Exsanguination: Understanding and Controlling Blood Loss

Exsanguination is defined as extensive and severe blood loss. Other terms for exsanguination are to “bleed out” or “bleed to death”. This can occur in different ways such as internal bleeding and external bleeding. It is an extreme form of blood loss, more severe than hemorrhaging. Exsanguination is excessive blood loss of 40% of total blood volume. This equals to 1/3rd of human fluid. Hemorrhaging is sometimes compared to exsanguination due to blood loss. However, hemorrhaging is defined as a large amount of blood that is lost during a short period of time. In medical terms, it represents less than 40% of blood loss. Unlike hemorrhage, exsanguination can occur over a long period of time at higher volumes. Statistics show that exsanguination is the leading cause of death in 80% of war fatalities and 50% of civilian fatalities. Individuals suffering from exsanguination can die in just 3 minutes. Consequently, exsanguination is life threatening and fatal if left untreated.

BLOOD

Human blood is made up of basic elements. Along with water, blood is filled with cells, plasma, nutrients such as sugar, hormones, waste products, and other agents. It helps fight against disease and transports oxygen throughout the body. Although blood contains basic properties, there are fundamental differences. Differences can be seen in blood antigens. Antigens are molecules located in the blood that triggers an immune response. They react to toxins, antibodies, and other foreign agents. Due to these subtle differences, human blood is characterized into blood groups.

 Human Blood Groups

Antigens are found on the surface of red blood cells and define the differences in human blood groups. Human blood group is ABO. ABO makes up the four main blood groups, each categorized by the presence of two specific antigens known as A and B.

  • Group A contains A antigen only. The A antigen is on the surface of red blood cells. B antibody is also present. However, B antibody makes up its plasma antibody.
  • Group B contains B antigen only. The B antigen is on the surface of red blood cells, A antibody is also present. However A antibodies make up its plasma antibody.
  • Group AB contains A and B antigens together on the surface of red blood cells. With both A and B antigens located in human red blood cells, there is no A or B plasma in its antibodies.
  • Group O contains no A or B antigens on the surface of red blood cells. However, both A and B antigens are found in the plasma antibody.

The third antigen of human blood is Rh which should also be considered. It defines the presences of negative and positive antigens in the ABO blood group. Given the differences of human blood, people can have negative reactions to blood when not grouped according to their characteristics. Despite these differences, universal blood and donor compatibility is:

  • Red cell donor has Type O negative
  • Plasma donor has Type AB positive

 

Common and Rare Blood Groups

There are common blood groups and rare blood groups. Together, there are 8 blood groups in total.  Most Americans are O+. Statistics indicate that, 53% of Hispanics, 47% of African Americans, 39% of Asians, and 37% of Caucasians, are O+. In this consecutive order the remaining common blood groups are A+ making up 25% of the American population and B+ making up 15%. The last five, making up less than 5% of the population, can be observed below.

Blood Type(Population Percentage)

  1. O+ (45%)
  2. A+ (25%)
  3. B+ (15%)
  4. AB+ (5%)
  5. O- (5%)
  6. A- (4%)
  7. B- (1%)
  8. AB-(0.4%)

Of the human ABO blood group, the last five blood types (listed above) are considered rare. This includes O-, A-, B-, and AB-, the rarest in the world. Only one in nearly 200 people have AB- blood type. Although AB- is significantly rare, the rarest blood type is hh. Some call this blood group the “Bombay” blood group. It is significantly rare and can only be found in 0.00004% of the world population. Although this blood group is the rarest, people with hh blood type are compatible to all blood groups in the ABO system. Therefore they can donate their blood to everyone. However, hh individuals can only receive O- blood.

 

Canine Blood

Unlike human blood, canine blood consists of DEA antigens. While human blood only has 4 main blood groups, canine blood has 8 or more blood groups. Canine blood typing is very different from human blood. Canine antigens are found by observing blood proteins on the surface of blood cells. There are a minimum of 7 canine erythrocyte antigens; these are blood products known as DEA. Canine blood DEA ranges from DEA 1.1, 1.2, 3 and consecutively to DEA 7. The canine DEA blood group, DEA 1.1- is universally known to be unmatchable and compatible with all canine blood groups. DEA 4 is also a blood group that is compatible with all canine blood groups. However, DEA 4 is a rare blood group. Despite the differences in compatibility and the large variety of canine blood groups, most canine blood is compatible with each other. The only blood group that is incompatible is DEA 1.1+ blood group. This is because canines can adapt to a variety of incompatible blood groups. Canines do not have natural antibodies in their blood that fight against foreign agents. This gives them the ability to handle such occurrences. When it comes to canine blood groups, the most important concern is DEA 1.1- and a canine’s reaction to this group. Presence of DEA 1.1+ can prevent an animal from the ability to receive blood.

