If A Patient Is Experiencing A Hemorrhage You Should

If a Patient is Experiencing a Hemorrhage, You Should… Act Fast and Follow These Steps

A hemorrhage, or severe bleeding, is a life-threatening emergency requiring immediate action. The speed and effectiveness of your response can significantly impact the patient's outcome. This article outlines the crucial steps to take when faced with a hemorrhaging patient, covering assessment, initial treatment, and ongoing care considerations. Remember, this information is for educational purposes and should not replace professional medical training. Always prioritize calling emergency medical services (EMS).

Assessing the Situation: The ABCDEs of Trauma

Before initiating any treatment, a rapid assessment is paramount. This follows the ABCDE approach, a systematic method for evaluating trauma patients:

A – Airway:

• Establish and maintain a patent airway. Is the patient conscious? Can they speak? Look for obstructions like blood clots, vomitus, or broken teeth. If necessary, gently tilt the head and lift the chin (unless a neck injury is suspected). Consider using a jaw thrust maneuver if a neck injury is possible.
• Listen for breathing sounds. Are they present and equal bilaterally? The absence of breath sounds indicates a potential airway compromise.
• Provide supplemental oxygen. Administer high-flow oxygen via a non-rebreather mask if available.

B – Breathing:

• Assess respiratory rate and depth. Is breathing shallow, rapid, or labored? Observe the chest rise and fall for symmetry.
• Check for chest trauma. Look for sucking chest wounds, flail chest, or paradoxical breathing.
• Assist ventilation if necessary. If the patient is not breathing adequately, provide rescue breaths using a bag-valve mask (BVM) with supplemental oxygen.

C – Circulation:

• Control the bleeding. This is the most crucial step in managing a hemorrhage. Direct pressure on the bleeding site is the initial intervention. Elevate the bleeding limb if possible, without causing further injury.
• Check for signs of shock. These include pale, cool, clammy skin; rapid, weak pulse; and altered mental status.
• Monitor vital signs. Continuously assess the patient's heart rate, blood pressure, and respiratory rate.

D – Disability:

• Assess neurological status. Check the patient's level of consciousness using the Glasgow Coma Scale (GCS). Note any signs of head injury, such as pupillary changes or altered mental status.

E – Exposure:

• Remove clothing to fully expose the injury site. This allows for a thorough assessment of the extent of the bleeding and any other injuries.
• Prevent hypothermia. Cover the patient with blankets to maintain body temperature, as hypothermia can worsen the condition.

Controlling the Hemorrhage: Immediate Actions

Once the initial assessment is complete, focus on controlling the bleeding. Different types of hemorrhage require different approaches:

External Hemorrhage:

• Direct Pressure: Apply firm, direct pressure to the bleeding wound using a clean cloth or dressing. Do not remove the initial dressing, even if it becomes saturated. Add more dressings on top and continue applying pressure.
• Elevation: If possible, elevate the bleeding extremity above the heart to reduce blood flow to the injured area.
• Pressure Points: As a last resort, if direct pressure is insufficient, consider applying pressure to pressure points (e.g., brachial artery for arm bleeds, femoral artery for leg bleeds). However, this should only be attempted if direct pressure is ineffective and you're adequately trained.
• Tourniquet: In cases of severe, life-threatening extremity bleeding that cannot be controlled with direct pressure, a tourniquet may be necessary. This is a last resort and requires proper training. Apply the tourniquet high on the limb, between the injury and the heart, and tighten until bleeding stops. Always clearly mark the time of tourniquet application.

Internal Hemorrhage:

Internal hemorrhage is more challenging to manage and requires immediate medical attention. Signs may include:

• Rapid, weak pulse.
• Low blood pressure.
• Cool, clammy skin.
• Rapid breathing.
• Decreased level of consciousness.
• Distended abdomen (in abdominal bleeds).

For suspected internal hemorrhage, immediate EMS activation is crucial. Support the patient's airway and breathing while awaiting medical assistance.

Ongoing Care and Monitoring: Post-Hemorrhage Management

Once the bleeding is controlled, ongoing monitoring is critical:

• Continue to monitor vital signs. Track heart rate, blood pressure, respiratory rate, and oxygen saturation. Report any significant changes to EMS.
• Maintain airway and breathing. Continue to provide supplemental oxygen as needed.
• Prevent hypothermia. Keep the patient warm with blankets.
• Observe for signs of complications. These include shock, infection, and organ damage.
• Provide psychological support. Reassure the patient and offer comfort.

Specific Hemorrhage Scenarios and Responses

Let's delve into some specific scenarios and the appropriate actions:

Nosebleed (Epistaxis):

• Have the patient sit upright and lean slightly forward. This prevents blood from running down the throat and causing aspiration.
• Pinch the nostrils together firmly. Apply direct pressure for at least 10-15 minutes.
• Apply cold compresses to the bridge of the nose.
• If bleeding persists after 15 minutes, seek medical attention.

Lacerations (Cuts):

• Control bleeding with direct pressure.
• Clean the wound gently with clean water or saline.
• Apply a sterile dressing.
• Seek medical attention if bleeding is profuse, the wound is deep, or there are signs of infection.

Internal Bleeding (Gastrointestinal Bleed):

• Monitor vital signs carefully.
• Keep the patient NPO (nothing by mouth).
• Administer oxygen as needed.
• Seek immediate medical attention.

Preventing Hemorrhage: Importance of First Aid Training

Knowing how to manage a hemorrhage is a critical skill. First aid training equips individuals with the knowledge and practical skills to effectively respond to bleeding emergencies. Regular refresher courses ensure that knowledge remains up-to-date and skills remain sharp. The ability to swiftly assess, act, and manage a hemorrhagic event can dramatically improve patient outcomes.

The Importance of Calling Emergency Medical Services (EMS)

It is crucial to emphasize the critical importance of contacting emergency medical services (EMS) immediately. No matter how minor the bleeding may seem, professional medical assessment and intervention are essential. EMS professionals possess the advanced skills and equipment to effectively manage severe bleeding, stabilize the patient, and transport them to a hospital for definitive care. Delaying this crucial step can have life-threatening consequences.

Conclusion: A Coordinated Response Saves Lives

Managing a hemorrhage is a multi-faceted process requiring a coordinated and timely response. From the initial assessment using the ABCDEs of trauma to the continuous monitoring and appropriate treatment, each step plays a crucial role in improving patient survival. Remember, the primary focus should be on controlling bleeding, maintaining vital functions, and immediately seeking professional medical help. Understanding and implementing these steps can be the difference between life and death. This information serves as a guide and does not replace professional medical training. Always prioritize seeking assistance from qualified medical professionals.