pressure points for heavy blood loss

[Cliff Stamp]

I was doing some research trying to determine what to do with heavy blood loss besides "seek medical attention". Davenport covers two methods besides pressure+elevation which are tourniquet and pressure points.

Pressure points are just appying pressure to a a major blood vessel above the wound cite to reduce blood flow. He doesn't give any reasons or descriptions on when to use this in conjuction with direct pressure and elevation at the wound site.

With tourniquets he simply says if the other methods "fail" then it is to be considered and states that losing the part cut off is a real possibility which implies that you do nothing once it is applied. He also doesn't comment on futher care at all, such as amputation for infection.

This is a real problem with most survival books, they will go into great detail about many of the aspects of survival, shelter, food, signaling, including worse case senarios (no equipment), but for health related matters this is often vague and open ended.

Now in regards to the advice of :

-seek medical attention
-become a doctor and carry the necessary supplies at all times

This isn't realistic for a survivial forum, it is akin to asking how to build a friction fire and told :

-carry a blast match + tinder at all times

So, similar to many of the situations where an individual finds themselves in a survival situation how do you judge when pressure and elevation "fails" . Most won't cover this at all and will just say, if one bandage fails apply another.

Assuming you know this part then and apply a tourniquet do you just then write off the limb as there is nothing further to be done without highly specialized equipment and training?

Why are pressure points and a tourniquet so radically differnet. Isn't a tourniquet just the same thing, constriction of blood flow by apply pressure above the wound cite. Can't you simply use a tournique to do the same thing if you simply don't tighten it fully. If you apply one can't you use it to try to reduce blood flow rather than stop it completely.

-Cliff

 

[Outdoors]

I believe how to use pressure points is covered in the regular first aid classes. Are you current? It would be hard (for me) to explain, but it's pretty straightforward if you see it demonstrated. Maybe LSky or one of the other professionals can explain it in words. Failing that, I believe the various outdoor medicine books and videos have good pictures.

There's a picture of one pressure point at the cert site under the title :disaster medical operation 1.
http://training.fema.gov/emiweb/CERT/mtrls.asp

Pat

BTW"-carry a blast match + tinder at all times "
I carry a firesteel and tinder all the time. What so hard about that?

Pat

 

[RunzWithScissors]

With a pressure point, hopefully you have some sort of dressing and bandage over the wound and if the blood keeps flowing you apply pressure until a clot forms. You aren't stopping all flow to the affected area just radically slowing it down.

With a tourniquet, you stop all flow entering and leaving the affected area. If you need to apply one (generally an option of last resort) put it as close to the wound as possible and write down the time that it was started. Preferably write on the leg or arm itself in Sharpie.

As long as you have dressings, it is always better to keep adding dressings and applying pressure and elevating the area until the bleeding stops.

I hope this helps

Chad

 

[Outdoors]

Sorry Cliff,
Had to reread your post a few times to see what your question actually was. I see now that you are asking the difference between the two methods, not how to apply a pp. I thought the tourniquet thread already answered your question, though. Maybe I still am not clear on what your question is.

Pat

 

[allenC]

Keep in mind that I'm merely a radiographer (X-ray Tech) and am not a medical doctor, and I could be wrong, but here's how I understand it:

Elevating the wounded part above the level of the heart is merely using gravity to help stop or slow down the blood flow/loss, and it keeps more blood in the torso and head (to the vital organs and the brain) and so also helps to combat shock.

As for the difference between holding pressure or using a tourniquet:
As I understand it, you hold pressure or use a "pressure dressing" on a wound when there is a reasonable expectation that the wound will clot and that the bleeding will stop long before the patient is in danger of dying.
OTOH, a tourniquet is applied when there is no expectation that the wound will clot and a belief that the bleeding will not stop with pressure alone.

