Traumatic Hemostasis Techniques
Trauma refers to external damage to the body or object caused by external objects such as impact, collision, or erosion by chemicals. Blood is an important substance that maintains life activities. It is a substance that circulates through the heart and blood vessel cavities. In adults, blood volume accounts for about 8% of body weight, and bleeding is one of the main complications after trauma.
Bleeding refers to the rupture of blood vessels leading to the flow of blood outside the blood vessels. After trauma, the easiest and most common thing that occurs is bleeding. Severe trauma often causes massive bleeding that endangers the lives of the injured. Effective and timely hemostasis for the injured person at the scene is a necessary measure to save lives. Trauma refers to external damage to the body or object caused by external objects such as impact, collision, or erosion by chemicals.
Classification of Trauma
According to the cause of injury: it can be classified as mechanical injuries, such as cutting, crushing, slicing, or falling injuries; animal bites; chemical injuries, such as burns and scalds.
According to the severity of the injury: it can be classified as mild, moderate, or severe.
According to the nature of the wound: it can be classified as open injury, such as stab wounds, where the wound is exposed to the outside world, increasing the likelihood of infection; closed injuries, where there is no visible wound but the consequences are more severe.
Assessment of the Bleeding Site in Trauma
Subcutaneous bleeding: usually caused by falls, impacts, crushes, or bruises, resulting in bleeding in soft tissue under the skin, forming hematomas or bruises, which can self-heal in the short term.
Internal bleeding: no visible bleeding on the surface, blood flows into tissues, organs, or body cavities (such as the thoracic, abdominal, and cranial cavities) through ruptured blood vessels. It can only be judged based on the general or local symptoms of the injured person, such as pale complexion, vomiting blood, abdominal pain, bloody stools, rapid and weak pulse, etc. The situation is severe, and emergency hospital treatment is required as on-site treatment is not feasible.
The assessment of internal bleeding can be done in the following ways:
Firstly, by checking for symptoms of bleeding in the mouth, sputum, stools, or urine to determine if there is bleeding in the relevant internal organs.
Secondly, by observing systemic symptoms, such as pale complexion, cold sweat, cold limbs, rapid and weak pulse, unconsciousness, vomiting, and whether there is swelling and pain in the chest, abdomen, or skull, to determine if important organs such as the liver, spleen, stomach, and brain have internal bleeding.
External bleeding: visible on the surface, blood flows out of the body through the skin damage site.
Judgment of Different Types of Blood Vessel Bleeding
Arterial bleeding: Arterial blood has a high oxygen content, and blood flows out in a jet with a bright red colour. The amount of blood loss is large, and it can be life-threatening if not stopped immediately.
Venous bleeding: Venous blood has a low oxygen content, and blood flows out in a steady stream with a dark red colour. If not stopped in time, it can result in a large amount of blood loss over a long period of time and can also be life-threatening.
Capillary bleeding: Blood seeps out in droplets, changing colour from bright red to dark red, and the amount of blood loss is small. It often stops bleeding automatically.
Hemostasis Methods for Common Traumatic Bleeding
Hemostasis by Compression Method
Directly compress the wound to stop bleeding
Which is suitable for minor bleeding. Clean gauze, sterile gauze, clean towels, clothing, scarfs, etc. can be used to press on the bleeding site to achieve hemostasis. Generally, compression for about 10 minutes can stop the bleeding.
The specific steps are as follows:
Use the pressure hemostasis method, place a clean cloth or towel on the wound, and directly press for 10-20 minutes.
After the bleeding stops, wrap it lightly with a bandage, without wrapping it too tightly.
Do not use degreased cotton or paper to pad the wound, and do not apply medication to the wound.
If the wound is not contaminated by dirt, rinse it with liquid first and do not use soap.
Do not wipe off the blood clots or plasma around the bleeding wound, and do not remove foreign bodies such as glass fragments in the wound. You should immediately seek medical treatment at the hospital.
Finger Pressure Hemostasis Method
It is applicable for severe bleeding in certain areas of the head and limbs. The method is to press the artery close to the heart with fingers and push the artery towards the underlying bone to block the blood flow and achieve hemostasis.
It is important to note that the index or ring finger should be used to find the pressure point, not the thumb, as the thumb has a large central artery that can lead to misjudgment. Once the pressure point of the artery is located, the thumb or multiple fingers can be used for pressure.
Head and Facial Artery Compression Method
Finger pressure on the superficial temporal artery: Suitable for severe bleeding from one side of the head and forehead. Use one hand's thumb to press on the temporomandibular joint of the injured side to compress the superficial temporal artery, and the other hand to stabilize the head of the casualty.
