Haemorrhage Control

This article was last modified Aug 1st 2011 by Matt Ladbrook

Learning objectives 

Recognise haemorrhage as a major cause of mortality and morbidity

Understand that arrest of critical haemorrhage may often need to be the first priority

Be able to deploy a wide spectrum of techniques to arrest haemorrhage

Understand the recent major changes in the approach to haemorrhage control

Introduction

Haemorrhage is the second leading cause of civilian trauma related mortality and the leading cause of battlefield mortality.

Many advances have come from military conflicts in the last ten years.  This has caused us to re-learn valuable lessons that were forgotten.

High energy mechanisms of injury on the battlefield eg..traumatic amputation, have led to the development of the concept of 'critical bleeding' (blood loss that will be fatal in a very short time period).  This recognition has shifted the priority of treatment from "AcBC"  to "<C>AcBC" - Control of critical bleeding taking higher priority even than Airway management.

Whilst unusual away form the battlefield, the recognition and control of critical bleeding is essential in any setting.

In the austere environment blood is like heat, once lost it cannot be replaced.

Assessing and managing haemorrhage

In critical haemorrhage the initial action must be to control the bleeding quickly.  This is usually a tourniquet or direct pressure.   However, the nature of some wounds may make this difficult or impossible.

Techniques for controlling haemorrhage (in no particular order):

• Direct pressure
• Indirect pressure
• Tourniquet
• Elevation and immobilisation (these augment other techniques but are not sufficient on their own)
  
• Haemostatic agents

This is not a 'ladder' and techniques will often need to be combined or revisited.  The guiding principal is 'Control the haemorrhage now, and this gives you the time to then re-assess and consider less aggressive techniques to maintain control'

The following is our structure to help you classify and treat haemorrhage

Types of haemorrhage

Internal

External

tourniquetable

non-

Key points

Myth-busters - formally debunk any incorrect but commonly believed ideas

Current Affairs - bleeding edge of the science, controversies, ongoing research areas, identify gaps in knowledge (which might lead readers to research areas)

Further reading References