 

THE CIRCULATORY SYSTEM

In the 1600’s a physician name William Harvey of England discovered the circulatory system. During this time, many scientists misunderstood the function and performance of HUMAN organs. By dissecting and studying the heart and blood system of animals, Harvey was the first to discover the heart’s function. It works to pump blood throughout the body. Understanding veins, arteries, and blood flow, Harvey proved that blood moves around the body in a circle. The circle allows blood to continuously throughout the body that is controlled by the heart’s muscular contractions. Harvey understood that blood flow begins in the heart, circulate around the body, and return back to it’s source. Through his research, Harvey’s work pioneered one of the greatest discoveries in human biology.

Many are familiar with the circulatory system recognizing it as a network of blood flow and distribution. However, this system is also associated with the cardiovascular system. It includes blood, blood vessels, and the heart. Together with the lymphatic system (recycled blood) and the cardiovascular system, the circulatory system functions to maintain and redistribute blood throughout the body. Humans have a closed cardiovascular system. This means that blood remains enclosed within the circulatory network, moving between the arteries, veins, and capillaries to transport oxygen and nutrients to vital organs.

Blood Volume Content

Everyone has different blood volume content.  Blood volume is the amount of blood a single person holds within their body. This varies depending on height, weight, and sex. As a result, children have a smaller blood volume compared to than an adult. Also, men are likely to have more blood volume content than women. However, the average adult has between 5 to 6 quarts of blood or 10-12 pints. The average adult weighs roughly 160 pounds and 5 liters of blood. This is the amount of blood that the heart pumps within a 24 hour period. 5 liters amounts to 7% of human body weight or 1.2 gallons of blood.

People who live at high altitudes are more likely to have higher blood volume than individuals at lower altitudes; the additional blood volume in high altitudes account for the low levels of oxygen in the air. When air quality is poor, the body compensates by holding higher volumes of blood to better circulate the limited amount of oxygen. In addition, pregnant women have higher blood volume than non-pregnant women. Again, this is to compensate for the additional nutrients the body requires to sustain a fetus. In many instances, blood volume in women increases as much as 25% to 50% during pregnancy. The increase in volume accounts for both the fetus and the woman’s growing reproductive system. Consequently, babies and children have much less blood volume than adults. Premature babies have a blood volume weighing just several ounces. Babies and toddlers blood volume is about 1 pint. Older children average 2 pints and more. A woman or large child weighing roughly 100 pounds will have a blood volume of only 3 pints.

The kidneys control the amount of blood in the body. When blood volume is high, the kidneys absorb less fluids and release excess fluids through urination. The kidneys also have an adverse effect when blood volume is low. The kidneys will then retain water to increase blood volume to sufficient and healthy levels. Individuals can easily calculate their body’s blood volume content by measuring their weight. For every 2.2 pounds (1 kilogram), a person contains about 60 to 80 ml of blood.

 Allowable Blood Blood Loss

The blood volume content determines how much blood loss an individual can withstand without it becoming harmful, dangerous, or life threatening. When donating blood, organizations such as the Red Cross and Blood Bank remove anywhere between 8% to 10% of donor blood. This amounts to about 1 pint. This amount of blood loss is safe and does not cause serious effects for humans. This is referred to as Allowable Blood Loss or ABL. An individual’s ABL can be calculated based on an individual’s estimate blood volume. To determine the Estimated Blood Volume or EBV, the following formula may be used:

EBV= weight x average blood volume

However, it is dangerous for an individual to lose more than 10% of his or her blood volume. Although blood banks safely remove 1 pint of blood, losing twice as much blood (2 pints) is considered life threatening. This can cause an individual to go into shock and even death. In children, loosing just 1 pint of blood is life threatening.

