER been taught to keep applying more & more dressings.
1 trauma pad with direct pressure.
If it doesn't work, get someone to apply direct pressure while you go for the brachial/femoral artery and use indirect pressure.
If blood still soaking through at that point, you should be already booking it to the hospital!
i agree with changing location of pressure ive always questions when dealing with bleeds like that why cant we treat it like a tourniquet required injury and apply pressure above the wound while still applying secondary pressure directly to the wound
Thank you man at least one person who learned it like I did. You have a nasty wound on your arm. Go and squeeze the upper arm in order to tighten the arteria brachialis and slow the blood flow, then apply your pressure bandage and you should almost always be good to go in like a minute
Blood in the veins is moving from the limb towards the heart. So for this idea to work on a venous bleed, you would need to apply pressure distal to the wound to prevent blood flow.
@@objectiverunamok8918 you would not have such massively bleeding wounds if only the veins are affected except for some extreme cases of anticoagulations. And because the bloodflow in the veins is regulated passively by the arteries next to them, proximal pressure is highly effective anyways.
What you say makes sense to me. It has always seemed to me that after a point you're just extracting blood by capillary action when you apply more fibers.
I always learned that if the bleeding doesn't stop with direct pressure at the site of the injury, to then apply pressure to the major artery proximal to the wound. But I have no real life experience.
I've worked under 5 seperate EMS protocol systems. All of them regarded pressure points as an ineffective technique. But I haven't worked as a paramedic for over 10 years.
I honestly understand your idea and yes there is a point in game plan change. However, I do believe if we can slow the blood flow through multiple layers while applying direct pressure we can help the clotting under the first layer do its job better. If the clotting under the first layer had begun to start to work removing that layer brings us back to square one.
I managed to stop a bleed by strait up pinching a vane that i nicked . Ye a small bit of gauze over it . When I got to the ER they took it off and it squirted they asked how much blood I had lost and when I said none they brought blood anyway. My reaction time was fast enough that I got the vane before it filled the wound with enough blood to leak . 3 drops of blood on the floor and a bit on the table and in my mom's car as she rushed me off . But when they closed of the blood vessel in the operating room I lost alot of blood. So the fact that I am thin enough to be able to pinch off my vanes because they basically on the outside of my arm like noodles glued to a sausage 😂. I pinched my skin purple and there was a bruse higher up my arm where I pinched and the next day my right hand was more painful than the one I cut open because of the constant muscle tension of sitting and holding what was basically a slit vane for 4 hours in an emergency room. Should have let go would have had service faster😅 😂😂 but had I placed something over it I would not have been able to hold it like that . I was told that I was actually very lucky I managed to stop it that quickly. Was the one on the side of the left hand taking blood from the thumb index and middle finger. It runs over tendon on the back of the hand that moves the thumb . Hope that describes
the image better.
If it is bleeding that badly wouldn’t a tourniquet help the clot?
Silly question, but if you've filled the 2nd 5x9, why not remove the 2nd one, adjust position, and apply a new 2nd, instead of "building the mattress?"
Great work in explaining the simple truth about what we do and see in reality vs. A "case study" that creates a protocol.
My training from Cub Scouts through EMT school was first bandage stays, the second one gets replaced if it bleeds through. Also if it's still bleeding more pressure.
Changed up the game as directed. I decided to just cut the arm off. You were right. There was no longer bleeding from the arm.
And there was no arm.
Problem solved.
@@lisamecham5712 no pain. No gain.
Maybe I'm stupid, but I have always felt that the ultimate goal was to keep as much of the red stuff inside the "people tank" as possible. I too have seen an arm or lower leg wound with six or eight inches of pads stacked like hotcakes and then wrapped in place with stretch gauze. Considering that each 5x9 soaks up about 4-6 oz of blood, stacking five of them up means you've just wicked about a pint and a half of blood into the bandages. As you say, the whole exercise revolves around getting clots to form at the wound -- not four, five, six pads away.
I would think a gash that's bleeding that bad needs to be flushed, butterflied together, slap a 5x9 across the top, then put the waxy wrapper from the pad down as a backer, and if pressure on that doesn't cut it, it's time for either a tourniquet or at least a snug ace bandage wrap. In any event, no matter what preps happen, try to keep that first pad in place.
Glad you keep training us, and also glad you keep thinking beyond the "abc's" of first aid.
Just like how you pull combat gauze out of a wound if it becomes blood soaked.
Great point, the whole purpose is to stop the bleed.
Wouldn't the only problem come from removing the first bandage? So it seems it wouldnt disrupt any clotting to remove the second bandage and leave the first one
THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS (ACEP)...Two dressings, replace both if still bleed through.
