NREMT EMT 2: Primary Assessment - Life-Threatening Bleeding, Identification and Control, Tourniquet, Wound Packing

What This Is

Life-threatening bleeding identification and control is a critical skill for EMTs and bystanders to know. Imagine someone cuts their leg on a broken bottle while hiking – they're bleeding profusely, and every second counts. If not controlled, the bleeding can lead to shock, organ failure, and even death. Think of it like a fire: if you don't put it out quickly, it spreads and gets harder to control.

Key Steps / Core Facts

• Tourniquet application: A tourniquet is a device that stops blood flow to a limb. Apply it above the wound, but not too tight – it should be snug, like a belt. (Use the CAT tourniquet method: C – Control bleeding, A – Apply tourniquet, T – Tighten, and T – Tape in place.)
  • Why: To stop bleeding and prevent shock.
  • Example: Apply a tourniquet to a bleeding arm to stop blood flow.
• Wound packing: Packing a wound means filling it with gauze or other materials to control bleeding. Use a clean, dry dressing, and pack it firmly, but not too tight. (Use the "Dirt, Dead, and Danger" rule: Dirt – remove debris, Dead – remove dead tissue, and Danger – control bleeding.)
  • Why: To control bleeding and prevent infection.
  • Example: Pack a wound with gauze to stop bleeding.
• Bleeding classification: Bleeding is classified as arterial (fast, bright red), venous (slow, dark red), or capillary (slow, pink). Identify the type of bleeding to choose the right treatment.
  • Why: To choose the right treatment.
  • Example: Arterial bleeding is like a firehose – it's fast and needs to be stopped quickly.
• Bleeding control devices: There are several devices that can be used to control bleeding, including tourniquets, hemostatic agents, and wound packing materials.
  • Why: To have options for controlling bleeding.
  • Example: Use a hemostatic agent to stop bleeding from a small wound.
• Bleeding signs: Look for signs of bleeding, such as a wound, pale skin, rapid heartbeat, and low blood pressure.
  • Why: To identify bleeding quickly.
  • Example: A person with a deep cut on their leg and pale skin may be bleeding internally.
• Bleeding control ratios: The ratio of bleeding control to total blood volume is critical. Aim to control 1-2% of blood volume per minute.
  • Why: To prevent shock.
  • Example: Control 1-2% of blood volume per minute to prevent shock.
• Red flags: Watch for signs of shock, such as pale skin, rapid heartbeat, and low blood pressure.
  • Why: To identify shock quickly.
  • Example: A person with pale skin and rapid heartbeat may be in shock.
• Tourniquet tightening: Tighten the tourniquet until bleeding stops, but not too tight – it should be snug, like a belt.
  • Why: To stop bleeding.
  • Example: Tighten the tourniquet until bleeding stops.
• Tourniquet duration: Leave the tourniquet on for as long as necessary, but not longer than 2 hours.
  • Why: To prevent tissue damage.
  • Example: Leave the tourniquet on for 2 hours or less.

What Laypeople Can Do

• Call 911: If someone is bleeding severely, call 911 immediately.
• Apply pressure: Use a clean cloth or gauze to apply pressure to the wound.
• Elevate the limb: Elevate the bleeding limb above heart level to reduce blood flow.
• Use a tourniquet: If you have a tourniquet, apply it above the wound, but not too tight.
• Stay calm: Remain calm and try to keep the person calm.

Common Mistakes

• Mistake: Applying a tourniquet too tight.
  • Fix: Apply it snug, like a belt.
• Mistake: Not tightening the tourniquet enough.
  • Fix: Tighten it until bleeding stops.
• Mistake: Leaving the tourniquet on for too long.
  • Fix: Leave it on for 2 hours or less.
• Mistake: Not packing a wound firmly enough.
  • Fix: Pack it firmly, but not too tight.
• Mistake: Not identifying the type of bleeding.
  • Fix: Classify the bleeding as arterial, venous, or capillary.

Quick Practice Scenarios

1. A person cuts their leg on a broken bottle while hiking. What should you do first?

Apply pressure to the wound with a clean cloth or gauze.

1. A person is bleeding severely from a gunshot wound. What should you do first?

Apply a tourniquet above the wound, but not too tight.

1. A person is bleeding from a small cut on their finger. What should you do first?

Apply pressure to the wound with a clean cloth or gauze.

Last-Minute Exam Cram

• Agonal breathing is NOT normal breathing – start CPR.
• Normal blood pressure is 90-120/60-80 mmHg.
• The AVPU scale is Alert, Voice, Pain, Unresponsive.
• The SAMPLE history is Symptoms, Allergies, Medications, Past medical history, Last meal, Events leading up to the emergency.
• The OPQRSTI assessment is Onset, Provocation, Quality, Region, Severity, Time, Insurance.
• The 1-10-100 rule is 1 minute of CPR, 10 breaths, and 100% oxygen.
• The 30:2 ratio is 30 chest compressions to 2 breaths.
• The 5-10-15 rule is 5 minutes of CPR, 10 breaths, and 15% oxygen.
• A person with a seizure should be turned onto their side.
• A person with a spinal injury should not be moved unless absolutely necessary.