Wednesday, April 11, 2012

Treating The Hemorrhagic Wound

This is a guest article written by Joseph Alton, M.D., aka Dr. Bones. Dr. Bones and Nurse Amy can be found at http://www.doomandbloom.net/. I’ve met Dr. Bones and Nurse Amy before and did an interview for them not that long ago. They recently published a book called “The Doom and Bloom(tm) Survival Medicine Handbook: Keep your loved ones healthy in every disaster, from wildfires to a complete societal collapse”.

Treating The Hemorrhagic Wound

Cuts in the skin can be minor or catastrophic, superficial or deep, clean or infected.  Most significant cuts (also called lacerations) are associated with bleeding, sometimes major.  Bleeding can be venous, which manifests as dark red blood, draining steadily from the wound.   Bleeding can also be arterial, which is bright red and comes out in spurts that correspond to the pulse of the patient. As the vein and artery run together, a serious cut can have both. The first course of action is to stop the hemorrhage.

Oftentimes, direct pressure on the bleeding area might stop bleeding all by itself.  The medic should always have nitrile gloves in his/her pack, to prevent the wound from contamination from a “dirty” hand.  If there are no gloves, grab a bandanna or other barrier and press it into the wound.  Additionally, pressing on the “pressure point” for the area injured will help slow bleeding.

Pressure points are locations where major arteries come close enough to the skin to be compressed by pressure.  Pressing on this area will slow down bleeding further down the track of the blood vessel.  Therefore, we can make a “map” of specific areas to concentrate your efforts to decrease bleeding.

For example, there is a large blood vessel behind each knee known as the Popliteal Artery.  If you have a bleeding wound in the lower leg, say your calf, applying pressure on the back of the knee will help stop the hemorrhage.  A diagram of the major pressure points are below.

 Source: armystudyguide.com

If this fails to stop the bleeding, it may be appropriate to use a tourniquet.  The military uses a CAT tourniquet, which is simple to use and could be even be placed with one hand, if the injured person is the medic!   It is important to note that the tourniquet, once placed, should be loosened every five-fifteen minutes or so, to allow blood flow to uninjured areas and to determine whether the bleeding has stopped. Tourniquets are painful if they are in place for too long, and prolonged use could actually cause your patient to lose a limb due to lack of circulation.  As well, your body will build up toxins in the extremity that will be concentrated, and rush into your body core when you release the tourniquet.  It takes less than an hour or two with a tourniquet on to cause this problem.  As an aside, if the hemorrhage is severe, you may have to use the tourniquet earlier in the process so that you can clearly evaluate the source of the bleeding.

Once you are comfortable that major bleeding has abated, lossen the tourniquet and see where you are..   Packing the wound with bandages is useful to apply pressure to the wound (the bandage is not just for sopping up the blood..  Wet the cloth with clean water, if available, and wring it out until almost dry.  More than one bandage may be required to keep the wound from bleeding further. It’s important to make sure that your bandage puts the most pressure where the bleeding is occurring in the wound.  Again, keep pressure on the wound.  Cover the whole area with a dry dressing  for further protection.  The Israeli army developed an excellent bandage which is easy to use and is found almost everywhere survival gear is sold. The advantage of the Israel battle dressing is that it applies pressure on the bleeding area for you. Don’t forget that bandages get dirty and should be changed often.  Twice a day is a minimum until it becomes completely dry.

 The above process of stopping hemorrhage and dressing a wound will also work for traumatic injuries such as knife wounds and gunshot wounds. You have probably heard that you should not remove a knife because it can cause the hemorrhage to worsen.  This will give you time to get the patient to the hospital, but what if there are no hospitals?  You will have to transport your victim to your base camp and prepare to remove the knife.  It can’t stay in there for months while you’re waiting for society to stabilize.  Having substances that promote clotting will be useful here.

 In particularly heavy bleeding, the use of hemostatic powders such as Celox or Quik-Clot will help stop the hemorrhage.  These products also come in “combat gauze”, which is a gauze dressing impregnated with the powder.
Bullet wounds are the opposite, in that the bullet is usually removed if at all possible.  In a collapse situation, however, you may want to avoid digging for the bullet as it can cause further contamination and bleeding.  For a historical example, take the case of President James Garfield.  In 1881, President Garfield was shot by an assassin.  In their rush to remove the bullet, 12 different physicians placed their (ungloved) hands in the wound.  The wound, which would not have been mortal in all probability, became infected; the President died after a month in agony.  Think twice before removing a projectile that isn’t clearly visible and easily reached in a wound that has stopped bleeding.

Back to bandages:  Wound dressings must be changed regularly (twice a day or whenever the bandage is saturated with blood, fluids, etc.) in order to give the best chance for quick healing.  Whenever you change a dressing, it is important to clean the wound area with boiled water(cooled) or an antiseptic solution such as dilute Betadine (povidone-iodine).  Use 1 part Betadine to 10 parts water.  Remember the old saying, “The solution to pollution is dilution”!  Using a bulb syringe will provide a little pressure to the flow of water (also called irrigation), and wash out old clots and dirt.  You may notice some bleeding restarting; apply pressure with a clean bandage until it stops.

This article could be a book in itself, but this should give you a good idea of where to start when dealing with a bleeding wound.   Learn as much as you can now, in the present, to preserve your health in an uncertain future.

Dr. Bones

The Doom and Bloom(tm) Survival Medicine Handbook: Keep your loved ones healthy in every disaster, from wildfires to a complete societal collapse

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