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Old December 4, 2005, 10:30 PM   #1
SevenRoundMags
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How to stop gunshot wound bleeding

Something I thought about today, and thought this would be the best place to ask. Whats the best way to stop bleeding from any kind of puncture wound, specifically a gunshot wound? Do you simply put your finger into the permanent wound cavity? Is it better to use a cloth or medical gauz? After plugging the wound (if that is indeed the best way) whats the next step?

thanks.
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Old December 4, 2005, 10:46 PM   #2
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Speaking as someone who did the paramedic thing for a while, although it depends on the location of the wound, what is injured, what made the wound, what resources are immediately available, etc., but usually the best thing is to apply pressure over the wound with a piece of absorbent cloth. The next best step is to call 911 and wait for the friendly people in the large van with lights on it. They will take you to the nearest appropriate hospital for definitive treatment.
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Old December 4, 2005, 10:48 PM   #3
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Any type of clean padding, preferably gauze, trauma dressing, or a bunch of gauze pads applied with direct pressure directly over the wound. If that does not staunch the bleeding then you need to try and elevate the wound if possible. If elevation isn't working, then you move onto going to direct pressure with pressure point pressure. The "last resort" is a tourniquette.
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Old December 4, 2005, 11:03 PM   #4
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my corpsman once told me that the smaller teen tampons are perfect for 7.62 bullet holes
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Old December 4, 2005, 11:07 PM   #5
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So are you supposed to apply pressure on top of the hole, or actually go INTO the hole? Also, what if you have no materials available? Could you just shove your finger into the wound? I know it sounds strange, but would it work? And what do you mean by elevate?
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Old December 4, 2005, 11:14 PM   #6
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Internal bleeding would most likely be the real problem; not much you can do about that in the field, except treat for shock. Chest wound problem would probably be tension pneumothorax (collapsed lung). Seal the wound with anything airtight, tape, cellophane from cigarette wrapper, etc. etc. Maintian airway & CPR if necessary.
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Old December 4, 2005, 11:23 PM   #7
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Just thinking as a Boy Scout, here, with no formal training, I would think that the tampon IN the wound would slow internal bleeding, in addition to pressure on the entry area. I think pressure on the entry area would not do much to slow the bleeding internally, particularly on a through-and-through wound. You could still be losing a LOT of blood.

I think if there is danger of bleeding out, the tampon thing would be best. If no immediate danger of bleeding out, external pressure is fine.

But hey, my opinion is no better than yours.
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Old December 4, 2005, 11:26 PM   #8
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To elevate a wound is to get it above the level of the heart in relation to the ground. So if lil Billy shot himself in the foot, he should probably lay down with his foot propped up on something while pressure is applied to he hole he made.

Something useful for wounds in limbs, but of limited use in COM cases.

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Old December 5, 2005, 12:03 AM   #9
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Quote:
Chest wound problem would probably be tension pneumothorax (collapsed lung). Seal the wound with anything airtight, tape, cellophane from cigarette wrapper, etc. etc. Maintian airway & CPR if necessary
You do not want to seal the wound completely. You want to use a bandage that is sealed only on 3 sides. One side of the bandage needs to be left open to allow pressure form the chest cavity to escape during exhalation. A completely sealed bandage will cause the pneumothorax to become worse since the pressure can not leave the chest cavity.

COM shots typically create some real heavy internal trauma. What you need is plenty of direct pressure on the wound, front and back, and my ALS bus on scene very quickly!!
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Old December 5, 2005, 12:06 AM   #10
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I dont know if this is smart to do but in a desperate emeracy in one survival book I read if your bleeding heavily in a deep cut on your arms or legs or in another non-chest area, They suggested that you burnt the wound to seal it

I dont know if this would work for a gunshot wound but I would imagine it could. IT would hurt quite badly though but if your in the middle of nowhere it would be better then slowly bleeding to death I would imagine.

Only way I'd ever do this is if I am moose hunting since the closest hospital is a long chopper ride away from the closest town to Thunder Bay. And the fact I am out in the middle of nowhere in the bush doesnt help ether.

I guess getting burnt in the inside and out sealing the wound might be better in a no hope to get to a hospital situation but reading this in exactly one survival book only makes me wonder if it would actually work or not. Mind you I have heard this from other people I know that it would work and they are reliable most of the time thats the only reason I am mentioning this

Can any of you comment on this ??