This reminds me of the 1st time I ever had to hold pressure on a femoral artery...
It was right after the patient had a heart cath, the doctor called me over and told me to put on some sterile gloves (that should have warned me), and then told me to put my hands on top of his own.
He then slid his hands out from under mine and told me to hold very firm pressure and that he would be back to check on me in about 30 minutes!
Yep, there's nothing like getting to know a lady while holding pressure on her inner thigh/groin for 30 minutes and making small talk.
Later, another more experienced Tech told me that they sometimes use sandbags to apply pressure.

Allen.

 

[adfprpusn]

With massive blood loss, don't forget to also check for and likely treat for shock. lay the victim down on thier back and elevate their feet about a foot or so. read; slide a log or stool or something under their feet. Cover them with a blanket. Remember, shock kills.

 

[Cliff Stamp]

As for the difference between holding pressure or using a tourniquet:As I understand it, you hold pressure or use a "pressure dressing" on a wound ...

Not direct pressure on a wound, direct pressure on one of the major blood flow points above the wound site, this is used in conjunction with the pressure applied at the wound cite.

My question was two fold :

-how to address the need for more severe measures that direct pressure + elevation

-what to do when they are applied, long term with no rescue possible

And lastly how come a tourniquet can't be used similar to pressure points to reduce blood flow and not simply shut it on/off?

-Cliff

 

[Outdoors]

Not direct pressure on a wound, direct pressure on one of the major blood flow points above the wound site, this is used in conjunction with the pressure applied at the wound cite.

My question was two fold :

-how to address the need for more severe measures that direct pressure + elevation

-what to do when they are applied, long term with no rescue possible

And lastly how come a tourniquet can't be used similar to pressure points to reduce blood flow and not simply shut it on/off?

-Cliff

Ximinez: NOBODY expects the Spanish Inquisition! Our chief weapon is surprise...surprise and fear...fear and surprise.... Our two weapons are fear and surprise...and ruthless efficiency.... Our *three* weapons are fear, surprise, and ruthless efficiency...and an almost fanatical devotion to the Pope.... Our *four*...no... *Amongst* our weapons.... Amongst our weaponry...are such elements as fear, surprise.... I'll come in again.

[The Inquisition exits]

Chapman: I didn't expect a kind of Spanish Inquisition.

[JARRING CHORD]


[The cardinals burst in]

Ximinez: NOBODY expects the Spanish Inquisition! Amongst our weaponry are such diverse elements as: fear, surprise, ruthless efficiency, an almost fanatical devotion to the Pope, and nice red uniforms - Oh damn!
[To Cardinal Biggles] I can't say it - you'll have to say it.
Biggles: What?
Ximinez: You'll have to say the bit about 'Our chief weapons are ...'
Biggles: [rather horrified]: I couldn't do that...

[Ximinez bundles the cardinals outside again]

Chapman: I didn't expect a kind of Spanish Inquisition.

I'm sorry, Cliff.
I just couldn't resist

Pat

 

[Thomas Linton]

As noted above, use of the pressure points slows blood flow TO the area.

The tourniquet can be used to slow or stop flow to AND from the area. (If it's still gushing, more turns. If you wanted to stop and it's still flowing, more turns.)

When faced with severe arterial bleeding in a location far from professional help -- in term of time -- all choices are merely relatively good or bad.

 

[oldnbusted]

Bear in mind that when you apply pressure to a major vessel to reduce bleeding, you aren't constricting other, smaller blood vessels, thus allowing blood supply to tissue in the affected area and "below", whereas a tourniquet constricts all vessels in the affected limb, shutting off total blood supply. I imagine that it would be nigh on impossible to use a tourniquet to apply pressure to just one major blood vessel. Hence the pressure point method.

 

[Ebbtide]

I guess the SkyLizards aren't biting today.
Better luck tomorrow.

 

[Ravaillac]

Pressure point are generally recommanded when you can't work on wound e.g.: people stabbed in the arm with knife left in wound, in that case, getting the knife out the wound is not generally not recommended, as it may increase bleeding. So you can't apply bandage or direct pressure.

