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From an article by Andrew Fisher
Massive hemorrhage is strictly about massive hemorrhage, the treatments include tourniquet application, which should be the first treatment applied in true massive hemorrhage. It is not unreasonable to apply a pressure bandage, if you do it should be a hemostatic dressing for compressible hemorrhage not amenable to limb tourniquet use or as an adjunct to tourniquet removal. Junctional tourniquets and the use of XSTAT® is also approved to control massive hemorrhage.
Hemorrhage is the leading cause of preventable death in combat. Bellamy (Figure 1) found that massive hemorrhage from extremities comprised over 9% of the all deaths in Vietnam. However, of the leading three causes of preventable death, it was about 60%. Similarly, Eastridge et al. (Figure 2) found 91% of the potentially survivable patients died from hemorrhage. This is directly relatable to the civilian sector. Since 2001, there have been over 2,000,000 deaths from trauma.
Over the last 10 years in the United States, there have been over 400,000 potentially survivable deaths, most of which were hemorrhage. Hesitation to immediately address massive hemorrhage is a significant reason to immediately apply a tourniquet. The easiest, quickest, and most efficient method of hemorrhage control is by tourniquet application. If after addressing life threats, it is determined that the hemorrhage did not need a tourniquet, it can be converted.
Two hours of tourniquet time is safe and they are used on a regular basis in orthopedic surgeries. Finally, there is no discussion of fluid resuscitation during the identification and treatment of massive hemorrhage.
When is bleeding life-threatening?
- There is pulsatile or steady bleeding from the wound.
- Blood is pooling on the ground.
- The overlying clothes are soaked with blood.
- Bandages or makeshift bandages used to cover the wound are ineffective and steadily becoming soaked with blood.
- There is a traumatic amputation of the arm or leg.
- There was prior bleeding, and the patient is now in shock (unconscious, confused, pale).
How long does it take to bleed to death from a complete femoral artery and vein disruption?
- Casualties with such an injury can bleed to death in as little as 3 minutes