EXSANGUINATION AND TRAUMA 

Exsanguination is defined as severe blood loss. This can be life threatening as individuals will literally bleed to death. As a result, exsanguination can occur in various situations. Exsanguination is the number one cause of death for soldiers in combat. It also occurs in car accidents, shootings, stabbings, self-induced suicides, partial and complete amputations, childbirth, and alcohol related deaths. Not only is exsanguination associated with external bleeding it is also associated to internal bleeding. This includes hemorrhaging such postpartum, ulcers, and aneurysms. Weather suffering from internal bleeding or external bleeding, exsanguination is serious, dangerous, and fatal.

Exsanguination is a primary cause of death in war zones. The reason for this is eminent danger associated with war. As many as 90% of injuries that occur in combat result from fatal wounds. Although this is evident in war zones it also occurs in civilian life with the aid of gun wounds and other weapons. Accidents that occur in battle include ballistics, blunt force trauma, blast, thermal force, along with various combinations of these listed. A large percentage of soldiers suffer from penetrating fragments and bullets from gunfire. Of these injuries the majority are soft tissue and extremity injuries. More likely these injuries occur in the head, chest, or from multiple gun wounds. As many of 50% of soldiers in combat will die as a result of exsanguination, typically internal hemorrhaging.

Weather suffering from exsanguination in combat or in civilian life, individuals who suffer from severe blood loss are more likely to die as a result. Those who attempt suicide by cutting major arteries also suffer from exsanguination. These individuals will typically target the arteries in their wrist. Exsanguination can also occur when individuals fall from great heights, incidents of violence such as fights, stabbings, excetera.

 External Exsanguination

External bleeding is defined as blood loss that occurs from an open wound. There are different forms of exsanguination that occur in external bleeding. These include arterial bleeding, venous bleeding, and capillary bleeding.

  • SIGNS of Arterial bleeding: Arterial bleeding is described as a gush of blood that comes out in pulses. The pulsing is a result of rhythm of the heartbeat. In some cases, blood will squirt out from the wound several feet high. Arterial bleeding is associated with Rapid Blood Loss. In this situation, an individual will lose consciousness in seconds. Within a few minutes the individual can go into cardiac arrest. When exsanguination is left untreated, the person can expire in just 3 minutes. The blood from this source is bright red in color.
  • ARTERIAL BLEEDING is the most severe case of exsanguination. This is because arteries are main vessels that carry blood throughout the body. It is part of the circulatory system and described as muscular walled tubes. The arteries transports oxygenated blood away from the heart to important organs. Arteries are the largest blood vessels in the body. Therefore, bleeding from this area is dangerous and potentially fatal. When this form of bleeding occurs, a large amount of blood can be lost in short period of time. In cut arteries the blood is less likely to clot to decrease bleeding and blood flow. Blood loss will occur quickly when bleeding out from the artery. This is the most dangerous form of external bleeding due to high risk of fatality. The probability of bleeding to death from arterial bleeding depends on which artery is cut. If the artery is small, it is less likely to create fatal exsanguination. However, if it is a major artery, bleeding is likely to be sever.
  • SIGNS of Venous Bleeding- Venous bleeding is typically very dark in color and oozes from the body in a steady stream. Bleeding occurs in a constant and continuous flow. The blood from this area is dark being described as burgundy or maroon. When venous bleeding occurs, the vein is likely to collapse due to the injury.  If deep veins are injured, the likelihood of exsanguination increases due to massive bleeding from this area that is difficult to control.
  • VENOUS BLEEDING are cuts and wounds associated with the veins. Veins control the flow of blood containing wastes and lacking oxygen. The veins work to move blood towards the lungs and heart. This blood is on the return side, makings its way through the body and eventually back to the heart. They are made up of thin walls that connect with other parts of the circulatory system including arteries and capillaries. However, veins are much smaller than arteries. Due to their size, veins do not have much flow pressure. Therefore, when venous bleeding occurs, it flows out from the wound in a steady stream. Some associate this flow with oozing out. Although veins are smaller, have a decreased flow, and transports oxygen deprived blood, venous bleeding remains life threatening. The risk of fatality increases if left untreated. This form of bleeding is often affected by prolonged bleeding. Depending on the vein wounded, bleeding may be rapid or flow steadily over a period of hours.
  • SIGNS of Capillary Bleeding- Capillary bleeding is slow. It does not flow or squirt from the wound like other cuts. Instead, blood is described as oozing out. Bleeding here is usually small and considered minor. They are associated with common scrapes and other woods.
  • CAPILLARY BLEEDING is another form of external bleeding. Capillaries are blood vessels that are much smaller in size and diameter. They are small tubes, smaller than a pinpoint and described as having hair-like thinness. Capillaries are the most common type of bleeding and are found within the bodily tissues. They have thin walls so that materials and minerals can easily climb through. Although they have different functions, they primarily help to bring oxygen and nutrients into tissues from the blood stream. Capillaries work together with the other blood vessels of the circulatory system. They help feed organs and other major body parts with what it needs. Due to their small size and function, bleeding here is easy to control even in large amounts. With a small blood flow, capillary bleeding can clot to decreases the risk of exsanguination. Blood from this type of wound can have varying colors, depending on what the capillary was doing when the injury occurred. Capillary bleeding is bright red and full of oxygen or dark red and lacking nutrients. Although capillary bleeding is not life threatening, it has an increased risk of infection from foreign contaminates. 

