Continuing to make you listen to the music of my youth, I’ve gone for a bit of Linkin Park. I thought i’d briefly talk about haemorrhage control. How comfortable are you at being able to control bleeding in a trauma patient? How many ways can you use an israeli bandage? Do you know what an israeli bandage is? Do you know about the haemorrhage control ladder? What is a CAT? ( I will do another post dedicated to them soon!). What is Hemcon (TM)/Celox (TM)?
Okay, so imagine you’re the trauma team leader in resus and a patient is brought in with a bleeding penetrating neck wound. In the spirit of CABC, how will you control the bleeding from the two sites?
I came across the haemorrhage control ladder only recently and helped me clarify my approach to bleeding:
Again this is one of many versions of the ladder you can find. This particular one is the ladder I use in clinical practice. Let’s assume simple dressing is the first step. Your ED may have a “major haemorrhage control” trolley. If it does spend some time going through it so you know what’s in it. In times of stress ( i.e. managing a sick patient) you should be able to quickly locate the required equipment.
The Israeli dressing:
There are commonly 3 different sizes: 4, 6, and 8 inches.
- the sterile non-adhering dressing that is designed to allow removing the bandage without reopening a wound.
- the pressure applicator or the pressure bar that is placed directly over the wound to stop the bleeding by applying pressure. It allows to wrap the bandage around a wound in different directions. This is a useful feature for stopping bleeding in groin and head injuries.
- the closure bar that is used to secure the bandage and to apply additional pressure to a wound. The closure bar can be used by a “simple sliding motions with one hand.”
This videos below show you how to apply it to wounds on the arm, leg and head. However there is a way of applying it. Watch it and practice! Now you can use the israeli bandage for neck wounds as well. It seems a bit more tricky, but after a few practice attempts I managed to get it! ( Now if I can do it then anyone can!)
Some top tips for the israeli bandage:
- Make sure the absorbent part of the bandage is directly applied to the wound.
- When you open the packaging, make sure the bandage doesn’t unravel, it’s much easier to apply it when it’s still rolled up
- Practice using it!
Now if the wound is still bleeding put another bandage on. ( It may not be appropriate for neck wounds! but definitely consider it for wounds located on limbs).
If bleeding is still not controlled get the hem con/ celox out! These are examples of haemostatic gauzes that come into their own for haemorrhage control at junctional sites (neck, axilla, groin, perineum) where tourniquets can’t be applied. There are two main types:
- Factor concentrators: (eg Quickclot) Granules absorb water, concentrates coagulation factors & promotes clotting
- Mucoadhesive agents: (eg Celox, Hemcom) Chitosan-based, anionic attraction of red cells, adherence to wound surface.
They must be used in conjunction with a dressing. They can come in a ribbon/ gauze/ granules. If you are using a ribbon then a 2 person technique is best with one person holding the ball of ribbon and the second person placing it into the wound.
For this scenario, you go through the haemorrhage control ladder and an israeli bandage manages to stem the bleeding. Phew! This could buy you some valuable time, especially if you are in a rural ED without any vascular/ ENT specialists on site!
Like I said in the beginning, there will be a separate post on the CAT. So to sum up:
1) Find your own Haemorrhage Control Ladder to use.
2) Watch the videos on how to apply the bandages.
3) Practice, Practice, Practice applying them and know where they are in your department!