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Care of Clients in Cellular Aberrations,

Acute Biologic Crisis (ABC), Emergency and Disaster Nursing
(NCM106)
Acute Biologic Crisis I

Acute Biologic Crisis
Historical Background
Early development of Emergency Medical Service (EMS) was initiated on July 21, 1861 after the medical
care and evacuation disaster experienced by the Union Army of Potomac at Bull Run (North Virginia,
USA)

EMS Advancement
Recognition of:
o Army Surgeons
o Medical Corps
o Ambulances
o Hospitals
Refinement and Improvement of:
o Administration
o Professional Personnel
o Transportation
o Hospital Sanitation
o Medical Records
These resulted to advances in:
o Army Surgeons
o Field Resuscitations
o Efficiency of transportation
o Energetic treatment of casualty

Historical Impact
Decreases in the rates of casualty:
o 8% During World War I
o 4.5% During World War II
o 2.5% During the Korean War
o Less than 2% During the Vietnam
War

Prevalent Emergency Cases
Trauma
Burns
Spinal Cord Injury (SCI)
Acute MI
NB with congenital abnormality
Poisoning
Alcohol-induced cases
Psychiatric cases

Technologies and Upgrades
Reporting and access
Responses system
Field stabilization
Optimal resuscitation
Initial care facilities
Well extended; progressive and intensive critical care
o Interhospital Phase
o Advanced Phase
o Critical Phase
o Rehabilitation Phase
Trained technical and Professional EMS Personnel working as a team
o Nurse
o Physician
o Emergency Technician
o Systems Coordinator
o Directors
Upgrade of above operations (Prehospital personnel)
o Emergency Medical Technician Ambulance
o Emergency Medical Technician Paramedics
o CPR Team (Non-EMS Personnel) Firefighters, Police Officers, Life Guards
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Nursing Focus in Emergency Situations
Prehospital Intrahospital
Assume position of responsibility
Supervision of both EMS and non-EMS
personnel during acute care provision
Assists in life support care

Legal Issues in the Emergency Room (ER)
1. Consent
o Conscious = Get consent
o Unconscious
If 24 y/o revive even if without consent
If pediatric client Get consent from guardian / parent
(EXCEPT IF: Communicable Disease, Emancipated Disease, Alcohol induced /
Pregnancy Cases)
2. Restraint
o Physical / Chemical Restraint
Physical: Hard Leather, Body Straps Continuous patient monitoring
o If patient is doing self directed injury / injury to others Put in ISOLATION for 72 HRS ONLY
3. Legislation: Give care even if patient has no money
o COBRA 1986
o OBRA 1990
o EMTALA 1988
4. Reporting: Government stats any disease and mortality
5. Collection and Presentation of Evidences: Collect the clothes, specimens, bullets, etc
6. Violence

Ethical Issues
- Unexpected deaths
- Organ and Tissue Donor
- Child abandonment

Competencies for RNs
Responsibility to Emergency and Mass Casualty Incidents
Basic Approach
Standards of Care Guidelines
Whenever a patient is with a potentially life threatening condition, proceed with the following:
o Remove the patient from potential source of danger Live electrical current, water, fire
o Go through the primary emergency assessment
o Call for help as soon as possible
o Assist with transport and further assess and care as indicated
Note: This information should serve as a general guide only. Each patient situation presents a unique set of
clinical factors and requires nursing judgment to guide care, which may include additional or alternate
measures.

