How To Pack An External Trauma Wound
One small positive that has come out of the war in Iraq is that the fatality rate of injured soldiers is the lowest in the history of warfare. Almost 90% of injured soldiers are surviving. There are many factors contibuting to this including the use of body armor, rapid transport out of the field to a graduated level of care, the training that
ordinary soldiers and marines receive in placing tourniquets, the use of hemostatic agents, and the increasing skill and professionalism of the field medics and trauma nurses and doctors.
The care injured soldiers now receive in the field was highlighted by a recent cover story by Time Magazine about a young urologist who is estimated to have saved 36 lives in the fighting around Fallujah, Iraq. If you read the story carefully, you will see that he actually did not really do any operating on those wounded soldiers. So, how then, did he save all those lives? He packed wounds.
When packing a wound, there are some basic tenets and steps to follow:
1. Remember that almost all external wounds can be packed sufficiently to prevent exsanguination.
2. Injured veins are easier to pack than injured arteries as the pressure needed to occlude a bleeding vein is much less and vein walls are easily compressible.
3. Most extremity arteries can also be packed – this includes the brachial artery (in the upper arm) and the femoral artery (in the upper thigh).
4. An important point to remember is that the packing has to go where the blood is originating, not where the blood is pooling. Packing is most effective when it applies “point” pressure at the injured vessel wall.
5. Packing material should be opened and spread into the thinnest layer possible before applying. It should not be applied folded or “balled up.”
6. Care should be taken to place the packing inside and under the skin edges of the wound and not just on the wound.
7. Packing should be as tight as possible or until the wound is bulging with the pack.
8. Packing can be done with many materials. Soldiers use something called an ABD which stands for army battle dressing. Soldiers have also been known to use their T-shirts and uniforms.
9. Once the pack is in place, continued manual pressure is used. Again, this should be point pressure over the area of direct bleeding with the tips of the fingers or a fist and not just “pushing down on the wound” with the palm of the hand.
10. Once the pack is in place, the experienced practitioner will almost never remove the packs until definitive care is available (that is, proximal and distal control of the bleeding has been obtained). Removing the packs can dislodge any clots that have formed and cause another hemorrhage. As packs become saturated, most practitioners will place clean packs on top.
11. The wound is sufficiently packed when the bleeding has been controlled sufficiently to allow the patient to make it to the next level of care without exsanguination. It does not have to completely control all bleeding (which may be coming from bleeding skin edges).
12. The key to packing a wound for beginning medics and trauma surgeons is staying cool under pressure and not panicking when seeing the first gushes of blood. In major vessel injuries, the first packs will undoubtedly be placed in a field with seemingly uncontrollable hemorrhage.
Copyright 2006 Insidesurgery.com