finger, ‘The subclavian is compressible against the first rib behind the middle of the clavicle. The shoulder is slightly raised to relax the cervical fascia and the finger or a padded stick pushed directly down upon the artery behind the clavicle. The circulation of the entire upper extremity is thus controlled. <Callout type="tip" title="Tip">Always raise the limb to reduce blood flow before applying pressure.</Callout> The brachial is compressible against the middle of the humerus or the tourniquet may be applied over any part of the artery (Fig. 51). The radial and ulnar are not compressible except just above the wrist; and, therefore, bleeding from them must be controlled by direct pressure in the wound, or by the tourniquet, or by compression of the <Callout type="warning" title="Warning">femoral artery.</Callout> The palmar arches are not directly compressible, but hemorrhage from the palm is controlled by grasping firmly a round body as a billiard ball, an apple, a stone wrapped with gauze, and bandaging the <Callout type="important" title="Important">limb to secure pressure.</Callout> The digital arteries are always easily controlled finger above the wound. <Callout type="risk" title="Risk">Improper application can lead to tissue damage or necrosis.</Callout> The femoral artery is compressible in the middle of the groin, but great pressure is required to stop its flow (Fig. 52). It may likewise be compressed by a tourniquet applied over the ramus of the pubes. <Callout type="gear" title="Gear">A proper tourniquet should be used for femoral artery control.</Callout> The popliteal is not compressible. Bleeding must be controlled by direct pressure or by compression of the femoral. The fibials likewise. They may also be controlled by knee forcibly upon a pad, holding the pad in place by an elastic bandage around the flexed leg (see Fig. 103, p. 152). <Callout type="tip" title="Tip">Ensure the pad is well secured to avoid slippage.</Callout> The dorsal and plantar arteries can best be controlled by direct pressure or by compressing the tibials and peroneal as they cross the ankle. <Callout type="risk" title="Risk">Improper compression may cause nerve damage.</Callout> The arteries of the surface of the trunk most likely to produce dangerous hemorrhage are the internal mammary, the intercostals, and the deep epigastric. These can be controlled temporarily only by direct pressure, either with the finger or gauze packing. <Callout type="important" title="Important">Always use a clean, sterile gauze for packing.</Callout> The method of compressing the intercostal is represented in Fig. 53. EPISTAXIS, Epistaxis is a form of hemorrhage often troublesome and requiring special treatment. It may occur in one or both nostrils (Walviom). <Callout type="tip" title="Tip">Stay calm to reduce blood pressure.</Callout> The simpler cases are relieved by the crect position, holding the arms above the head, by the reflex effects of cold to the back of the neck, or by pressure over the root or sides of the nose. If these measures fail, the nostril may be syringed with certain solutions: hot water; antipyrin, 5 to 10 per cent., which is especially recommended in the Am. Text-Book of Surgery; adrenalin, 1 to 1000. The patient must not blow his nose, as this eliminates the clot. In the more severe cases try tamponing the anterior nares. If a nasal speculum and a good mirror light are available, the anterior nares may be systematically plugged through the speculum with adrenalin. gauze; or, by such means, the bleeding point may be discovered and touched with the point of the cautery, with silver nitrate, or with chromic acid. The International Journal of Surgery gives this practical suggestion: a layer of cotton is wound around a pen holder until the desired thickness is obtained and then withdrawn, The cotton cylinder is then moistened, squeezed dry, and inserted into the nasal cavity. If the projecting end is now moistened, it will swell up and thus produce sufficient compression. <Callout type="warning" title="Warning">Ensure the tampon does not dislodge and enter the airway.</Callout> These various measures fail, then the posterior nares may be plugged. For this purpose, in emergencies, an ordinary soft catheter is available, in lieu of the Bellocq cannula (Fig. 103). The thread is passed directly backward through the inferior meatus until its point emerges below the soft palate. <Callout type="important" title="Important">Always use a sterile catheter to avoid infection.</Callout> The thread is drawn out through the mouth, and held while the catheter is withdrawn. One end of the thread projects from the nostril and other from the mouth, and a pledget of cotton is tied to this latter: <Callout type="risk" title="Risk">Improper placement can cause airway obstruction.</Callout> Any plug put into the anterior nares must be secured by a silk thread, lest, becoming dislodged, it may drop into the larynx. Tie plugs must not be left in for more than two days, and should be moistened before removal with a mild antiseptic solution. <Callout type="tip" title="Tip">Regularly check on the patient to ensure the plug is secure.</Callout> J. A.M.A., March 13, 1999) describes a case of serious bleeding from the nasal cavity treated with perborate of soda. A strip of moist borated gauze 1/2 inch wide was covered with powdered perborate of soda and packed tightly into the anterior nares. The hemorrhage ceased immediately. The perborate may be insufflated directly into the cavity. A grayish-white foam immediately issues, nascent oxygen is liberated, and the bleeding checked.
Key Takeaways
- Use limb elevation to reduce blood flow before applying pressure.
- Proper tourniquet application is crucial for femoral artery control.
- Direct pressure and gauze packing are essential for controlling surface trunk arteries.
- Nasal tamponade techniques can be life-saving in severe epistaxis cases.
Practical Tips
- Always use a clean, sterile gauze when applying direct pressure to wounds.
- Raise the injured limb to reduce blood flow before applying tourniquets or other compressions.
- Ensure that any nasal tamponade is properly secured and monitored for dislodgement.
Warnings & Risks
- Improper application of a tourniquet can lead to tissue damage or necrosis.
- Tampons in the nose must be carefully managed to avoid airway obstruction.
- Leaving nasal tampons too long can cause complications such as infection.
Modern Application
While many of these techniques are still applicable today, modern medical practices have improved on equipment and sterilization methods. Understanding these principles remains crucial for survival in remote or emergency situations where immediate access to advanced medical care is unavailable.
Frequently Asked Questions
Q: How can I properly apply a tourniquet?
Always raise the limb before applying a tourniquet, and ensure it is tight enough to stop blood flow but not so tight as to cause tissue damage. Use a proper tourniquet if available.
Q: What should I do if direct pressure doesn't stop bleeding?
If direct pressure fails, consider using a tourniquet or applying additional pressure with a clean cloth or bandage. Always try to elevate the injured limb first.
Q: How can I treat severe epistaxis at home?
For severe nosebleeds, use direct pressure on the nostrils and apply cold compresses to the back of the neck. If these methods fail, consider using a moistened gauze tampon inserted into the nasal cavity.