Emergency Assessment (Chief Complaint, Primary Ax, Secondary Ax, Focused Ax)
1. Chief Complaint
What brings the patient to the ER?
Based on the patients own words
Dont change the CC to a medical diagnosis without adequate cues
2. Primary Assessment
The first step in the primary assessment is to determine if the patient is conscious
Identify life-threatening problems (Airway, Breathing, Circulation) [CAB (2010)]
Appropriate interventions are required before proceeding to secondary assessment
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A Airway = Does the patient have an open airway?
B Breathing = Is the patient breathing? Excessive use of accessory muscles (Breathlessness)
C Circulation =
o Is circulation in immediate jeopardy?
o Is there a pulse?
o Is there profuse bleeding?
In seriously injured / ill patients, it is recommended to add two more letters to the Primary Survey
D Disability
o Assess level of consciousness and pupils
o A more complete neurologic survey will be completed in the secondary survey
A Is the patient ALERT?
V Does the patient respond to VOICE?
P Does the patient respond to PAINFUL STIMULI?
U The patient is UNRESPONSIVE even to painful stimuli
E Exposure
o Undress the patient to look for clues to injury / illness, such as wounds / skin
lesions
3. Secondary Assessment
Systematic
Brief (2 3 Minutes)
Head-to-Toe
To detect and prioritize additional injuries / to detect signs of underlying medical conditions
Continuation
i. History
Brief history of the CC, accident, illness
Taken from the patient or an accompanied person
- Relative
- Prehospital provider
What is the mechanism of injury the circumstance, force, location and time
When did the symptom appear?
Was the patient unconscious after the accident?
How did the patient reach the hospital?
What was the health status of the patient before the accident or illness?
Is there a history of illness?
Is the patient currently taking medications?
Does the patient have any allergies?
Under what health care provider was the patient in? (Name of Provider)
Was the treatment attempted before arrival at the hospital (Home Remedies,
OTC Drugs etc.)
ii. Vital Signs
Routinely includes: Temperature, Pulse Rate, Respiratory Rate, Blood Pressure
and Pain Scale
When obtained early in assessment, they help to complete baseline data

iii. Head-To-Toe Assessment
+ General Appearance
- Position / Posture / Gait
- LOC Restlessness is a
DANGER SIGN
- Behavior and degree of distance
- Cooperation
- Skin condition and color
+ Head / Scalp
- Bleeding
- Deformity and Depressions
- Facial Symmetry
+ Ears
- Blood
- Clear Fluid (CSF)
- Battles Sign (Bluish
discoloration of the mastoid area)
+ Eyes
- Pupil size and reaction to light
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- Extraocular Motions (Cardinal
Gazes)
- Orbital Ecchymosis (Raccoons
Eye)
- Gross Vision
- Conjunctivae Examine for
pallor / cyanosis
+ Nose
- Blood
- CSF
+ Mouth
- Missing teeth
- Cyanosis of the lips
- Foreign materials / vomitus
+ Neck
- Tracheal deviations
Hemothorax
- Jugular distention
- Tenderness
+ Chest
- Symmetry
- Tenderness / Pain
- Ecchymosis
- Subcutaneous Emphysema
- Soft tissue injury
- Breath sounds
- Heart sounds
+ Abdomen
- Distended / Rigidity
- Tenderness / Pain
- Guarding
- Bowel Sounds
- Soft tissue injury
+ Pelvis
- Stability
- Tenderness
+ Genitalia
- Bleeding
- Priaprism
- Pain
- Wound / Trauma
- Rectal Tone
+ Extremities
- Pain
- Deformities and Bruises
- Pulses
- Sensation and Strength
- Soft tissue injury
- Edema
+ Posterior (Observe Cervical spine
precautions in trauma patients)
- Soft tissue injury
- Spinal tenderness Pain during
movement
- Pin and tenderness

4. Focused Assessment
A more detailed assessment of
deviation from normal / problems
identified in the secondary survey
If more than one focused
assessment is necessary, any
problems identified with the
PULMONARY,
CARDIOVASCULAR, or
NEUROLOGIC System should be
ASSESSED FIRST!

Triage
Definition: Is a French verb, meaning
to sort
Most patients entering an emergency
department are greeted by a Triage Nurse
The role of the Triage Nurse is to do brief
evaluation of the patient to determine a level
of acuity / priorities of care
Thus, the Triage Nurse acts as a gatekeeper,
sorting patients into categories, ensuring that
the more seriously ill are treated first

Triage in Clinical Setting
- Standardized Triage categories are usually
developed within each emergency
department
- Most common Triage systems consist of 3
Levels of acuity
Emergent / I
Urgent / II
Nonemergent / III

EMERGENT / I
) Immediate medical intervention!!
) Delay in treatment is potentially life or limb-
threatening
) Includes conditions such as: (SAC-MACE)
Severe shock
Airway compromise
Cardiac arrest
Multisystem trauma
Altered level of consciousness
Cervical spine injuries
Eclampsia

URGENT / II
) Stable but whose condition requires medium
intervention within a few hours
) No immediate threat to life or limb for these
patients
) Conditions includes: (FMM-DL)
o Fever
o Minor Burns
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o Minor Musculoskeletal Injury
o Dizziness
o Lacerations