Then you have to apply pressure points away from wound, these some sorts of "lighter" tourniquets: touriquets will virtually stop all bleeding in the limb, pressure points will stop light/medium bleeding, reduce important bleeding.
Tourniquets will pretty quickly start neurologic damages. Pressure points will do the same in a much slowermanner.
As for tourniquets, pressure points are supposed not to be released until you get professional medical support, for pretty much the same reasons.
This induce that when you start one, you should prepare yourself to hold it for a long period (which means choose a good stance, stance that can be kept for a long time are part of pressure points learning), it also means that if you're alone with your buddy you'll have to get medical attention first (and here comes tourniquet). The whole thing means this method will generally only be suitable in the outdoors if your group is at least three people. In urban or rural populated area, near roads, shouting/signaling is an option.

Heard some professional med worker know how to make "moderate" tourniquets that may replace pressure point, leaving your hands free. I'm not sure about that thing, and would never try to improvise it myself though.

Best method whenever possible and effective is always direct pressure/compressive bandages. People also value hemostatic pliers these can be very effective but require a lot more skill.

 

[LSkylizard]

...Why are pressure points and a tourniquet so radically differnet...

As for this question, it is easy. The difference is one of "real estate". A TQ cuts off a whole lot of it while PP will specifically isolate a region (in general). Ideally, the pressure point will be distal enough to allow other collateral vessels to branch. This means uninjured vessels are free to perfuse the limb while you compress the injured vessel. A TQ compresses all vessels distal to it as it is circumferential and functions in a strangulating fashion.

…With tourniquets he simply says if the other methods "fail" …how do you judge when pressure and elevation "fails" . Most won't cover this at all and will just say, if one bandage fails apply another…

Cliff, yes, you need training to get a better answer to these questions. There are extremes on either direction. Sometimes, it is obvious (i.e. you are laying on the ground and your foot is in a tree). Other times you do not know when you apply pressure if it will stop bleeding. The finer points are better taught with specific training and ideally experience…remember SF medics learn/practice their craft on living livestock…after extensive training/lectures. Unfortunately there is no shortcut to the answers you seek.

…Assuming you know this part then and apply a tourniquet do you just then write off the limb as there is nothing further to be done without highly specialized equipment and training?…

This is generally correct. Though, new technologies and bandages are being developed that may help by applying after you stop the bleeding and then enabling removal of the TQ. Again, you must have specific training and you require the correct supplies.

Using a TQ and applying other techniques are scenario specific. The question is are you alone? Is there more then one person with you? Are you trying to improvise a TQ or do you have a NEW military issue model? Were is the injury (upper extremity vs lower, thigh vs calf, etc&#8230? It is good that you are interested. However, the extent of information you desire is not readily amenable to transmitting this way. It would be nice to be able to always self rescue or rescue your buddy without having to carry much. Sometimes, you just can't and he/she will die or loose a limb, or something, etc... It sucks. But, that is life. Not all situations are recoverable. I have seen this even in the hospital!

Finally….hesitation fills my belly….there are changes in the wind about using a TQ in place of DP. This of course is for the trained professional. It involves having the right supplies including hemostats and hemostatic dressings. It is not used in a patient in shock. This training can not be obtained by reading through a forum.

 

[Cliff Stamp]

As for tourniquets, pressure points are supposed not to be released until you get professional medical support, for pretty much the same reasons.

This is what confused me, in some survival manuals it states that pressure points are to be released.

In regards to TQ I still don't see why you can't not tighten them to the point where they are on/off but just constricted trying to control the blood flow and thus give the wound the mechanics to heal while minimizing fluid loss.

Best method whenever possible and effective is always direct pressure/compressive bandages.

Can you apply too much pressure, speaking only of your hand/weight?

This means uninjured vessels are free to perfuse the limb while you compress the injured vessel.

This then makes them completely different, as pressure point would then be similar to clamping the major bleeder at the cite. Can you generalize the pressure point to the cite location?

Other times you do not know when you apply pressure if it will stop bleeding.

Yeah, that was what I was thinking of as waiting to see may make for too much blood loss.