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Old December 5, 2005, 12:12 AM   #11
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+1 for Gddyup

If gauze is not available, fabric or cloth will do (t-shirt, bedsheet, etc).

You want to stop the bleeding and not cause more damage. If the wound is at a limb elevate it above the heart

Tampoons???? Can any ladies help me out here. If you put a tampoon or a diaper in water it expands A LOT. This may rip the wound open more, or expand down into the wound. Sure it might stop the bleeding, but now you have a foriegn object spreading deeper into the wound, causing internal damage.

Finger in the bullet hole, sure if it fits, but again you don't want to cause more damage. Stop the bleeding, but don't shove your finger in past the first knuckle.
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Old December 5, 2005, 12:49 AM   #12
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Quote:
You do not want to seal the wound completely. You want to use a bandage that is sealed only on 3 sides. One side of the bandage needs to be left open to allow pressure form the chest cavity to escape during exhalation. A completely sealed bandage will cause the pneumothorax to become worse since the pressure can not leave the chest cavity.
Huh! Thanks, I didn't know that! Of course, my EMT training is a little outdated... by about 2 decades!
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Old December 5, 2005, 12:59 AM   #13
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I'm thinking "no tampons"

They do expand, yes, and the issue is not just to soak up the blood but to try and control the bleeding. I've always been taught in first aid classes to put pressure on the wound. Fingers only go into wounds in the most extreme of cases (like maybe a femoral artery's blown to bits? IDK....some of the emt's on here are going to have to elaborate on that)

But ix-nay on the ampons-tay. Besides, do you REALLY want to carry them around in YOUR POCKETS??? Hee hee.

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Old December 5, 2005, 01:07 AM   #14
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The first thing to do is secure the scene. Ceasefire and weapons are cold/unloaded. Leave the weapon involved in the shooting alone, treat it like a viper. Call or send someone for help. Calm the shooting victim. Check the ABCs. Airway, breathing and circulation. Tilt their head slightly back to open the airway. Make sure they are breathing normally, or not. Check the carotid artery in the neck for a good pulse. If there is severe bleeding such as 3' spurts of blood, you have arterial bleeding. Locate where it is coming from. If it is below the knee, apply a rifle sling or belt at least 1" wide about 3" above the woundsite. Slowly apply prssure until the bleeding slows/stops. Apply a topical dressing of clean material and wait for EMS. Use an inkpen or magic marker to place TK on the forehead in large letters, the time applied and the location. If there is little bleeding, that usually indicates internal bleeding. The only thing you can do is treat for shock. Keep the shooting victim warm and monitor the ABCs. Do NOT give the shooting victim anything by mouth, no liquids especially alcohol. A great and gaping wound usually presents more of an infection risk than anything else. Apply a clean topical dressing and treat for shock while monitoring the ABCs. If there are bowels hanging out, DO NOT push them back inside! Apply dampened topical dressing, treat for shock and monitor the ABCs. If a hand, foot, leg or arm are severely damaged or partially amputated, elevate the wound above the heart, if there is NOT arterial spurting, DO NOT apply a constrictive device. Apply a topical dressing and use the nearest pressure point to control bleeding. The main thing is to remain composed and call/send for help. If the shooting victim stops breathing, tilt the head back to open the airway. Look for breathing by watching the chest. Listen for breathing with your ear close to their face. Feel for breathing by placing your hand on their abdomen/belly. If there is NO breathing, keep their head tilted back, pinch their nostrils(nose) closed with your hand and place your mouth over theirs. Breathe out and push your breath into them. Do this twice and then look, listen and feel again. If they are still not breathing, give them mouth to mouth at a rate of 1 breath every 5 seconds or 12/minute. CPR is no biggie either. After 1 minute, check the carotid pulse in the neck. If there is no pulse, chest compressions will be added to the mouth to mouth. You simply locate the Xiphoid process which is where the ribs come together. Yo place the heel of your hand two finger widths above the xiphoid process. Place the other hand on top and compress down. You don't use your upper body, you actually lock your elbows and use your upper body mass to lean down. Compress roughly 2" deep and give 15 chest compressions in a row and then 2 mouth to mouth breaths. Continue until aid arrives. There may (should be) a AED or heart shock machine available. Follow the simple directions. There are tons of medical supplies at www.galls.com
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Old December 5, 2005, 01:16 AM   #15
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Others touched on exit wounds. You may have to hunt for one. Look the shooting victim over from front to back, side to side, top to bottom and diagonally also. A bullet can be deflected by a hip and come out anywhere.
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Old December 5, 2005, 06:01 AM   #16
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Tx of GSW's is based on anatomic region.