NONEMERGENT / III
) Chronic / Minor Injuries
) There is no danger to life or limb by having these patients wait
) No obvious distress
) Conditions includes: (MR-CD)
Missed Menses
Routine
Chronic low back pain
Dental Problems

COMMUNICATION SKILLS
Communication with a Person as a Psychological Being
- A total person is much more than the sum of his / her parts
- Psychic functions: Sensing, Thinking, Feeling, and Intuition
Sensing Process through which one gathers objective data
I smell alcohol
I see an unconscious person who is dressed in dirty worn clothes
Thinking Cognitive process through which one recognizes the meaning of the data
Alcohol is a CNS depressant
This person needs to be evaluated
Feeling The affective process of all mental life
I hate alcoholics
Intuition The quick perception of truth without conscious attention or reasoning
This person has no social support system and probably lives on a squatters area
- NURSING ALERT!!
Nurses frequently make the error of stating that what they sense is sensed by another
How? Once the nurse begins to think, feel, or use intuition, the sensory function is altered
E Example:
E Nurse may think: Ang toxic naman ng relatives na to! with a failure to sense that this
relatives state is brought only by anxiety which needs attention.
E The nurses reactions and future actions may be affected in a way the nurse will be less
caring than expected
E Therefore, to understand anothers psyche, the nurse must rely upon reports from the
patient (Including relatives)

PEOPLE ARE SOCIAL BEINGS
- From the moment of birth until death, a person is either dependent on, independent from or interdependent
with others
- The way people make decisions is affected by their culture, which is affected by formed attitudes, values
- And beliefs and these norms (i.e. culture, belief and values) are brought about by relationships they had
- Understanding the WHY behavior is more often than not a prerequisite to decide how to help, this can be
understood only through the process called COMMUNICATION

Silent and Audible Language
According to Sigmund Freud, No mortal can keep a secret. If his lips are silent, he chatters with his
fingertips; betrayal oozes out of him at every pore
All behavior has some meaning and is a form of communication



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SILENT LANGUAGE (Space, Clothing, Color, Time, Gestures)
1. Language of Space
- Placement of equipment
- Arrangement of furniture in the waiting area
- Distribution of nurse stations to cubicles
- Where the nurse sits***
2. Language of Clothing
- Theres a difference between the nurse who comes to work in jeans and changes into a scrub
gown and who arrives in a neat well fitting uniform
3. Language of Color
- Warm Colors Red, Orange, Yellow
- Cool Colors Green, Blue, Gray
4. Language of Time
- For a tardy and punctual nurse, what is communicated to the rest of the staff
- For a patient, what do these words mean?
- In a few minutes
- In a while
- A short time ago
5. Language of Gestures
- Gestures expressive notions or actions
- Subtle type Use of eyes, placement of hands, body movement when talking
- Dramatic type Suicide
- Leans forward
- Glancing
- NURSING ALERT!
To interpret anothers gestures without validating that interpretations may cause a mistake

AUDIBLE LANGUAGE
o Therefore, the nurse must not only hear, but also listen to what people say
o When someone is speaking of facts, one is describing those

How to Improve Communication Skills?
Identify yourself and your goal when interacting with a patient
Assist patient to identify what he / she thinks / feels
Seek validity for the assumptions made about patients and their behaviors

Stress and Anxiety in the ED (Emergency Department)
- Common words associated with ED are:
- Excitement Danger
- High emotions and activity
- Definition of Anxiety
+ A primitive emotional response with somatic components elicited by external and internal cues
+ Frequently associated with sense of:
- Hopelessness
- Isolation
- Alienation
- Insecurity

Reponses to Anxiety
Physical Because of Sympathetic Nervous
system
Cold sweats
Butterflies in the stomach
, Pounding HR
Flushed face
Dilated Pupils
RR


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LEVELS of ANXIETY (Mild, Moderate, Severe, Panic)
Degree or level of anxiety has definite effect on a person
Mild Anxiety
Motivates
Ex: It is rare for an average student to consistently study for an examination weeks ahead
Alertness, concentration and retention of necessary information
Moderate Anxiety
Patient who routinely get sick, anxiety to moderate level
Such level leads to increased concern for self, thus ability to see periphery
Do not hear and see everything
Annoyed / Angry
Unable to pick up cues
Nursing Responsibilities
^ Constant reassurance
^ Inability to recognize that the patient is in moderate anxiety will cause care
provider to get angry and defensive
Interventions:
1. Lessen anxiety
2. Use simple words
3. Provide quiet environment
Severe Anxiety
Ability to focus, comprehend and integrate environmental stimulus
Inability to move toward any goal
Use one word only
- Come
- Sit
Panic Anxiety
Prevention of Anxiety
Simple explanations
Clear directions
Interpretation
Fear of isolation
o Tell the patient that his/her family is in the waiting room and knows their general
condition
Dont give false reassurance