Internal Exsanguination

Exsanguination can also occur through internal bleeding. Internal bleeding is defined as bleeding that occurs within the body and the skin is left unbroken. This can be very hazardous and dangerous. Unlike external bleeding, there is no open wound. Therefore it may be difficult to detect to the untrained eye. This can occur for a number of reasons. When an individual is hit by a blunt force, either from a violent encounter or accident, he or she may suffer from internal bleeding.

Examples of Internal Bleeding

  • Blunt force trauma to the lungs, kidneys, liver, or spleen. (Trauma to the lungs can cause an individual to literally drown or suffocate in their own blood).
  • Alcoholics suffer internal bleeding due to ruptures in their blood vessels.
  • People with liver disease, peptic ulcers, aneurysms, and broken bones
  • Bleeding in the brain with stroke like symptoms
  • Car accidents
  • Falls from great heights
  • Cancer such as prostate cancer and various diseases and complications
  • Gastro-intestinal tract
  • Pancreas
  • Ectopic pregnancy

With no open wound or obvious signs of trauma internal bleeding can becoming very serious and life threatening. Internal bleeding can cause organs to compress and dysfunction. Furthermore, it encourages hypovolemic shock which can end in fatality.

Signs of Internal bleeding

Signs of internal bleeding vary. It depends on the location of the bleeding, body structures and functions affected, and the amount of bleeding. For example, individuals suffering from confusion or weakness may have internal bleeding of the brain. This is common in brain trauma. Other symptoms include shortness of breath, lightheadedness, and tarry stool when an individual is suffering from gastrointestinal bleeding. With signs and symptoms differing according to the area that is bleeding out, it is important to recognize and become familiar with the signs and symptoms of internal bleeding.

  • Altered mental state or stroke like symptoms including slurred speech and poor vision (aneurysm)
  • Bleeding from the mouth, rectum or urine (abdominal bleeding)
  • Non-menstrual vaginal bleeding
  • Joint pain and loss of range of motion
  • Vomiting blood; bright red, dark red, or coffee grind appearance
  • Black Stool, with a tarry texture and foul smell
  • Pain tenderness, bruising, or swelling
  • Bruised or rigid abdomen

Internal bleeding can cause serious bodily injury and even fatality if not treated and controlled. When treating an individual with internal bleeding, the patient should first be checked to assess stability. This is to maintain a patients ABC’s, for Airway, Breathing, and Circulation:

  • Patient’s Airway is open
  • Patient is Breathing
  • Patient has adequate Circulation

Individuals experiences internal bleeding should first be monitored for breathing. Vomiting should be expected. If this occurs, the individual must be turned on their left side to reduce occurrence of aspiration (vomit inhalation) and for drainage. Further treatment for internal bleeding will consist of identifying where bleeding is occurring, stop bleeding from its source, and repair internal damage to be performed by medical staff and doctors.

 

HYPOVOLEMIC SHOCK

Hypovolemic Shock is a condition associated with exsanguination and hemorrhage. When blood loss becomes severe and uncontrollable, individuals will go into shock. This happens when the heart is unable to pump enough blood to help support the body. When individuals suffer from hypovolemic shock, their organs begin to shut down. If left uncontrolled, this can be life threatening. Therefore, hypovolemic shock is considered a medical emergency. The outcomes can be fatal when entering the 3rd and 4th stages of shock. Even when given immediate medical attention results can be deadly. In normal conditions an individual will go into shock when they lose about one fifth of their blood, or 20% blood content. This can occur in both internal and external bleeding. Although it is common in cases of severe loss of blood, it is also common in severe burns and lesions, intravascular water (low sodium), head trauma (neurogenic dysfunction), and some prescription medicines.

