1. Bleeding

2. Part 1
You and your EMT partner are dispatched to a cabinet-making shop for a traumatic injury. Once on scene you find a conscious, alert, and oriented 27-year-old man bleeding heavily from his left arm. Your patient explains that he was working with the band saw when he slipped and ran his arm into the blade.

3. Part 1
He is holding a rag against the wound. The rag is saturated with bright red blood. He states that he cut his arm approximately 10 minutes prior to your arrival and has not been able to make it stop bleeding.

4. Part 1 1. What does the color of the blood suggest about the injury?
2. What steps should be taken to stop the bleeding?

5. Part 2
During the primary assessment, you note that the patient has a patent airway, is showing no signs of respiratory distress, and lung sounds are clear and equal bilaterally. You quickly dress the wound with a sterile bulky dressing. Your partner applies high-flow oxygen via a nonrebreathing mask. While holding direct pressure, you check for a radial pulse. You find the pulse to be rapid and weak. You note a capillary refill of greater than 2 seconds. The patient’s skin is pale, cool, and moist to the touch.

6. Part 2
3. What is concerning about this patient’s pulse and skin condition?
4. How do these findings affect your transport decision?

7. Part 3
Due to the amount of blood loss and your patient’s present condition, you decide on a rapid transport. While gathering additional information about the incident, you find that the dressing is becoming saturated with blood. You apply additional dressings. With your partner’s assistance, you quickly load your patient into the ambulance and begin transporting. Once in the ambulance, your patient tells you that he is feeling nauseous and light-headed.

8. Part 3
5. Should saturated dressings be removed prior to applying additional dressings?
6. What type of assessment would be most appropriate for this patient?

9. Part 4
The additional dressings you applied quickly become saturated. You apply more dressings, continue to hold direct pressure, and consider the use of a tourniquet. Fortunately, the bleeding begins to subside. With the bleeding under control, you continue with your primary assessment.

10. Part 4
Your vital signs show a rapid, thready pulse of 96 beats/min; shallow rapid respirations of 24 breaths/min; slightly dilated and sluggish pupils; and pale, cool, and clammy skin. Your patient states that he feels like he is going to vomit and is extremely dizzy.

11. Part 4
7. What condition does your patient’s signs and symptoms suggest?
8. What treatment should you provide?

12. Summary
When you are dealing with a bleeding problem, standard precautions should always be your first concern. Always ensure that you and your partner are wearing the appropriate personal protective equipment. When assessing your patient, remember that not all major bleeding is external. Consider the mechanism of injury (MOI).

13. Summary
Don’t get tunnel vision and be distracted by the obvious injury. Listen to your patients—they know better than anyone when something does not feel right. Follow your ABCs and always prepare to treat for shock. Complete a full secondary assessment if patient condition and time allow.