Understanding basic anatomy of the arteries is helpful when trying to pack a wound that is not amenable to a tourniquet, or if a tourniquet is not available.

Powerball: wadding up gauze to go directly onto the artery to build up your cork

Cork: built up gauze that you use to hold pressure on an artery

3D packing: packing gauze around your cork in the void space of the wound to keep the cork on the artery. Imagine the wound as a 3D cavity and how you would fill the space with gauze around the cork.

When wound packing, if you have hemostatic gauze be sure to use that first. If you don’t have hemostatic gauze do not panic. Proper technique trumps everything. The key is consistent directional pressure against the artery.

I like to place my Powerball on the artery once I’ve located it. Once you get this, do not release pressure on the artery. Push and replace building the Powerball into a cork. Once you have it built up a fair bit, 3D pack around the cork to keep it from falling off the artery or creating a pocket/void space for the cork to fall into as you wound pack. Remember, blood will find the path of Meath resistance. Build up the wound pack switching between the void space and the cork until the gauze is coming out of the wound. Depending on the wound pattern you may have to use multiple rolls of gauze.

I will pause once I’ve had the bleed controlled but not fully packed to ensure I’m not continuing to pack a wound that isn’t occluding the artery. Be methodical about this. Don’t just shove gauze randomly into a wound. If the bleed is not controlled partway through my pack I will readjust the “cork” back onto the artery and ensure I continue to put pressure on the artery, not the void space/tissue around the artery.

Pack gauze until you have a convex mound on top of the skin so you can more easily apply pressure. I like to use the heel of my hand using two hands and locked arms to use my bone structure. Holding pressure towards the artery, not just straight down. 5 minutes for standard gauze, 2.5 minutes for hemostatic.

After a clot has been formed apply a pressure bandage and reassess for re-bleeding after movement and periodically every 5 minutes for critical patients.

свернуть