However, the extent of information you desire is not readily amenable to transmitting this way.

Consider this senario with you acting as part of a S&R team. You are looking for the individual, he makes radio contact, you determine his rough location but it will take you at least an hour to locate him. He then shouts frantically that "Roger has slashed his forearm on a rock and is bleeding heavily, it soaked through my shirt fast, what do I do?" Is your experienced of any benefit to them or do you have to be on site?

This training can not be obtained by reading through a forum.

You are misunderstanding its purpose. Most threads like these in general are not to obtain the necessary skills but to simply give one the necessary questions to be answered and direct where the experience should be directed. I can for example tell someone in great detail how to build a variety of brush shelters, this doesn't mean they should not actually build them because they read the instructions nor if there was an instructor locally they would ignore it. What it would do is just give them a framework to lay such information upon and insure during said training that relevant questions were addressed.

-Cliff

 

[Ravaillac]

This is what confused me, in some survival manuals it states that pressure points are to be released.

Well, this is what I learned. I, fortunately, had no occasion to try it on a real wound, but instructor clearly stated that those compression points where not to be released. That said, they generally imply that you're not too far from medical support, and they generally not bother students with multiple advanced techniques in order not to confuse them. I guess we should ask this on a medical forum, or you should ask your doctor next time you visit him.

Can you apply too much pressure, speaking only of your hand/weight?

Generally advised method is to use palm, so pressure is a lot less focused, I've never heard any problem or advice regarding that precise topic, so I guess it is unlikely.

 

[LSkylizard]

This is what confused me, in some survival manuals it states that pressure points are to be released…

It depends on how proximal (close to the trunk/abdomen) your situation requires the pressure applied. If you are up to the groin because an individual is hemorrhaging out big leg vessels…just hold on. Again, if the individual is in shock, you do not release for reasons similar/equilavent to those in the TQ thread.

…In regards to TQ I still don't see why you can't not tighten them to the point where they are on/off but just constricted trying to control the blood flow and thus give the wound the mechanics to heal while minimizing fluid loss. …

A couple of issues. First, wound healing takes time! So, no, you do not apply a minimal TQ to allow enough hemorrhage control for the wound to “heal”. The ischemia induced by low blood flow is counterproductive to healing. Second, TQ applies global pressure. It will require enough pressure to tamponade the injured vessels. By coincidence, this is generally the exact amount of pressure required to stop the healthy vessels from perfusing…

…as pressure point would then be similar to clamping the major bleeder at the cite…

That would be the theory of their action. Sometimes all you need is a finger to apply direct pressure. In which case, you would not use a proximal pressure point....A "Judoka" can apply enough pressure to stop bleeding in 2 seconds ...I could not resist throwing in some sarcasm...sorry, mixing threads

…Consider this scenario…it will take you at least an hour to locate him…"Roger has slashed his forearm on a rock and is bleeding heavily, it soaked through my shirt fast, what do I do?" …

The question is a matter of what the rescue team has as supplies and what will be the time to locate as well as evacuate? Also, is Roger alone? Generally a wrist injury should be amenable to a proximal application of pressure…2 hours should be fine (assume 1 to locate and 1 to evacuate). If it is a major pumper, do your best. If Roger or his buddy have the training, they will need to determine if it does require a TQ or if it is appropriate. The S&R team will advise based on their expectations, their training, and their equipment/supplies.

…You are misunderstanding its purpose…What it would do is just give them a framework to lay such information upon and insure during said training that relevant questions were addressed…

That’s good. Most of these points, if not all will be addressed in training. The syllabus will give you a guideline as to what you should be capable of upon completion of the course. The course instructors in first response are always very acutely aware of what you should NOT be trying and will specifically tell you…Don’t do X! They do this because numerous individuals will go to short courses (i.e. 1week to 6 months, etc...) and then go home and think they are qualified as their family doctor. I see numerous paramedics and nurses avoiding insurance co-pays by buying drugs from vets and then trying to treat their families. This is dangerous. Families have been hurt by first responders (in the family) playing the doctor...a little knowledge can be dangerous...sometimes more so then ignorance. For example:

...Dont forget that you can get decent FISH antibiotics from vet suppliers that cost a fraction of human meds...I treat my myself, my family and pets all the time with them...Iv supplies and tubing etc... ARE legal in some states to purchase from med supply houses. Short of that look into VET supplies...