The tampon thing is off key...Pressure is the way to go on most.

As for the 3-sided tape thing (chest inj)...That is difficult sometimes, at best. Often cited to avoid the victim developing a tension pneumothorax.

In an urban setting (where EMS is usually minutes away), sealing a chest wound is probably easier, and the victim is going to get a chest tube anyway

Don't forget the neck...Neck wounds must be sealed.

Just .02 from an old operator


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Old December 5, 2005, 08:11 AM   #17
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Gsw

Speaking as a Paramedic the way to go is direct pressure and lots of it if cloth is blood soaked add another don't remove old dressing. What we use to carry in the ride for such occasions was a box of Kotex pads. For an extremity use the elastic bandages to apply pressure and depending on the location of the wound call 911 or if it's faster load an go ASAP to nearest hospital.
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Old December 5, 2005, 09:12 AM   #18
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I haven't tried this myself yet, but I recently read that Cayenne pepper stops bleeding:
http://www.healthcentral.com/peoples...408/53728.html
Doesn't sound like a whole lotta fun though.
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Old December 5, 2005, 09:36 AM   #19
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ptx

gddyup and Capt Charlie,
This is not a complete list of what to do when you have a thoracic puncture, but to add to what you are saying:
After sealing the wound, lay with the WOUNDED side down! That way, blood will come OUT the wound and not fill the chest cavity, which would eventually kink off the blood vessels to the heart, killing you.

yes, laying on the wound will hurt.

But it also gets the blood to pool in your head, where you need it; forces you to lay down which slows your heart and respirations, lessening their impact on the ptx; puts you in one spot for rescuers to find you; etc.

C-
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Old December 5, 2005, 10:11 AM   #20
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I was taught....

....the simple three. Direct pressure, pressure point, tourniquet. Escalate only when it's obvious it's not working, and don't pull anti-common sense stuff like a neck tourniquet either.
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Old December 5, 2005, 10:20 AM   #21
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what about....

Doesn't the military, medics, others carry that substance that clots and shuoldn't be removed until the individual is at a hospital medic station?

I thought you could purchase them (kind of spendy) but it was a packet that mixed with the blood and became hard.

?????
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Old December 5, 2005, 10:34 AM   #22
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Quote:
Originally Posted by BatmanX
Doesn't the military, medics, others carry that substance that clots and shuoldn't be removed until the individual is at a hospital medic station?
I belive you are referring to "QUICKCLOT"...A sawdust-like powder that works my removing ALL H20 (causes exothermic reaction) from blood at the sight of a hemmorrhage, thus leaving raw thrombin/clotting factors at the wound site.

Advantages:

Non-Compressable hemmorhage...Pour in and direct pressure over it

CAUTION:

- It gets REALLY HOT when applied...Has caused burns in some
- Beware when using in windy conditions...One grain in your eye...(see above)
- You have to have "eyes on the bleeder"...If you dump it into a bullet hole, it may not work that well...

There is more...

Quote:
Originally Posted by BatmanX
I thought you could purchase them (kind of spendy) but it was a packet that mixed with the blood and became hard.
Yes, Z-Medica offers Quickclot OTC...

But, it is a tool...not a "Magic Bullet" in trauma care...

Yes, when the exothermic reaction "cools" the quickclot will harden at the wound site.




?????
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Old December 5, 2005, 10:36 AM   #23
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thanks weeg...

Woud you suggest having it then?
Does it expire?

I believe more people survive gunshot wounds than stabbings, so would it be just fluff and a nicety in a situation? Or would it actually be beneficial?
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Old December 5, 2005, 10:49 AM   #24
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Batman...

Unless you are well trained in it's use, NO...There are inherent dangers involved.

As mentioned earlier, sometimes the basics (direct pressure, etc) are the best.

Hope this helps,

RW
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Old December 5, 2005, 11:19 AM   #25
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