Finger pressure on the facial artery: Suitable for severe bleeding from facial injuries. Use one hand's thumb and index finger or thumb and middle finger to press on the depression about 1cm in front of the bilateral lower forehead, blocking the blood flow of the facial artery. Because there are many small branches of the facial artery that interconnect with each other in the face, both sides must be compressed.
Finger pressure on the posterior auricular artery: Suitable for severe bleeding from injuries behind one ear. Use one hand's thumb to press on the depression below the mastoid process of the injured side, blocking the blood flow of the posterior auricular artery, and the other hand to stabilize the head of the casualty.
Finger pressure on the occipital artery: Suitable for severe bleeding from injuries near the occipital bone behind one side of the head. Use four fingers of one hand to press on the depression between the back of the ear and the occipital protuberance to block the blood flow of the occipital artery, and the other hand to stabilize the head of the casualty.
The Method of Pressing the Limb Arteries to Stop Bleeding
For bleeding from fingers: Use the thumb and index finger to pinch the finger artery on both sides of the injured finger root. Pressing the brachial artery: Suitable for severe bleeding below the elbow. Use the thumb of one hand to compress the brachial artery on the inner side of the middle of the upper arm to block the blood flow of the brachial artery, and the other hand to fix the injured arm.
Pressing the radial and ulnar arteries: Suitable for severe bleeding in the hand. Use the thumbs and index fingers of both hands to compress the radial artery and ulnar artery on both sides of the injured wrist to block the blood flow. Because the radial artery and ulnar artery have extensive anastomosis branches in the palm, both sides must be compressed at the same time to stop bleeding.
Pressing the finger (toe) artery: Suitable for severe bleeding from fingers (toes). Use the thumb and index finger to compress the finger (toe) artery on both sides of the injured finger (toe) to block the blood flow.
Pressing the femoral artery: Suitable for severe bleeding in one lower limb. Use the thumbs, fists, or palm roots of both hands to compress the femoral artery slightly below the midpoint of the inguinal groove of the injured limb, and the compression time is longer, to block the blood flow of the femoral artery. The injured person should be in a sitting or lying position.
Pressing the anterior and posterior tibial arteries: Suitable for severe bleeding in one foot. Use the thumbs and index fingers of both hands to compress the anterior tibial artery in the middle of the foot dorsum and the posterior tibial artery between the heel and the medial malleolus.
Popliteal artery compression point: Used for severe bleeding in the lower leg and below. After feeling the pulsation of the popliteal artery in the middle of the popliteal fossa, use the thumb or palm root to compress it deeply into the popliteal fossa to stop bleeding.
Subclavian artery compression point: Use the index finger to compress the subclavian artery pulsation point in the middle of the ipsilateral clavicular fossa and press it towards the first rib.
Packing Hemostasis Method
For bleeding from deep vascular injuries in soft tissues, such as nosebleeds, deep neck wounds, or deep wounds on the thigh or back, it is difficult to find the bleeding site, and there are often arterial and venous injuries at the same time. After quickly cleaning and disinfecting, use sterile gauze to fill and press the wound, then add a large piece of sterile dressing to compress and bandage the wound to stop bleeding.
Hemostasis by Flexion Method
When compression hemostasis is ineffective for limb bleeding, if there is no fracture, you can use extreme flexion of the joint to compress the blood vessel to achieve hemostasis. For example, if there is bleeding in the forearm or lower leg, put a cotton pad in the elbow or knee fossa, and then make the joint extremely flexed. Finally, tie the lower leg and thigh or forearm and upper arm with an “8” shaped bandage to temporarily stop bleeding.
Compression Bandaging Hemostasis Method
The compression bandaging hemostasis method is widely used for various wounds. The materials used for bandaging are pads made of gauze, bandages, and other items. First, cover the wound with a sterile dressing, and then place a clean gauze or bandage folded to the size of the wound on top of the sterile dressing. Finally, use a bandage to apply pressure and wrap it tightly to stop bleeding while ensuring that the distant artery still pulsates.
If the bandage is too loose, hemostasis will be ineffective. If it is too tight, it can cause ischemia and necrosis of the distant tissue. If there are bone fragments in the wound, this method is prohibited to avoid aggravating the injury.
Hemostasis Method Using Tourniquet
This method is used to control bleeding from large, complex or fast bleeding wounds in the limbs, typically caused by ruptured major blood vessels or when other first-aid measures have failed. A tourniquet usually refers to an elastic rubber band or any item on hand, such as a belt, tie, scarf, towel, headband, cloth or triangular bandage.
The tourniquet should be tied on the proximal end of the wound, which is the side of the limb closest to the heart. For example, in the case of bleeding below the knee joint, the tourniquet should be tied at an appropriate location on the thigh. If the bleeding continues below the elbow joint, the tourniquet should be tied above the elbow joint. When tying a tourniquet, it should be tightened to the point where there is minimal or no fresh blood flowing from the wound.
