the closed fist of one hand and use the other hand togive additional pressure. The artery at this point isdeeply buried in some of the heaviest muscle tissue inthe body, so a great deal of pressure must be exerted tocompress the artery against the bone.Bleeding between the knee and the foot may becontrolled by firm pressure at the knee. If pressure atthe side of the knee does not stop the bleeding, hold thefront of the knee with one hand and thrust your fist hardagainst the artery behind the knee, as shown in figure4-27K. If necessary, you can place a folded compressor bandage behind the knee, bend the leg back, andhold it in place by a firm bandage. This is a mosteffective way of controlling bleeding, but it is souncomfortable for the victim that it should be usedonly as a last resort.You should memorize these pressure points so thatyou will know immediately which point to use forcontrolling hemorrhage from a particular part of thebody. Remember, the correct pressure point is thatwhich is (1) nearest the wound, and (2) between thewound and the main part of the body.It is very tiring to apply digital pressure, and it canseldom be maintained for more than 15 minutes.Pressure points are recommended for use while directpressure is being applied to a serious wound by asecond rescuer. Using the pressure-point technique isalso advised after a compress, bandage, or dressing hasbeen applied to the wound, since this method will slowthe flow of blood to the area, thus giving the directpressure technique a better chance to stop thehemorrhage. The pressure-point system is alsorecommended as a stopgap measure until a pressuredressing or a tourniquet can be applied.ElevationThe elevation of an extremity, where appropriate,can be an effective aid in hemorrhage control whenused in conjunction with other methods of control,especially direct pressure. This is because the amountof blood entering the extremity is decreased by theuphill gravitational effect. Do not elevate an extremityuntil it is certain that no bones have been broken oruntil broken bones are properly splinted.SplintsAnother effective method of hemorrhage controlin cases of bone fractures is splinting. Theimmobilization of sharp bone ends reduces furthertissue trauma and allows lacerated blood vessels toclot. In addition, the gentle pressure exerted by thesplint helps the clotting process by giving additionalsupport to compresses or dressings already in placeover open fracture sites.Later in this chapter we will go into the subject ofsplinting in greater detail.TourniquetsA tourniquet is a constricting band that is usedto cut off the supply of blood to an injured limb.Use a tourniquet only as a last resort and if thecontrol of hemorrhage by other means proves to bedifficult or impossible. A tourniquet must alwaysbe applied above the wound (i.e., toward the trunk),and it must be applied as close to the wound aspractical.Basically, a tourniquet consists of a pad, a band,and a device for tightening the band so that the bloodvessels will be compressed. It is best to use a pad,compress, or similar pressure object, if one isavailable. The pressure object goes under the band andmust be placed directly over the artery or it willactually decrease the pressure on the artery, allowing agreater flow of blood. If a tourniquet placed over apressure object does not stop the bleeding, there is agood chance that the pressure object is in the wrongplace. If placement is not effective, shift the objectaround until the tourniquet, when tightened, willcontrol the bleeding.Any long flat material may be used as the band. Itis important that the band be flat: belts, stockings, flatstrips of rubber, or neckerchiefs may be used; however,rope, wire, string, or very narrow pieces of cloth shouldnot be used because they can cut into the flesh. A shortstick may be used to twist the band, tightening thetourniquet. Figure 4-28 shows the proper steps inapplying a tourniquet.To be effective, a tourniquet must be tightenough to stop the arterial blood flow to the limb. Besure, therefore, to draw the tourniquet tight enoughto stop the bleeding. Do not make it any tighter thannecessary, though, since a tourniquet that is too tightcan lead to loss of the limb the tourniquet is appliedto.After you have brought the bleeding under controlwith the tourniquet, apply a sterile compress ordressing to the wound and fasten it in position with abandage.4-33
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