Controlling bleeding: tourniquets and pressure

During first aid courses, we are often asked about tourniquets. Tourniquets are one way to stop severe uncontrolled bleeding, however, they are really a last resort. Generally, the first recommendation would be to diligently try to control the bleeding with direct pressure. Firm enough pressure will stop any bleeding, as long as it is firm enough and applied for long enough. Some bleeding is usually OK. It cleans out wounds. If the wound is severe, or the bleeding is prolonged, it becomes a problem. The first step in controlling a bleeding wound is to "plug the hole." Like moss on a rolling stone, blood will not coagulate when it's flowing. Regardless how severe, all bleeding can be controlled.. Most bleeding can be stopped before the ambulance arrives at the scene. While performing the steps for controlling bleeding, if it is severe enough, someone should also be calling for an ambulance to respond. The best way to stop it is to place pressure directly on the wound. Firm enough pressure will control any bleed. If gauze is available, it is preferred. Gauze pads hold the blood on the wound and help the components stick together and clot.. If you don't have gauze, any cloth will work almost as well. If the gauze or towel soaks through, add more on top Do not remove the gauze. Peeling a dressing off the wound removes vital clotting agents and encourages bleeding to resume.

Hands only CPR when help is far away..

Hands-Only CPR is a potentially lifesaving option to be employed by individuals not trained in basic life saving techniques. without immediate, effective CPR from a witness, a person's chance of survival is minimal. · AHA's 'hands-only' guidelines might not be best for rural areas though. According to new research, Hands-only CPR (CPR without mouth-to-mouth resuscitation), might not be the most effective technique for rural or remote areas or for anyone who needs to wait quite a few minutes for an ambulance. Literature reviewed by Dr. Aaron Orkin found very little evidence to support those guidelines outside of urban settings or in communities with no 911 services. His findings were revealed in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. Of the ten studies on saving lives with hands-only CPR he reviewed, only 1 included rural populations and people who had to wait longer than 15 minutes for an ambulance. a number of those studies showed that folks who waited longer for ambulances to arrive had a stronger likelihood of survival if mouth-to-mouth respiration was performed in addition to chest compressions. "Urban studies can't always be applied outside big cities," said Dr. Orkin, a doctor and graduate student attached with the University of Toronto, "Rural communities might need different CPR recommendations than urban settings," he said. http://www.carpentercprsolutions.com/1/post/2013/05/hands-only-cpr-when-help-is-far-away.html

Is more epi better?

Epinephrine is the primary drug administered per ACLS protocol to patients in asystole, PEA, and ventricular fibrillation/ pulseless V-tach. Epinephrine will increase blood pressure and coronary perfusion throughout CPR via alpha-1-adrenoceptor agonist effects. The dose, timing and indications for epinephrine use are supported based on animal data. Recent studies question whether or not epinephrine provides any overall benefit for human patients. A randomized controlled trial shows that epinephrine for out-of-hospital cardiac arrest will increase the rate of pulse return, however, it doesn't considerably alter longer-term survival. Large controlled studies suggest that, despite increases in pulse return, epinephrine reduces long-term survival (to hospital discharge.) The damaging effects were greatest in patients found in ventricular fibrillation. Laboratory information suggest that harmful epinephrine-induced reductions in microvascular blood flow throughout the arrest, and in the post-arrest patient, might offset the useful effects epinephrine-induced increase in blood pressure throughout CPR.