What helps with stopping bleeding?

Management of Bleeding: Effective Strategies for Hemostasis

Direct pressure is the first-line intervention for controlling external bleeding, followed by tourniquets for severe limb hemorrhage when direct pressure fails. 1

Initial Approach to Bleeding Control

External Bleeding

1. Direct pressure to the bleeding site 1

   • Apply firm, continuous pressure directly to the wound until bleeding stops
   • Use gauze, cloth, or other available material
   • Maintain pressure for at least 3-5 minutes to allow natural hemostasis

2. For severe limb hemorrhage that doesn't respond to direct pressure:

   • Apply a tourniquet proximal to the bleeding site 1
   • Note the time of application and communicate this to emergency services
   • Re-evaluate the effectiveness and necessity of the tourniquet as soon as possible 1
   • Consider hemostatic dressings when standard bleeding control is ineffective 1

3. For wounds with difficult compression:

   • Consider local cold therapy for injuries to extremities or scalp 1
   • Use caution with cold therapy in children due to hypothermia risk 1

Critical Points

• Pressure points and limb elevation are NOT recommended for bleeding control 1
• Tourniquets should be applied by trained individuals 1
• Minimize time between injury and intervention for ongoing hemorrhage 1

Management Based on Bleeding Severity

Life-threatening Bleeding

1. Immediate actions:

   • Control obvious bleeding points (pressure, tourniquet, hemostatic dressings) 1
   • Secure large-bore IV access 1
   • Administer high-flow oxygen 1
   • Draw baseline blood tests (CBC, coagulation studies) 1
   • Maintain systolic blood pressure of 80-100 mmHg until bleeding is controlled 1
   • Warm the patient and all transfused fluids 1

2. Pharmacological interventions:

   • Consider tranexamic acid: 10-15 mg/kg followed by infusion of 1-5 mg/kg/h 1, 2, 3
   • For patients on anticoagulants, follow specific reversal protocols 1

Non-life-threatening Bleeding

1. Continue direct pressure 1
2. Provide local therapy and supportive care 1
3. Assess for and manage comorbidities that could contribute to bleeding 1

Special Considerations

Bleeding in Anticoagulated Patients

1. Stop the anticoagulant 1
2. Provide local therapy/manual compression 1
3. For vitamin K antagonists:
   • Consider vitamin K administration (IV or oral) 1
   • For severe bleeding, consider prothrombin complex concentrates 1, 4

Bleeding Disorders

1. Administer specific factor replacement or DDAVP as indicated on emergency care cards 5
2. Consult hematology early 5
3. Consider recombinant factor VIIa for critical bleeding in specific situations 1, 4

Anorectal Bleeding

1. Check vital signs, hemoglobin, hematocrit, and coagulation status 1
2. For severe bleeding, perform blood typing and cross-matching 1
3. Maintain hemoglobin >7 g/dL and mean arterial pressure >65 mmHg 1

Organizational Aspects for Hospital Settings

1. Hospitals must have a major hemorrhage protocol 1

2. Designate clear roles:

   • Team leader to coordinate management
   • Communications lead to liaise with laboratories
   • Personnel for securing IV access and transporting blood products 1

3. Ongoing assessment:

   • Look for obvious and internal blood loss
   • Assess physiology (skin color, heart rate, blood pressure, capillary refill, consciousness) 1

Pitfalls and Caveats

• Delay in controlling bleeding significantly increases mortality 1
• Excessive fluid resuscitation before hemorrhage control can worsen outcomes 1
• Tourniquets left in place too long can cause tissue damage; reassess frequently 1
• Don't underestimate internal bleeding when external bleeding appears controlled
• For patients with bleeding disorders, administer specific treatments before pursuing investigations 5

By following these evidence-based approaches to bleeding control, you can effectively manage hemorrhage and improve patient outcomes.