Psychological Considerations in Emergency Nursing
Psychological Considerations:
Body Trauma is an insult to physiologic and psychological homeostasis
It requires both physiologic and psychological healing
^ Approach to the patient
^ Approach to the family
Understand and accept the anxieties of the patient
Be aware of the patients fear of death, mutilation and isolation
^ Personalize situation
^ Speak, react and respond in a warm manner
^ Give explanations on a level that the patient can grasp
^ Accept the rights of the patient and family to have and display their own feelings
^ Maintain a calm and reassuring manner
Understand and support loss of control (Emotional, Physical and Intellectual)
Treat the UNCONSCIOUS patient as if CONSCIOUS
^ Touch
^ Call by name
^ Explain every procedure
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^ Avoid making negative comments
^ Orient the patient
^ Reinforce by repeating this information
^ Orient to reality in a clam and reassuring way
^ Encourage the family to do the same
Be prepared to handle all aspects of acute trauma; know what to expect and what to do
^ Alleviate the nurses anxiety and patient confidence

Approach to Family
- Inform the family all about the patient (Location and Treatment)
- Recognize and allow verbalization of anxiety, remorse, anger, guilt, and criticism
- Allow the family to relieve the events, actions and feelings preceding admission to the Emergency
Department
- Deal with reality as gently and quickly as possible; avoid encouraging and supporting denial
- Assist the family to cope with sudden unexpected death. Some helpful measures include the following:
+ Take the family to a private place
+ Take the family together so they can mourn
- Assure the family that all possible treatment was done
- Avoid using euphemisms (the substitution of an agreeable or inoffensive expression for one that may
offend / suggest something unpleasant) such as Passed on
- Show the family that you care by touching, offering coffee and so forth
- Allow the family to talk about the deceased permits ventilation of feeling of loss
- Encourage family to support each other and to express emotions freely, grief, loss, anger, helplessness,
fears, disbelief
- Avoid volunteering unnecessary information (Patient was drinking and so forth)
- Avoid giving sedation to family members
- Be cognizant of cultural and religious belief and needs
- Encourage family members to view the body if they wish
+ Go with family to see the body
+ Show acceptance of the body by touching to give family permission to touch and talk to the body
+ Spend a few minutes with the family, listening to them
- Encourage the ED Staff to discuss among themselves their reaction to the event to share intense feelings for
review and for group support

Death and Dying and the Grieving Process
1. Shock and Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Agencies


First AID! R.E.D. Points
Fundamentals
- It is better to know first aid and not need it, than to need it than not know it

First Aid
Immediate care given to an injured / suddenly ill person
Does not take the place of proper medical treatment

Legal Issues
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Consent
^ Expressed
^ Implied
Abandonment
Negligence
^ Duty to act
^ Breach of duty
^ Injury and damages inflicted

ACTIONS IN AN EMERGENCY
Recognize the EMERGENCY
Decide to help
Contact EMS if needed
Assess the victim
Provide first aid

Scene Survey
o Ensure safety of rescuer and victim
o Look for 3 THINGS
1) Hazards that could be dangerous to you, the victims and bystanders
2) The mechanism / cause of the injury / injuries
3) The number of victims

Call EMS
o Give the following information:
1. Phone number
2. Your location
3. What happened
4. Number of people needing help
5. The victims condition
6. What had been done to the victims

Disease Precaution
o Personal Protective Equipment (PPE)
- Gloves
- Protective Eyewear
- Mouth-to-Barrier Device
o Universal Precautions / Body Substance Isolation
o Vaccines

Multiple Casually Incidents
E Large number of casualties
E Obvious disorder
E Overwhelming demand of care from rescuers
E Early notification of the Emergency services
E Role of the first aiders

