I recently conducted advanced first aid training for a group of participants that have basic first aid knowledge ...and better than basic in some cases. It was interesting to note that some changes in Australian Resuscitation Council (ARC) guidelines had not being passed on from the training that they had done in the past.
To give you a background, the ARC are responsible for setting the main guidelines for our first aid courses to follow. This is by no means is the only major reference point, but the ARC is really the guru.
I had a question in class about bleeding and what to do if the haemorrhage is so bad that the initial padding gets soaked and the bleeding does not stop despite the mandatory pressure and elevation. My answer was to remove all padding and bandages, check that the pressure was being applied to the right area and place a new dressing over the wound, bandage and continue with the elevation.
This was quickly beaten down by a number of participants.
Now this is OK with me as I do like some debate on techniques in class. I find that whatever gives a better understanding of the topic leads to better retention and hopefully a better outcome for the patient. I asked if this technique was not taught in the last class they attended and I got a resounding no.
My mind was in overdrive, I knew I had read somewhere that this is the appropriate treatment for management of a major bleed that just won't stop, but when a few people tell you that it is wrong, you tend to second guess yourself.
You will notice that I have not mentioned tourniquet yet. The reason is that tourniquet is the last resort to arrest a haemorrhage...and we aren't quite at that point yet.
So at the lunchtime break I remembered to check the ARC guidelines just to make sure I wasn't being a complete and utter noobie. Luckily for me I was correct. The guideline basically says that if major bleeding continues after padding and bandaging and elevation, that it may be necessary to remove the pad to make sure the bleeding point has not been missed. Phew!
Another area that was questioned was with amputation and what to do with the amputated part once bleeding was under control. I had always advised to place the part in a sealed plastic bag or container and place that bag or container in a container of cold water with ice to form a type of ice slurry. The idea is to keep the part cold but not frozen and to not allow ice or water to come into direct contact with the part. I thought some research was in order as there was a bit of conjecture about the ice part.
Researching this topic I have found a large array of answers. All suggest that the amputated part be kept cold and not in contact with ice. Some advise that the part be placed in saline soaked gauze or dry gauze before being placed into the sealed bag or container. One piece of advice from the American College of Surgeons states to place the part in gauze soaked with ringers lactate (similar to Hartmann's solution) then put into a plastic container and that container into another filled with ice.
There is no advice from ARC on this matter so I have put on my practical hat and thought, what is the best way for the layperson to look after an amputated part in a first aid setting? Now this as always, does not constitute medical advice and is no substitute for completing a first aid course however, if I was looking after an amputated part and I had already controlled the bleeding I would:
- Place the part in a sealed plastic bag
- Fill a container with ice/water slurry
- Put a tea towel/towel/cloth onto the slurry
- Place the plastic bag with the part onto the cloth in the container filled with ice/water slurry
- Ensure that the part does not come in direct contact with ice or water
- Ensure part is transported with the patient if possible
I have come to this conclusion as plastic bags are readily available and the tea towel/towel/cloth will offer a little protection to the part and ensure that part does not come into direct contact with ice.
So there you have it, I have basically used Queensland Ambulance Service management of an amputated part plus evidence for other sources and added a little practicality for the first aider.
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