 Hypovolemic Shock Signs and Symptoms

Hypovolemic shock is categorized into 4 stages.

Stage 1 is characterized by 15% blood volume loss. In this stage the patient has normal blood pressure, respiratory rate, and mental status. In some cases, the individual may have minor signs of anxiety. However, the most significant sign is pale or pasty skin.

Stage 2 is characterized by 15% to 30% blood volume loss. In this stage, the respiratory rate and diastolic pressure has increased. Although the blood pressure is constant, there are signs of a narrow pulse pressure, sweating, anxiety and restlessness.

Stage 3 is characterized by 30% to 40% blood volume loss. In this stage, the patient is showing classic signs of hypovolemic shock. The blood pressure falls significantly (100mmHg or less), sweating, pale skin, and altered mental status.

Stage 4 is characterized as a loss of more than 40% of blood volume. The patient has a weak pulse (>140), decreased blood pressure (70 mmHg), loss or decreased consciousness, cold skin, and pronounced tachypnea.

Children When hypovolemic shock occurs in children, they display many of the similar signs and symptoms. However, children will maintain a normal blood pressure for a longer period of time. Blood pressure will not decline until the 3rd stage of shock. When the blood pressure begins to decline, it will do so rapidly. In many cases, their blood pressure will drop dramatically and severely.

Common Signs and Symptoms– When an individual enters hypovolemic shock, symptoms will continue to steadily increase with the increase loss of blood. The common signs of shock are low blood pressure, paling skin, and capillary refills. Other affects include signs of dizziness, thirst, or nausea. As an individual bleeds out, signs and symptoms of shock will cause increased anxiety and confusion, rapid breathing, sweating, and pale skin. In addition, the patient will grow weak, as the blood pressure and body temperature drops and pulse increases.

 

Hypovolemic Shock Treatment

  1. To treat hypovolemic shock, measures should be taken to control internal or external bleeding. Once the blood flow is sufficiently controlled, the patient should be kept warm to reduce sweating, increases body temperature, and avoid hypothermia.
  1. The patient should be placed on a flat surface with the patients legs raised a foot of the ground. This will help blood flow and increase circulation.
  1. Fluids should not be given to the patient by mouth and the patient should be discouraged from sleep to avoid unconsciousness or coma.

 

STAUNCHING

When the body begins to bleed out, whether internal or external, stanching methods can be used treat bleeding. Staunching is used to reduce or restrict blood flow from an open wound. This includes minor cuts to sever arterial bleeding. Depending on the severity of the cut and the health conditions of the individual, some wounds will clot, reducing or eliminating blood flow. However, when bleeding is constant and continues, steps and treatment methods must be used to curve blood loss.

 

Ancient Staunching Methods

There are traditional and ancient methods to stanch a wound, used before the era of modern medicine. These include herbal remedies that are useful and produce positive results for both internal and external bleeding. One ancient remedy known as “bleeding” helped to relieve internal bleeding. This was done by creating an open wound near the bruised area. For external bleeding, roots and herbs were used. Examples are comfrey root, European golden rod, self-heal, shavegrass, shepherd’s purse, and wild alum roots. In parts of Europe and Asia individuals treated internal and external bleeding with the use of roots, herbs, and bandages. Some of these are recognized today.

Herbal Remedies

Cayenne Pepper can be used to treat both internal and external bleeding. This spicy pepper can be applied to minor cuts and deep punctures to stop bleeding within minutes. Some suggest it can be placed on large wounds and even exposed bones to stop severe bleeding. There should be no concern for irritation. This pepper works as a counter-irritant. When applied to an open wound, the pepper also works to normalize blood pressure. This allows blood flow to reduce pressure which makes it difficult for blood to concentrate and flow from the wounded area. The blood clots almost immediately. To apply cayenne pepper to an external wound, the spice may be placed directly on the injury. The pepper requires no modification for application. In some cases, cayenne pepper can be mixed with water and saturated with a gauze and placed over the wound. This also works to reducing bleeding.

Cayenne Pepper can also be taken orally to reduce internal bleeding. When there is internal bleeding in the stomach and throat, the pepper must be dissolved with hot water, (one teaspoon of cayenne pepper for every 1 cup of water).