TRIAGE (BALIKAN NLNG UNG KNINA)
) Occasionally move the patient first before assessment
) The safest way possible with the least chance of injury
) Factors:
Mental status of the patient
Environment
Available resources
) General Rules
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Let your equipment do the work
Get as much help as you can
Never risk falling / injuring yourself
Follow the rule of body mechanics
) Body Mechanics
The safest and most efficient method of using your body to gain a mechanical advantage
Keep the weight of the object as close to the body as possible
) Victim Assessment
Initial assessment
Recognize threats
Physical Examination and SAMPLE History

INITIAL ASSESSMENT
The AVPU Scale
A Is the patient ALERT?
V Does the patient respond to VOICE?
P Does the patient respond to PAINFUL STIMULI?
U The patient is UNRESPONSIVE even to painful stimuli
SAMPLE History
S Symptoms = What is wrong?
A Allergies = Are you allergic to anything?
M Medications = Are you taking any medications? What are they for?
P Past Medical History = Have you had this problem before?
L Last Oral = When did you last eat/drink? What was it?
E Events = How did you get hurt? What led to this problem?
PEARL and DOTS
Pupils are Equal And Reactive to Light
DOTS
D Deformity
O
T
S


















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CHOKING
Foreign Body Airway Obstruction (FBAO)
About 3,800 deaths are reported to be caused by FBAO (Choking) every year

Causes:
- Choking usually occurs during eating
- Meat is the most common cause of obstruction in adults
- A variety of foods and foreign bodies have been the cause of obstruction in children

Risk Factors:
- Large, poorly chewed pieces of food
- Elevated blood alcohol levels
- Dentures
- Playing, crying, laughing / talking while food / foreign bodies are in the mouth

Prevention:
- Cut food into small pieces
- Chew slowly and thoroughly
- Avoid excessive intake of alcohol
- Avoid laughing and talking while chewing and swallowing

Recognition:
1. Determine if the victim is choking
Determine if the victim is able to speak or cough
Victim may be using the Universal distress signal of choking (Clutching the neck between
thumb and index finger)
Rescuer can ask Are you choking?
2. Position the patient
Stand behind victim
Wrap your arms around the victims body
Grab the victims hand and put them down
3. Perform abdominal thrusts
Press fist into abdomen with quick inward and upward thrusts
4. Victim becomes unconscious: position the patient
5. Check for foreign body
Sweep deeply into mouth with hooked fingers to remove foreign body
6. Open the airway
Tap / gently shake the victim
Rescuer shouts Are you okay?
7. Give rescue breaths
Attempt rescue breathing
Try to give 2 breaths
If needed, reposition the head
Try again

Observe Airway, Infant of less than 1 Year Old
1. Check for responsiveness
- Tap / gently shake shoulder
2. Call for help
- If the victim is unconscious, rescuer shouts HELP!
- If a second rescuer is available, have him activate the EMS
3. Position the infant
- Turn on back, if necessary on a firm, hard surface while supporting the head and neck
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4. Open the airway
- Head-tilt, chin-lift method
5. Determine breathlessness
- Look at chest for movement
- Listen for breathing
- Feel for breathing on your ear for 3 5 seconds
6. Patient is not breathing: GIVE RESCUE BREATHS
- Maintain an open airway
- Try to give rescue breaths
- Use a mouth-over-mouth and nose seal
- Reposition the head
- Try to give rescue breaths
7. Delivery back blows
- Deliver up to 5 back blows forcefully between the shoulder blades with the heel of one hand
8. Deliver chest thrusts
- Deliver up to 5 thrusts in the mid-sternal region, using the same landmark as those for chest
compression
9. Perform tongue-jaw lift
- Do not perform a blind finger sweep
- Remove foreign body only if you can see it!
10. Give rescue breaths
- Maintain an open airway
- Try to give rescue breaths
- Observe chest rise and fall; listen and feel for escape
- Reposition the head and try to give rescue breaths
11. Repeat sequence until successful
12. Unsuccessful resuscitation: Activate EMS!
- If you are alone and your efforts are unsuccessful, activate EMS after about 1 minute of effort
to clear the airway
13. Observe removal: Check for breathing and pulse

TRANSPORTING PATIENTS
Body Mechanics
Use teamwork, equipment and imagination
Use the power-lift and power-grip
Lift an object as close to you as possible
Use legs, hips and gluteal muscles plus abdominal muscles
Proper posture Ears, shoulders and hips in vertical alignment
Improve personal physical fitness

Communication and Teamwork
Size u the scene
Consider the weight of the patient and recognize the need for additional help
Be aware of the physical abilities and limitations of each member
Select the most appropriate equipment for the job

