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Old 03-18-2007, 07:28 PM   #1
Shabo
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Question Radial Artery Bleed


Guys, I recently completed an ER clinical where we had a pt arrive by BLS truck with a 1-2 cm lac to the middle of the rt forearm. The elderly pt had apparently been bleeding for a while before help arrived. Pt was Alert upon BLS arrival and the bleeding was uncontrolled. They attempted to stop the bleed but couldn't and wrapped it in gauze and a cravat for transport. The pt completely decompensated before arrival to the ER and resuscitation was unsuccessful. I was hoping that you could help me with a few questions.

1. How long do you think it would take to bleed out from this wound? (meds unknown)
2. Is there a reason a tourniquet wouldn't be applied?
3. What would your response have been?

Thanks,
Shabo


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Old 03-18-2007, 07:57 PM   #2
Jon
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Time to bleed out?

I've been told, anecdotaly, that if you slit your wrist the "right way" to kill yourself, you will only be able to slit one wrist (because you won't be able to make the slit wrist arm work to cut the other one) and that you will die very quickly.

In First Aid, for the last few years, torniquets have been "frowned on" because there is concern for ischemia of the appendage. My BLS protocols call for a torniquet only if the exsanguination is uncontrollable, where the descion is between a possible amputation of the arm or the patient dying. This is only after all other methods have failed.

As for why BLS didn't use a TQ... well, their protocols may not allow it, the EMT's may be under the impression that a TQ is evil (like leeches), and the EMT's may not have felt that the bleeding was really uncontrolled.

Might I have used a tourniquet? Perhaps... I wasn't there... I can't say what I would have done.
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I can't wait until people actually know what we're talking about when they get called an LIV lol
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Old 03-18-2007, 10:24 PM   #3
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In my thirty years, I have yet seen anyone die from "slit wrist".. and I have seen some real nasty ones that even caused amputations. Usually the vessels will constrict initially and there may be even little bleeding.

Second, I do not understand allowing anyone to exsanguinate out. Direct pressure, pressure points should be able to control any extremity bleeding. I have even used a blood pressure cuff pumped just tight enough to cease the arterial flow on a patient that was on Coumadin. (This was per physician orders)..

Many people "spazz" over bleeding, chances are they did not hold enough pressure or long enough. Many attempt to pull off bandages and place new ones, this is just like pulling off scabs.. allowing bleeding to occur.

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Old 03-18-2007, 11:23 PM   #4
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Guys, I recently completed an ER clinical where we had a pt arrive by BLS truck with a 1-2 cm lac to the middle of the rt forearm. The elderly pt had apparently been bleeding for a while before help arrived. Pt was Alert upon BLS arrival and the bleeding was uncontrolled. They attempted to stop the bleed but couldn't and wrapped it in gauze and a cravat for transport. The pt completely decompensated before arrival to the ER and resuscitation was unsuccessful. I was hoping that you could help me with a few questions.

1. How long do you think it would take to bleed out from this wound? (meds unknown)
2. Is there a reason a tourniquet wouldn't be applied?
3. What would your response have been?

Thanks,
Shabo

I tourniquet is a great thing if used by educated medical professionals (paramedics) and not boy scouts--lol. Talk to trauma surgeons and they will tell you they use them routinely for hours in the operating room. In 99.9% cases like the one you mentioned, a tourniquet would not be needed. I would do what I've been trained to do. Remember your 4 Ps. Pinpoint, prompt, precise, pressure. Don't just hap-hazardly wrap the wound with gobs of dressing. Then elevate the extremity. I would be willing to bet money this would have worked. If not however, use the BP cuff and partially constrict it. Then as a last resort, cut off all blood flow with the big T of some sort. This all should be done very quickly and calmly. There are some cases where you may have to "clamp" an artery shut with a tool, but I'm not going there.

And let me end this with a public service announcement. If you completely cut thought an artery, the body will restrict (suck up) that artery and stop the bleeding itself. The key to killing yourself is to only partially cut an artery. That way, you will bleed and bleed and the artery won't be able to constrict itself. good luck!
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Old 03-18-2007, 11:28 PM   #5
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in NYC it is against protocol to use a tourniquet (as well as a BP cuff to constrict blood flow, which is acting as a tourniquet)
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Old 03-18-2007, 11:57 PM   #6
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in NYC it is against protocol to use a tourniquet (as well as a BP cuff to constrict blood flow, which is acting as a tourniquet)
yea, nyc routinely goes against recognized national standards of care and common sense. I feel for you. There is good news though, protocols are just guidelines so screw em'.
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Old 03-19-2007, 12:01 AM   #7
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yea, nyc routinely goes against recognized national standards of care and common sense. I feel for you. There is good news though, protocols are just guidelines so screw em'.
Has nothing to do with going against common sense, has to do with the fact that in NYC you are never more than 5 minutes from a hospital. If you apply the right skills to control bleeding, you should make it to the hospital before it gets any worse.
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Old 03-19-2007, 12:10 AM   #8
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Has nothing to do with going against common sense, has to do with the fact that in NYC you are never more than 5 minutes from a hospital. If you apply the right skills to control bleeding, you should make it to the hospital before it gets any worse.
what if someone is pinned in a car and has already lost enough blood to put them in compensated shock. What if the extrication takes 40 mins for some reason. what are you going to do then? NYC is a great place, but their ems is stone age.
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Old 03-19-2007, 12:17 AM   #9
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what if someone is pinned in a car and has already lost enough blood to put them in compensated shock. What if the extrication takes 40 mins for some reason. what are you going to do then? NYC is a great place, but their ems is stone age.
If they have that many problems, they ain't making it. Be realistic, not outlandish.
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Old 03-19-2007, 12:27 AM   #10
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If they have that many problems, they ain't making it. Be realistic, not outlandish.
Lets say the only problem they had was an uncontrollable arterial bleed in the right leg and they were "trapped" with no other injuries. Don't play this game with me. And this is a completely reasonable scenario.
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