What is the management of an arterial hemorrhage?

From the Guidelines

To treat an arterial bleed, immediately apply direct pressure to the wound using a clean cloth, gauze, or your hand if nothing else is available, and consider the use of a tourniquet if bleeding is severe and doesn't stop with direct pressure, as recommended by the most recent guidelines 1. When treating an arterial bleed, it is crucial to prioritize immediate actions that control the bleeding and maintain the patient's vital signs.

• Apply direct pressure to the wound for at least 15 minutes without lifting to check the wound.
• Elevate the injured area above the level of the heart if possible.
• Use a tourniquet if necessary, applied 2-3 inches above the wound, and note the time of application.
• Call emergency services immediately, as arterial bleeding is life-threatening. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1 provides the most recent and comprehensive recommendations for managing arterial bleeding, including the use of tranexamic acid, fluid resuscitation, and damage-control surgery.
• Tranexamic acid should be administered as soon as possible to the trauma patient who is bleeding or at risk of significant bleeding.
• A restricted volume replacement strategy with a target systolic blood pressure of 80-90 mmHg should be employed until major bleeding has been stopped.
• Damage-control surgery should be performed in the severely injured patient presenting with haemorrhagic shock, signs of ongoing bleeding, coagulopathy, vascular and pancreatic injuries. It is essential to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to consider the most recent and highest-quality evidence available, such as the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1.

From the Research

Treating an Arterial Bleed

• Arterial bleeds are a serious medical condition that requires immediate attention to prevent excessive blood loss and potential death.
• Various methods can be used to control bleeding, including the use of tourniquets, tranexamic acid, and blood transfusions.

Methods for Controlling Bleeding

• Tourniquets can be used to control bleeding in limb injuries, but their effectiveness in reducing mortality and blood product use is still being researched 2.
• Tranexamic acid is an antifibrinolytic agent that has been shown to be effective in reducing blood loss and the need for blood transfusions in various clinical settings, including trauma and surgery 3, 4, 5.
• The combination of tranexamic acid and tourniquet use has been shown to be effective in reducing blood loss and transfusion needs in certain surgical procedures, such as total knee arthroplasty 6.

Blood Transfusions

• Blood transfusions can be used to replace lost blood and help stabilize the patient, but they carry their own risks and complications.
• The use of prehospital blood products, including packed red blood cells, has been shown to improve survival in injured patients at risk of hemorrhage 3.

Treatment Approaches

• The treatment approach for an arterial bleed will depend on the severity of the injury, the location of the bleed, and the patient's overall condition.
• A combination of methods, including tourniquet use, tranexamic acid administration, and blood transfusions, may be used to control bleeding and stabilize the patient.
• Further research is needed to determine the most effective treatment approaches for arterial bleeds and to optimize patient outcomes 3, 2.