Emergency Move
- Immediate environmental danger to the patient / rescuer, such as:
Fire / danger of fire
Exposure to explosives or other hazardous materials
Inability to protect the patient from other hazards at the scene
Inability to gain access to other patients who need life-saving care
Inability to provide life-saving care because of patient location / position

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Moving Patients
ONE-HANDED MOVE
1. Human Crutch
- If one leg is injured, help the victim walk on the GOOD leg while you support the injured side
2. Cradle Carry
- Used for children and light weight adults who cannot walk
3. Firemans Carry
- If the victims injuries permit, longer distances can be traveled if the victim is carried over
your shoulder
4. Pack Strap Carry
- Good for longer distances
5. Piggy-back Carry
- Use this method when the victim cannot walk but can use the arms to hand onto the rescuer

TWO-THREE PERSON MOVE
1. Two-Person Assist
- Similar to human crutch
2. Two-Handed Seat Carry
3. Four-Handed Seat Carry
4. Extremity Carry (Fore and Aft)
5. Chair Carry
- Useful for a narrow passage or up / down stairs
- Use sturdy chair that can take the victims weight
6. Hammock Carry
- 3 6 people stand on alternate sides of the injured person and link hands beneath the victim
7. Clothes Lift
- Improvised Stretchers
Door
Coat
Blanket
8. Blanket Lift
9. Four-Bearer Lift

Bandages
^ Broad-Fold Bandage
^ Open Triangular Bandage
^ Narrow-Fold Bandage
^ Square Knot

Reasons for SPLINTING
1. Minimizes / Prevents further neural, vascular and other soft tissue injury
2. Prevents a closed fracture from becoming an open fracture
3. Minimizes pain and discomfort
4. Facilitates transport of patient
5. Prevents paralysis in the case of spinal patients

General Rules of Splinting
1. Remove / cut away all clothing surrounding the injury
2. Remove all jewelry
3. Assess pulse, motor function and sensation distal to the injury
4. Cover all wounds with sterile dressing prior to splinting
5. Never intentionally replace protruding bond back into the skin!
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6. Pad the splint
7. Apply splint before moving the patient
8. Immobilize the joint above and below the fracture
9. When in doubt, splint the injury!

Hazards of Improper Splinting
Compression of neurovascular structures
Delay of transport
Reduced circulation
Aggravate the bone and joint injury

FIRST AID FOR BROKEN BONES
Goals:
E Prevent further injury
E To keep the injured limb steady
E To get the victim to the hospital

Symptoms:
Pain and tenderness
Inability to use the injured arm
Deformity, swelling
Bruises
Numbness
Pale, bluish skin

Splinting: Upper
Extremities
1. Arm Sling and Swathe
2. Upper Arm (Humerus)
3. Forearm (Radium / Ulna)
4. Fingers and Hands (Position of
function)

Splinting: Elbows and
Knees
1. Knee in Bent Position
2. Knee in Straight Position
3. Elbow in Bend Position
4. Elbow in Straight Position

Splinting: Lower
Extremities
1. Ankle / Foot
2. Lower leg (Tibia / Fibula)
3. Thigh (Femur)
4. Self Splint (leg)

External Bleeding
o Arterial Blood spurts from the wound, most serious type of bleeding, less likely to clot
o Venous Blood flows steadily or gushes easier to control
o Capillary Blood oozes, most common type of bleeding; can be controlled easily

^ Regardless of the type of bleeding, the first aid is the SAME
^ First and most importantly, you must CONTROL the BLEEDING!
^ Protect yourself against disease by wearing medical examination gloves, if not available, the following can
be used as an alternative:
Several layers of gauze pads
Plastic wrappers
Plastic bags
Water proof materials
^ Direct pressure stops most bleeding
^ A pressure bandage can free you to attend to
other injuries or victims
^ Do not remove a blood soaked dressing
^ Elevation of the injured extremity help reduce blood flow
^ If bleeding still continues, apply pressure at a
pressure point to slow blood flow



CAUTION: When controlling
bleeding DO NOT
- Touch a wound with your bare hands
- Use direct pressure on an eye injury, a
wound with an embedded object or a skull
fracture
- Remove a blood soaked dressing
- Remove an impaled object
- Apply a pressure bandage so tightly that it
cuts off circulation
- Use a tourniquet