M*A*S*H Recommended
Identify a Massive Bleed
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Early identification of severe hemorrhage is critical. The below image shows signs of ongoing life-threatening bleeding that may not have been noted or appropriately addressed in Care Under Fire.
These include:
Pulsatile Bleeding
Also called Arterial bleeding is the most serious type of bleeding. Since arterial blood flows from the heart, it’s oxygenated and bright red. It will also shoot out with each heartbeat in a rhythmic pattern.
Steady Bleeding
In this type of bleeding, the blood flows steadily. If it's a large vein, the bleeding may be gushing. When a vein is cut, most veins will collapse, which helps to slow the bleeding. If it's a deep vein such as an iliac vein, the bleed can be just as difficult to control as an arterial bleed
Bright Red Blood Pooling on the Ground or Soaking Overlying Clothing
The color of blood you see can indicate where the bleeding might be coming from. In this case, bright red blood indicates that it is oxygenated and likely an arterial bleed.
Blood Flowing at the Site of a Traumatic Amputation of an Arm or Leg
There will be extensive bleeding due to all of the blood vessels involved may not be vasoconstrictive. A second type of traumatic amputation occurs when the limb becomes completely detached from the body. As much as 1 L of blood may be lost before the arteries spasm and become vasoconstrictive (less than 1 minute).
Ineffective Bandage
Bandages that become soaked with blood generally indicate that the injury requires a tourniquet or the bandage was not placed on the wound correctly.
Any obvious ongoing life-threatening bleeding should be addressed immediately.
The below image talks about signs of ongoing life-threatening bleeding that may not have been noted or appropriately addressed in Care Under Fire. These include pulsatile blood, steady bleeding from the wound, blood pooling on the ground or soaking overlying clothing or bandages, or blood flowing at the site of a traumatic amputation of an arm or leg.
Any obvious ongoing life-threatening bleeding should be addressed immediately.
In combat casualties, early control of significant external hemorrhage is the most important intervention. Hemorrhage remains the predominant cause of preventable death in combat fatalities.
Early tourniquet use prevents limb exsanguination and saves lives. Nonindicated tourniquet placement is common (even when CUF is included as an indication), and morbidity is uncommon when tourniquet use is relatively brief.
1. Expose the injury, assess the bleeding source (assess for unrecognized hemorrhage), and control all sources of bleeding.
2. Control life-threatening external hemorrhage that is anatomically amenable to tourniquet use or for any traumatic amputation.
3. Remember: Bleeding should be stopped within 1 minute and the tourniquet fully secured within 3 minutes.
4. The time of tourniquet placement should be documented on the tourniquet itself and on the DD 1380 in TFC (but not during CUF).