Aloe Vera can be applied to external wounds such as scrapes and cuts. A calcium rich plant (gel), works to reduce bleeding through coagulation. In addition it helps blood circulation, stimulating flow to the surrounding areas. Aloe vera also kills germs and stimulates healing.

Current Staunching Methods

Exsanguination is very serious and should never be taken lightly. When this occurs, it is important to address the situation immediately. Blood loss should be controlled and treated as soon as possible. The injury is serious and life threatening when blood is squirting from the wound in pulses or a continuous rapid flow of blood.

  1. Lay the victim down on a flat surface. To avoid shock the individual’s legs must be elevated 1 foot of the ground.
  2. Check the patient’s vitals, including breathing and circulation
  3. Elevate the wound (if possible). If the wound is located on an unbroken limb it should be elevated above the heart.
  4. Apply direct pressure to the wound until bleeding stops. Clean gauze should be applied to the wound. A dressing, cloth, or hand can be used as a secondary method if gauze is unavailable.
  5. Continue to apply steady pressure. The gauze can be taped, tied, or wrapped around the wound to maintain continuous pressure. If the wound cannot be wrapped or taped, use heavy padding to maintain pressure.
  6. Look for seepage from the wound. More gauze may need to be applied during exsanguination. Do not over wrap or increase the amount of gauze applied to the wound. Instead, remove the bandage and reassess application.
  7. Use pressure points of bleeding continues
  8. Maintain pressure until bleeding stops
  9. Continue to monitor the victims vitals, including airway, breathing, and circulation.

 

When attempting to control blood loss. Never stop applying pressure. Do not do this even to check and see if the bleeding has stopped.

Applying Pressure- In the case of venous bleeding, this can be stopped with general pressure over the wound. However, in the case of arterial bleeding, specific pressure must be applied. This includes using finger tips to help apply pressure in or around the wound. Bleeding from the arteries are sever. Therefore, general pressure may not be enough to control bleeding.

Heart Medication- specifically anticoagulant will experience sever bleeding. Due to the medication, it will take longer to control blood loss. As a result, pressure must be applied for a longer period of time. It is always good to check the patient for a medical bracelet or necklace that may indicate this.

Pressure Points

When patients are at risk of exsanguination, pressure points may also be used to help control blood loss. Applying pressure to specific area can reduce blood circulation throughout the body. This will then reduce the amount of blood lost. This can also help minimize the risk of shock. Using pressure points can restrict blood from a major artery that feeds into the injured area that is bleeding out.

Where are Pressure Points

Pressure points are areas in which a pulse can be found. Therefore, it is important that these points can be identified. Every part of the body is connected by a major artery and vein that feeds it blood. The point of pressure that should be used depends on the area of the body that is bleeding out. If there is confusion regarding which pressure point to use, it may help to feel for a pulse at each pressure point of the body. If there is no pulse at the pressure point, this will indicate the point where pressure should be applied. Another indication are blue veins. This can also indicate where pressure should be applied.

There are 28 pressure points in all. 14 pressure points on each side of the body, the right side and the left side. Each pressure point has a corresponding pressure point on its opposite side. Pressure points include the wrist, forearm, two are located in the arm pit, two are located along the side of the neck, the face, the groin, upper thigh, two in the knees and three pressure points near the ankle.

Bleeding from the head– Pressure points for this type of injury is located in front of the ear. Trace a line from the corner of the eye going back towards the ear. A pulse will be felt under a slight indentation directly in front of the ear.

Bleeding from the lower face– Pressure points for this injury is located on the jaw bone. It can be found between the chin and the end of the jaw. Then, pinch the jaw bone between your finger and thumb.

Bleeding from the neck- Pressure points for this injury is located on the side of the neck. This is the carotid artery and the jugular vein. It can be found between the adams apple and neck muscle.

Bleeding from the arm/shoulder- Pressure points for this injury is located along the brachial artery (the forearm). If bleeding is located on the upper arm, apply pressure above the center collar bone. If bleeding is located on the lower arm, apply pressure to the vein located in the fold of the arm.

Bleeding from the hand- Pressure points for this injury is located on the inner wrist. A second pressure point for this injury can be found under the pinky finger.

Bleeding from the groin/thigh- Pressure points for this injury is located between the hip and groin. It can be found along the bikini line at the half-way between the two areas. This is the femoral artery and a lot of pressure must be applied to this pressure point to control blood loss.

Bleeding from the lower leg– Pressure points for this injury is located in the fold of the knee, on the popliteal artery.