DANGEROUS
There is no shortcut to being properly trained. You and your family should be worth the proper level of care. When I hear a PA, NP, LPN, and/or paramedic bragging about how they saved money by giving their kid a medication they got from their dogs vet, I get nauseous. I always wonder if they realize their ego is short changing the ones they love...I digress and am off topic, my apologies...It is probably too late and my comments probably already called out the....FLAMMER!

 

[skammer]

Liz,

Despite being called a ....... I do agree with your assesment of pressure points. Though most non massive injury bleeding is controlled by direct pressure. Pressure points are good to know.

As far as using vet meds? Well, to each his own. We are on different wave lengths when talking about survival preparedness. This topic has been dicussed at depth all over the net and accepted and confirmed by Dr's and Vets. I have friends in the spec ops world who routinely use vet meds and are trained under the table to acquire them.

As for using them, I have done so very effectively for known illnesses I can easily diagnose especially in myself. Taking proper doses and duration is not rocket science if you can read ie, merck manual among many other text in my medical reference library.

I study health care not just for me but for my families security as I do not trust any government system to be there for us when the SHTF. This fact has proven itself over and over in reality. Some people in New Orleans could have used this knowledge had they known what was about to happen to them. Many have vowed never to be underprepared again.

Main stream medicine is not relaiable in dire stiuations, volumous enough and can't be counted on ever.

FOr what its worth.

Skam

 

[LSkylizard]

...I have friends in the spec ops world who routinely use vet meds and are trained under the table to acquire them...

That is good. The last time we had a soldier with a chest/respiratory infection a seasoned Spec Ops soldier deferred to me. He stated to me, "I have the antibiotics. If we were in the field I would just give them to the soldier. Here now, I defer to your decision. I am leary to start pushing PRESCRIPTION meds under non-emergent conditions. I am trained to be a first responder and stand in for a physician. But, I am not a physician and this is not an emergency." I again throw out the rhetorical question: Do you think all wilderness medics and first responders are equivalent to Spec Ops Medics? A Spec Ops medics is a different ball game. However,when they leave the military, they are specifically instructed to NOT try and utilize their skills in regular day to day life beyond what they are licensed/certified to do as a CIVILIAN.

I will say that vet medications are not equally regulated. They may come off the conveyer belt at the same time. However, their shipping, handling, and storage is not as secure. I have seen vets receive meds and have them left on the doorstep in a blistering summer sun for several hours...no dry ice or insulation. It is one thing to use them in an emergency it is another thing to use them in non-emergent primary health care applications. I still believe families deserve better.

...volumous enough and can't be counted on ever...

What???

 

[Thomas Linton]

Imperfections aside, people count on mainstream medicine millions of times a day. Their reliance is justified by results in the vast majority of cases.

 

[pcnorton]

There is no shortcut to being properly trained. You and your family should be worth the proper level of care. When I hear a PA, NP, LPN, and/or paramedic bragging about how they saved money by giving their kid a medication they got from their dogs vet, I get nauseous. I always wonder if they realize their ego is short changing the ones they love...I digress and am off topic, my apologies...It is probably too late and my comments probably already called out the....FLAMMER!

As a PA, I resent your comment. How many times have you actually had any of those you mentioned say they have used Vet Meds? As a mandated reporter did you report them? (after all wouldn't that be child abuse)

PA-NP have enough access to get scripts and usually have INSURANCE so I find your comment reeking of exaggeration.

Now if you were to talk of Docs/PA/NP going to each other to get a script instead of seeing a another provider legitimately I would agree.(Hey Paul can you write me a Z-Pac...)

I wouldn't cut corners with my family.


Paul