Catastrophic Haemorrhage

Scenario:

You are doing some winter mountaineering in the Alps. A member of your group slipped on a steep section and slid down a snowy slope. They did not ice-axe arrest correctly and impaled themselves on their ice axe. As soon as the severity of the injury is seen, emergency help is called for. 

D – on steep terrain the other members of your group could be at risk. Safety of rescuers remains the priority.
R – patient is mumbling in response to voice.

(C) – blood all over the floor from a gushing wound in the thigh from an ice axe (keeps bleeding until tourniquet applied)

A - Airway is patent

B - RR – 30, O2 sats – 98%, equal chest expansion.

C - BP – 120/80mmHg, HR – 150bpm, central capillary refill < 2 sec, peripheral capillary refill > 2 sec

D - Cold is a priority as it increases coagulopathy, BM 6.3, pupils equal and reactive to light.

E - Full top-to-toe survey checking for other bleeds – bleeding from a wound on his back.

Priorities:

· Stop the bleeding (direct pressure, wound-packing, pressure dressings like Olaes or Israeli, haemostatic agents like Celox, tourniquet)

· Keeping the casualty warm and insulated.

· EVAC plan needs to be made

· Finding the secondary wound

· Consider IV access and weigh up fluids if available in your kit.

· Consider TXA if available in your medical kit

Casualty deterioration:

Casualty becomes unconscious – what do you need to do? Re-assess A-E:

D - as before.

R - casualty is no longer responsive to voice, responsive to pain.

A - Airway is patent

B - RR – 35, O2 sats – 92%, equal chest expansion.

C - BP – 80/30mmHg, no longer has a radial pulse. HR at carotid – 150bpm, central cap refill > 2 sec, peripheral cap refill > 2 sec.

Priorities:

IV and give 250ml fluid boluses to maintain a radial pulse

Keep the casualty warm

Communicate the casualty deterioration to any rescuers.