 Risks of Pressure Points

There are risks to using pressure points. Most importantly, pressure points do not apply to internal bleeding. Pressure points only apply in the case of external bleeding. Applying pressure to important arteries cannot be performed for a long period of time. It is recommended that pressure is not applied to these points for no longer than 10 minutes. Long term pressure to important veins and arteries can cause significant and irreversible damage. This includes brain damage and necrosis to the constricted area. When using the pressure point in the neck, the carotid artery, there is risk of hypoxia and reduce blood flow to the heart that can occur within minutes. In addition blocking blood flow can cause toxins to build up in the blood stream causing kidney failure.

Tourniquets

A tourniquet is a devise made to constrict and compress blood circulation. It is a tightly tied band that goes around the limb to restrict blood flow. It is another way to reduce blood supply to major arteries that feed an open wound. Tourniquets are used on limbs. It applies pressure to stem the flow of exsanguination. Due to the dangers and risk associated with tourniquets, they should only be used in life threatening situations. Furthermore, when used they should be used with caution. They have been used for centuries to control bleeding during amputation. However, by the end of the 1880’s physicians began to understand the complications that can occur from using this devise.

Surgical tourniquets are used during surgery. They help to curve blood loss during amputation. In surgical procedures, tourniquets allow for safety and precision. Most often surgical tourniquets are used during plastic surgery, orthopedic surgery, and for anesthesia. During anesthesia tourniquets are used to prevent medication from circulating into the limb.

Emergency tourniquets are used in the case of emergency to control blood loss. In this situation they are only used as a last resort. However, emergency tourniquets are used in limb trauma, when the limb has been extracted or cut severely in trauma.

Combat tourniquets, known as Combat Application Tourniquet (CAT), are used in the military on soldiers in combat. It is a small devise is carried in military first aid kits. It is also referred to as a self-applied tourniquet.

Limb occlusion pressure (LOP), is an added technology to tourniquets. It applies the minimum amount of pressure needed to stem blood flow. In addition, LOP can apply pressure for a specified time to maintain safety management. It can sense blood flow and account for the patients pulse. In addition, automatic systems have also been applied to tourniquets as an added safety feature. It monitors and controls pressure, cuff inflation, and can cut blood flow to a limb in just 30 seconds. Technological improvements of tourniquets including contoured and wide cuffs and integrated tourniquet cuff testing, all aid to improve safety and reduce long term damage.

 

Risks of Tourniquet Use

Tourniquet use is widely associated with limb paralysis and other complications. Tourniquets are known to be painful and characterized with hyperemia and hyperthermia. After the use of a tourniquet many patients complain of discomfort, known as Post-tourniquet syndrome. It is characterized by pain, numbness, paresis, stuffiness, and pale skin. In addition blistering, ischemic necrosis, cerebral hypoxia and compartment syndrome can occur as a result. Along with these affects, tourniquets can kill the tissue in the limb due to the loss of blood circulation to the limb. This can cause irreversible damage to the limb and loss of the limb.

Tourniquets should almost never be used. When used, they should only be used as a last resort due to the potential damage it can cause to extremities. Therefore, tourniquets are required when there is a choice between life and limb.

 

Positives to using Tourniquets

When tourniquets are used safely and appropriately, its use has positive results on reducing mortality and saving limbs. When individuals are educated on its use, safety, and precautions there is minimal risk of mortality or loss of limb.

 Tourniquet Use

The tourniquet should be tied around the injured limb several inches above the injury. Depending on the location, such as above the knee or elbow, the tourniquet should be placed above the joint. A stick or windlass should be used as a lever to turn the tie or knot. This will increase the pressure applied to restrict blood flow to the limb. The tourniquet should only be used for a short period of time to reduce the risk involved. Typically, tourniquet should apply pressure for no longer than 1 hour. If applied longer the patient may be at risk of limb loss.

  1. Maintain pressure on the wound and place the tourniquet at least 2 inches above the open wound
  2. Place a pad or cushion over the artery to be constricted
  3. Wrap the tourniquet around the extremity 2 times and tie a knot when finished
  4. Put a short stick or a similar object in the knot or tie before knotting it again
  5. Twist the stick to tighten the tourniquet to control bleeding
  6. Secure the stick in place to prevent it from unraveling

Bandages

Bandages are used to control blood loss. However, they can also be used as a dressing, a split, support, or restrict a part of the body. When exsanguination occurs, bandages can be used to apply pressure to the open wound. Due to their large range of use, there are different types of bandages that are used for different reasons. From the standard Band-Aids to gauzes, bandages are an effective way to control blood loss.

