Bleeding from a point source

[DocHoliday84]

Had the most ridiculous case yesterday, an elderly gentleman fell and hit his head, arrives by EMS bleeding from a forehead laceration. They wrapped his head and half of his face like a mummy, with gauze about 1 inch thick and he is still oozing and bleeding under that and everybody is freaking out about it. I unwrap him expecting to maybe see a laceration which is at least a fair size, given the fact that they buried his head and face completely in gauze, and it ends up turning out that it is just a small punctate area on his forehead that he is bleeding from. I proceed to fold up a single piece of 4x4 gauze and tape it directly onto the bleeding area and bleeding stops completely. Lol. I feel like I have seen so many similar situations with bleeding from a point source but this one was the most ridiculous in a while. Figured I'd ask and see what others have experienced, probably some good stories out there.

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[Siggy]

The classic inpatient rapid response for bleeding fistula. It’s dramatic and can make the walls look like a Pollock painting.

On the other hand, some gauze and a single finger plugs the whole. Wrap tightly with coban. If it doesn’t stop, it’s a simple vascular surgery consult to stitch off the fistula.

 

[Dr Mantis Toboggan]

The classic inpatient rapid response for bleeding fistula. It’s dramatic and can make the walls look like a Pollock painting.

On the other hand, some gauze and a single finger plugs the whole. Wrap tightly with coban. If it doesn’t stop, it’s a simple vascular surgery consult to stitch off the fistula.

I have had good luck with placing a single of figure of eight Prolene suture to stop these. I wonder if combat gauze would work though.

 

[Tiger26]

Once had a lady on warfarin bleed down to a hemoglobin of 2 this way over about a week. Spent like $100 gauze at Walgreens and then loosely kept wrapping it until she passed out.

Even with stab wounds, I usually need a 4x4 and a single finger or two of pressure.

 

[JacobMcCandles]

I have had good luck with placing a single of figure of eight Prolene suture to stop these. I wonder if combat gauze would work though.

Some places have those little buttons things that are made specifically for this, but, as you mentioned, a single stitch takes about 10 seconds to do and almost always works.

 

[RoyBasch]

Had the most ridiculous case yesterday, an elderly gentleman fell and hit his head, arrives by EMS bleeding from a forehead laceration. They wrapped his head and half of his face like a mummy, with gauze about 1 inch thick and he is still oozing and bleeding under that and everybody is freaking out about it. I unwrap him expecting to maybe see a laceration which is at least a fair size, given the fact that they buried his head and face completely in gauze, and it ends up turning out that it is just a small punctate area on his forehead that he is bleeding from. I proceed to fold up a single piece of 4x4 gauze and tape it directly onto the bleeding area and bleeding stops completely. Lol. I feel like I have seen so many similar situations with bleeding from a point source but this one was the most ridiculous in a while. Figured I'd ask and see what others have experienced, probably some good stories out there.

The crazy EMS gauze turbans for head wounds drive me crazy. I really want to do a little TED talk on basic physics that pressure = force/area, and you need focal pressure to control bleeding. This giant wad of increasingly loose kerlix doesn't do ****. Patient just comes in with a giant dramatic wad of saturated bloody padding on their head. I have no idea where the wound is or how bad it is. I just want to show them how to make an actual compressive dressing with a single 4x4 folded in quarters and coban/ace wrap. (more force, smaller area, higher pressure!)

Same TED talk for nurses who tell me "The finger/toe/hand laceration is HEMORRHAGING, you need to see it RIGHT NOW!"

 

[Jabbed]

Have you seen that fishnet webbing sleeve that is used to secure PICC lines? You can stretch it out and put it around someone’s head to secure a pressure dressing. It slides much less than the gauze/coban turban.

 

[turkeyjerky]

I always love it when people come in w/ epistaxis just holding kleenex under their nose. "It won't just won't stop doc!" Uhhh, 5 year old me knew how to pinch my nose.

Had a case a few weeks back where someone came in via EMS w/ report of "arterial bleeding". Forget where it was, but they had a massive pressure dressing applied, had made such a big deal to staff that they put in in the trauma bay and a bunch of people came by to watch me undress it. Turned out to be something like a tiny laceration that just needed a dab of dermabond (would've been fine w/ a bandaid honestly, and no--it was nowhere near potential vasculature).

