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Skin Hemorrhage Management

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Skin Hemorrhage Management, Control of External Bleeding

  • See Also
  1. Hemorrhage Management
  1. Apply direct manual pressure to external bleeding sites
    1. Focal, isolated manual pressure is the most important single measure for compressible Hemorrhage
    2. No amount of gauze can replace the directed manual pressure of a finger or hand over a external Hemorrhage site
    3. When controlled, pressure dressing may replace manual pressure (see below)
      1. Observe closely for continued bleeding after manual pressure is replaced with pressure dressing
      2. Reapply direct, focal manual pressure if bleeding recurrs despite pressure dressing
  2. Pressure dressing may replace manual pressure if it adequately controls bleeding
    1. Israeli Bandage is elastic wrap with gauze impregnated with clotting agent
    2. Sanitary napkins or pads may also be used with overlying direct pressure at wound site
    3. Small ball of gauze directly overlying Hemorrhage applied under pressure dressing
    4. Maintain direct pressure over bandage as needed to control bleeding
  3. Focal Rapidly bleeding sites (e.g. Scalp Wounds)
    1. See Scalp Laceration
    2. See Wound Repair
    3. See Finger Wound Hemostasis
    4. See Figure of Eight Suture
    5. Attempt to staple or Suture wound
  • Management
  • Hemorrhage Refractory to Local Measures
  1. See Hemorrhage Management
  2. Notify Trauma surgery of emergent surgical intervention for rapid, uncontrolled bleeding
  3. Consider occult Hemorrhage sources (see above)
  4. Tourniquet (Pneumatic Tourniquet or Windlass Tourniquet)
    1. Indicated for rapid extremity bleeding not controlled with direct manual pressure
    2. Temporizing only until surgical intervention within 1-2 hours
    3. Permanent ischemic injury occurs if Tourniquet left in place >4-5 hours
    4. Ineffective in junctional sites (e.g. axilla, groin, adductor canal)
    5. Obviously unusable at neck and trunk
  5. Topical Hemostatic Agent (Chitosan Dressing, Zeolite Mineral Dressing, Kaolin Mineral Dressing)
    1. Indicated for rapid bleeding in sites where Tourniquets cannot be used (see above)
    2. Not widely available outside of military and large Trauma Centers as of 2013
    3. Risk of wound contamination with hemostatic agent
  6. Foley Catheter
    1. Inserted into a bleeding wound site
    2. Balloon inflated with Normal Saline
    3. May be effective at bleeding sites where Tourniquets may not be used
      1. Consider at junctional sites (e.g. groin, neck)
  7. XStat (RevMedX, limited efficacy and safety data)
    1. FDA approved for gun shot wounds in 2014
    2. Syringe filled with small, compressed cellulose sponges
    3. Syringe applicator inserted at exsanguinating gun shot wound
  • References
  1. Freeman and Bourland (2021) Crit Dec Emerg Med 35(12): 3-11
  2. Kim, Tran, Lopez (2018) Crit Dec Emerg Med 32(12): 19-25
  3. Herbert and Alson in Herbert (2016) EM:Rap 16(2): 18
  4. Herbert (2012) EM:RAPC3 2(1): 1-2
  5. Petrosoniak and Swaminathan (2022) EM:Rap 22(11): 5-7
  6. Ringhauser (2019) Crit Dec Emerg Med 33(6): 19-25
  7. Shinkle and Ponce (2016) Crit Dec Emerg Med 30(8): 13
  8. Swaminathan and Shoenberger (2021) EM:Rap 21(8): 1
  9. Swaminathan and van de Leuv (2013) Crit Dec in Emerg Med 27(8): 11-17
  10. Swadron and Inaba in Herbert (2014) EM:Rap 14(12): 5
  11. Weingart and Swaminathan in Herbert (2021) EM:Rap 21(3): 5-8