What is the management of bleeding?

From the Guidelines

The management of bleeding involves applying direct pressure to the wound using a clean cloth or bandage for at least 15 minutes without removing it to check bleeding status, as recommended by the most recent and highest quality study 1. The approach to managing bleeding should prioritize controlling blood loss while minimizing the risk of further injury or complications.

• For severe bleeding, elevate the injured area above heart level if possible while maintaining pressure.
• If bleeding persists despite direct pressure, apply pressure to the appropriate arterial pressure point (such as the brachial artery for arm wounds or femoral artery for leg wounds).
• For significant bleeding, use a tourniquet only as a last resort, placing it 2-3 inches above the wound and tightening until bleeding stops, noting the time of application.
• Hemostatic agents like QuikClot or Celox can be applied directly to wounds when available. Once bleeding is controlled, clean the wound with saline or clean water and apply an appropriate dressing. For internal bleeding, which may present as bruising, pain, swelling, or signs of shock (rapid pulse, low blood pressure, confusion), immediate medical attention is essential. Medical professionals may use interventions including intravenous fluids, blood transfusions, vitamin K, tranexamic acid (loading dose 1g over 10 minutes, followed by 1g over 8 hours) 1, prothrombin complex concentrates, or surgical intervention depending on the cause and severity of bleeding. The use of tranexamic acid is supported by recent studies 1 as an effective and safe antifibrinolytic agent in cases of severe bleeding. Prompt recognition and appropriate intervention are critical as significant blood loss can rapidly lead to hypovolemic shock and organ damage. In cases of bleeding associated with antiplatelet therapy, etiological treatment of bleeding is essential, including haemostatic procedures and symptomatic treatment of haemorrhage, as outlined in recent guidelines 1.

From the FDA Drug Label

When dilutions are indicated, administration should be started immediately after mixture with the diluent, and unused portions of the dilution should be discarded, as well as unused contents of the ampul. In the event of shock or excessive blood loss, the use of whole blood or component therapy is indicated. Whole blood or component therapy may also be necessary if bleeding is severe. The management of bleeding may involve the use of whole blood or component therapy if bleeding is excessive or severe 2, 2.

• Vitamin K1 Injection may be given to correct anticoagulant-induced prothrombin deficiency or hypoprothrombinemia due to other causes.
• The dosage of Vitamin K1 Injection depends on the severity of the condition and response obtained.
• Phytonadione will not counteract the anticoagulant action of heparin.

From the Research

Management of Bleeding

The management of bleeding is a critical aspect of trauma care, as uncontrolled bleeding can lead to significant morbidity and mortality. Several studies have investigated the effectiveness of various interventions for controlling bleeding.

• Tranexamic acid: High-dose continuous infusion of tranexamic acid has been shown to be effective in controlling life-threatening bleeding in advanced cancer patients 3.
• Fresh frozen plasma: The use of fresh frozen plasma in combination with tranexamic acid or prothrombin complex concentrate has been found to improve resuscitation and clotting parameters in a porcine hemorrhagic shock model 4.
• Tourniquets: Tourniquets have been associated with a decrease in mortality when compared with direct manual pressure for controlling severe, life-threatening external bleeding 5.
• Hemostatic dressings: Hemostatic dressings have been found to result in a shorter time to hemostasis than direct manual pressure using standard dressings 5.
• Direct pressure: Direct pressure remains the most effective "medical" intervention for initial hemorrhage control, and should be used in conjunction with other methods of control, such as elevation and splinting of the affected extremity 6.

Bleeding Control Techniques

Several techniques can be used to control bleeding, including:

• Direct manual pressure: Applying direct pressure to the bleeding site to control hemorrhage 5, 6.
• Tourniquet application: Using a tourniquet to occlude blood flow to the affected limb 5, 6.
• Hemostatic dressings: Applying a hemostatic dressing to the bleeding site to promote clotting 5.
• Pressure dressings/bandages: Using a pressure dressing or bandage to apply pressure to the bleeding site 5, 6.
• Elevation and splinting: Elevating and splinting the affected extremity to reduce blood flow and promote clotting 6.

Training and Education

Training and education are critical components of bleeding control, as they can empower individuals to act quickly and effectively in emergency situations. The "Stop the Bleed" training program has been shown to increase participants' willingness and preparedness to intervene in a casualty event, as well as their knowledge of trauma and hemorrhage control 7.