Gauze- To curve blood loss and reduce the risks associated with exsanguination, gauze bandages are preferred. Gauzes are absorbent material that comes in varying shapes and sizes. It is made of a simple woven strip of material that acts as a barrier for the open wound. This barrier reduces the amount of blood loss and keeps the wound from coming in contact with foreign agents such as germs and reduces infections. It can be used over a sterile dressing to close off a wound and generate pressure to control bleeding. In this way it can also be used as to secure a splint or support an injury.

Compression bandages- They are most commonly associated with the standard Band-Aid and appropriate for long term use. These are referred to as short stretch compression bandages. Long stretch compression bandages are also frequently used in the medical field. They have the ability to stretch and are used on larger limbs. It has the ability to apply high and resting pressure. However, this bandage is not appropriate for long term use. Thus, they must be removed at night or periodically for comfort.

Cravat Bandage- These are also known as triangular bandages. They are typically 3 feet by 3 feet in size. However, it can be folded into various shapes including a strip or a triangle for its intended use. It has various uses. It can be used to make a tourniquet, a sling, or bandage.

Bandages have a shelf life ranging from 3 to 5 years depending on the bandage.

 

New Era Bandages

CitoGauze is a bandage that is used in the military. Although it looks like the typical gauze it is made up of biopolymer material that contains clotting agents. This can help reduce blood loss quickly by interacting with the red blood cells in the blood.

Gecko Bandage is used for internal injuries. This bandage has the ability to disintegrate over time without causing harm to the body. It does this by sticking to wet surfaces and becoming biodegradable once in contact.  This is a favorite among surgeons for internal injuries.

QuickClot are products made for dressing an open wounds. The chemical make-up and property of the gauze has ability to naturally help the blood clot when applied to a bleeding injury. The gauze is made up of kaolin clay that helps the body trigger clotting. It has been affective in the military and designed for use in the medical field.

Scaffold Bandage is made to act as a second skin for open wounds. It helps to heal skin and open wounds by attaching the patient’s skin cells to the bandage. The bandage is then attracted to the skin making the bandage biodegradable when the patient’s skin begins to heal.

Antiseptics

Topical anesthetics are used as a numbing devise to ease pain. They are used to numb the skin and open areas of the body including the eyes, ear, nose, throat, genitals, and anal cavities. It is most commonly used to help ease pain and different injuries. This includes cuts and scrapes to insect bites and allergic reactions.  It can be found in a range of textures and varieties including aerosols, sprays, lotions, jellies, ointments, and creams. Examples of topical anesthetics include lidocaine and benzocaine.

Use

Topical Antiseptics should only be used by physicians to ease general pain and discomfort when treating open wounds. It is typically used to apply treatment such as stitches and suturing.

 Risks

Some topical anesthetics cannot be used in open wounds. When used for this type of injury the body will absorb the anesthetic into the body causing rapid and harmful reactions to the body. Harmful reactions include seizures and rapid heartbeat. This is the same if used in inappropriate dosage. Therefore, it should not be used for open wounds or large cuts. It has the potential to cause irritation or infections.

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About Russia Robinson

I am an independent freelance writer and free thinker. I strive to use my writing talents to benefit the greater good of society, one word, one sentence, one page at a time. Originally from Richmond, California I attended San Francisco State University receiving a BA in English Creative Writing and American Literature in 2004. After this I attended post graduate studies in 2008 at Georgia’s Kennesaw State University in Technical Writing. With an academic background in English, I have spent more than 10 years’ helping young people succeed. This can be seen in my career background in education and mental health. I am a certifiable Language Arts teacher for the state of Georgia. I also worked in social services including juvenile mental health treatment services and counseling. As a result, I understand the diversity of problems people face in their everyday lives. With words put together like so, I promote equality and a healthy society for all people regardless of individual differences. Conducting research, writing articles, essays, and blogging, I push to educate others about various issues that affect people. I also do this creatively through short stories, poems, pictures, and a novel in progress. My hobbies and interest are reading and learning. I enjoy all things art and all things nature. From camping and astronomy to photography and cooking, I enjoy sighting seeing and socializing just as much as I enjoy curling in bed with a good book or binge watching TV.
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