 

[Janders]

Yes, all of this bothers me as well. Seems like a simple stop-the-bleed lesson should be part of BLS now. A half dozen ABD pads on a scalp wound just give the blood a nice place to congeal as it continues to pour out…

I consider myself pretty good at explaining things in really simple language to people from all types of backgrounds. I love teaching some simple anatomy/pathology to patients. But for the love of god, there is a significant subset of people who can NOT get the idea of pinching their nose when it is pouring blood. Two patients this week who just intermittently dabbed at the nare from below “still bleeding doc!”. After I put their hand on their nose and pinched for them to demonstrate the plan. Its OK, it makes my decision to go straight to rhinorocket easier

 

[RustedFox]

Yes, all of this bothers me as well. Seems like a simple stop-the-bleed lesson should be part of BLS now. A half dozen ABD pads on a scalp wound just give the blood a nice place to congeal as it continues to pour out…

I consider myself pretty good at explaining things in really simple language to people from all types of backgrounds. I love teaching some simple anatomy/pathology to patients. But for the love of god, there is a significant subset of people who can NOT get the idea of pinching their nose when it is pouring blood. Two patients this week who just intermittently dabbed at the nare from below “still bleeding doc!”. After I put their hand on their nose and pinched for them to demonstrate the plan. Its OK, it makes my decision to go straight to rhinorocket easier

I don't even screw around.
I look, and then rhino rocket after clots (if any) are evac'd.

Byeee.
Teaches them not to be dumb.

Which is what that other thread is about.

 

[RuralEDDoc]

I don't even screw around.
I look, and then rhino rocket after clots (if any) are evac'd.

Byeee.
Teaches them not to be dumb.

Which is what that other thread is about.

Ha. Yes. Although RustedFox and I sometimes disagree, we can still agree most people are idiots and, damn it people, pinch your damn nose.

 

[bravotwozero]

Ha. Yes. Although RustedFox and I sometimes disagree, we can still agree most people are idiots and, damn it people, pinch your damn nose.

I’ll make the improvised pincher device by taping together two tongue depressors and putting it on their noses, telling them to NOT remove it until I take it off myself.

Most will listen, a few idiots still won’t.

Sigh

 

[RustedFox]

I mean... FFS, people.
Aversion to/avoidance of unpleasant stimuli is the ONLY thing that works in most cases.

Let's not act like this isn't a viable solution.

 

[Apollyon]

I mean... FFS, people.
Aversion to/avoidance of unpleasant stimuli is the ONLY thing that works in most cases.

Let's not act like this isn't a viable solution.

So, "stick their nose in it"?

 

[RustedFox]

So, "stick their nose in it"?

In this case, stick it up their nose.

 

[thegenius]

I don't even screw around.
I look, and then rhino rocket after clots (if any) are evac'd.

Byeee.
Teaches them not to be dumb.

Which is what that other thread is about.

Oh boy

 

[GonnaBeADoc2222]

I don't even screw around.
I look, and then rhino rocket after clots (if any) are evac'd.

Byeee.
Teaches them not to be dumb.

Which is what that other thread is about.

How dare you shame the nose pickers. They are just trying to navigate the complex US healthcare system.

You must be anti-poor/immigrant/single mom.

I hope you get therapy so that you can heal.

 

[wook]

The classic inpatient rapid response for bleeding fistula. It’s dramatic and can make the walls look like a Pollock painting.

On the other hand, some gauze and a single finger plugs the whole. Wrap tightly with coban. If it doesn’t stop, it’s a simple vascular surgery consult to stitch off the fistula.

This!

I showed a shadowing paramedic the importance of point pressure on a bleeding fistula, by having him put his finger on the point and told him I'd be back in twenty minutes. When I came back, we had the paramedic remove his finger, and he was amazed as all bleeding had stopped (not the terminal kind).


Wook

 

[RustedFox]

How dare you shame the nose pickers. They are just trying to navigate the complex US healthcare system.

You must be anti-poor/immigrant/single mom.

I hope you get therapy so that you can heal.

(Ring Announcer Jim Ross):

**IS THAT REY MYSTERIO'S MUSIC?!**