TCCC....combat gauze...3 mins....then replace if still bleed.
What about leaving the first 5x9 on and readjusting, preserving the first but getting a better position?
Why not leave the first to maintain any clotting and adjusting pressure and reapplying gauze layer #2 from there?
2.5 years ago, we learned Direct Pressure, Elevation, and Pressure points.
Interesting video. I think most of have used multiple 4x4s on a wound, can't imagine using that many 5x9 or ABD on a wound. I can see your point. As others have said maybe an ABD wrapped with Kling or ACE for compression.
New Market EMS swat-t ?
Three? Even the old NREMT standard was just two, elevate and pressure point. Now it's one then a tourniquet.
I agree. When using the emergency roll of TP and duct tape at the job site you get a good wad, hold pressure then after a song or smoke pitch it out the window, put second wad on wound and tape in place. If it runs out the duct tape or you can't get it to stick due to river of blood you have to tell your boss, which might be worse then going to the doctor. Just saying ;)
Would it be ok to stack a couple and then wrap it with an ace bandage? I would think that would be the best way to apply even pressure to stop the bleeding. Also would free up your hands to asses/treat other possible wounds.
I am not a trained medic, but what you say makes sense.
How about.. keep the first pad in to maintain the possibility of clotting, BUT once it bleeds through 2nd one, just switch it with a clean one.
After the bleeding has stoped do we remove the gauze irrigate and clean wound and reapply new gauze and wrap it with cling, ace bandage, compression bandage, or self-adherent bandages.
Why would you not apply a light Turniquit to slow the blood flow allowing the blood to stop?
What about placing a hemostat like surgeons do on the actual vein that's fucked up
Please correct me if I'm wrong. If you go through the second 5x9, why not use a clotting agent and then a fresh 5x9 and apply a pressure bandage?
Would it make sense to place the first dressing, if it bleeds through add a second. If it bleeds through the second bandage, remove just the second bandage and apply a third bandage over the top of the first and throw away the second? This is assuming that you can remove the second bandage without pulling the first one off with it.
I would say if you have to put a 3rd or 4th ABD pad on and there is still more blood, there is not any clotting going on and you should pull it all off and put on a Blood Clotting sponge or another type of blood clotting tool.
Cant you just use celox?
You could if the bleeding is serious enough
SkinnyMedic gotcha so your in that halfway spot i see i see.
I ve watched Rns in the ED throw saturated 2x2s after saturated 2x2 in the floor after DCing an iv. Seriously. I counted 8 one time before she went to find more tape and never came back.
cuddlefish longbottomtonshireville In low light class, instructor said his partner shot dude 10 times in chest, dude got away and was found dead in er waiting room, sometimes the rns overlook stuff, 😁
The clot will be where the wound is, mayyyybe a little into the first pad. Why not just keep the first pad on to "protect the clot", and then just replace the second one when it's saturated?
Not controversial. I completely agree with you here. Great video, fellow Medic!
That works! Done it before.
Makes sense. I wonder if there would be value in leaving the base one on (for clotting) and changing out the #2 and #3 with fresh?
*"Israeli" Bandage after the 2nd 5x9.*
Good thought! Maybe even leave the first and swap the rest
If I see it bleeding like that, imma but 2 5x9 and a serious amount of pressure.... But that's why I like a pressure dressing, I'd rather use that.
Excellent thinking! I always learn useful information from your channel!
Going back to basics. Although the idea of replacing. The first 2 pads that are ineffective is a duh moment. Nicely done
But just like In Boy Scouts. Direct pressure. Elevation. Pressure point the. Tourniquet. In that order. Unless it's obviously an arterial bleed aka partial or complete amputation or deep penetrating wound. Aka gsw, stab etc.
The basics are called just that because well they work.
The bleed through to the 2nd and 3rd bandage, how much of it is just absorbtion from the saturation of the 1st bandage? A good percentage I think. Your thought is spot on. The more bandage you apply to a cut the more dissipated the pressure as it will spread out to a wider area causing less pressure on the focal point.
Good vid SM. 👍
I’ve learned so much from you. Thanks, Skinny Medic!!!! 👊🏼
I'm just seeing this and have a question...if I am treating a patient with a constant bleed, and they bleed through all my dressings, could I try a Hemostatic agent...or is that for an arterial bleed only? Meaning, if I have applied multiple trauma dressings and they bleed through, when I undress to reapply, why wouldn't I try a different approach altogether? Let me just say before someone blasts me...I haven't done active patient care since I was medically retired from the Marines almost 20 years ago...so I am a little behind in my CE's and Blocks LMAO. Thanks for the mental exercise.
Semper Fi
super thanks. good information for treating someone on anti coagulant meds.