HELP! Pressure points and bleeding control

[fakingpatience]

Hello All

I have a quick question for you about the use of pressure points to control bleeding. Which pressure points should you use for bleeds in various locations (so, if you have a bleed that isn't controlled with direct pressure on the arm or lower leg, where do you press?) Also, once the bleeding has stopped by using the pressure point, can you let go? If anyone knows of any links with the information out there that would be a great help! I have a skills test for a job I applied to on Tuesday, and apparently here they still use pressure points for bleeding control as it is one of the things I will be tested on (When I went through EMT school a year ago, we didn't learn about them other than "people used to use pressure points to control bleeding, now if it isn't controlled by direct pressure, go straight to a tourniquet") I can't find the information anywhere in my EMT text book either

As always, any help is greatly appreciated!

[fiznat]

What you learned in school is correct and is the standard of care. Nobody uses pressure points for bleeding control as far as I know. I'm actually really surprised that someone would consider it important enough to use in an exam. Honestly I can't see how you would be at a disadvantage by applying the standard of care for bleeding control and ignoring that pressure points stuff completely. If you want to review just a little light anatomy, I guess it couldn't hurt to know the names and locations of the major arteries feeding the extremities. At least then you have an "answer," if not the (antiquated) technique.

[Lone Star]

Hello All

I have a quick question for you about the use of pressure points to control bleeding. Which pressure points should you use for bleeds in various locations (so, if you have a bleed that isn't controlled with direct pressure on the arm or lower leg, where do you press?) Also, once the bleeding has stopped by using the pressure point, can you let go? If anyone knows of any links with the information out there that would be a great help! I have a skills test for a job I applied to on Tuesday, and apparently here they still use pressure points for bleeding control as it is one of the things I will be tested on (When I went through EMT school a year ago, we didn't learn about them other than "people used to use pressure points to control bleeding, now if it isn't controlled by direct pressure, go straight to a tourniquet") I can't find the information anywhere in my EMT text book either

As always, any help is greatly appreciated!

The 'new and improved' EMT education module doesn't teach about pressure points.

Years ago, when I went through EMT-B for the first time; we were taught that it was direct pressure, elevation, ice and pressure points. Tourniquets were a 'last resort', due to the thinking that they should only be applied in cases of 'loss of life or limb'.

In the arm, the brachial artery (just below the armpit) will control bleeding below that point. This can usually be accessed by pressing between the bicep and tricep muscles.

In the leg, the femoral artery is what you would use. This is just below the groin, but you're going to have to 'dig deep' into the thigh muscles to be able to get to it.

For the distal portion of the lower extremity, I think you might be able to use the Popliteal artery (in the back of the knee), and for the distal part of the uupper extremity, the distal end of the brachial artery (just prior to the bifurcation into the ulnar and radial arteries).

Bleeding in the foot is controlled by the posterior tibialis and the pedis dorsalis arteries. The hand is controlled by the ulnar and radial arteries.

The school of thought with pressure points is that you start as close to the site of bleeding as you can, and then work higher if it's not effective.

The new curricula teaches that the application of a tourniquet approximately 2" wide placed 2-3 inches proximal to the bleed is advised. Only tighten the tourniquet to the point that the bleeding stops and 'lock it in place'. Note the time of application and location for the recieving ER staff.

I have to agree with Fiznat on the point that the pressure points is an 'antiquated way of thinking'. This shows that the service is unwilling to accept the changes in curricula, and is trying to adhere to the 'this is the way we've always done things' mode of thinking, which is counterproductive to changes in patient care in the field.

[fakingpatience]

Thanks so much for your quick replies! That has been one of my frustrations of living in this new state, is that they don't follow national registry, which means some of the SOP are behind the times... I also have to put my 'pt' in a correct position for them showing s and s of hypoperfusion... which I assume means they want me to put my patient in Trendelenburg! Its frustrating, having learned that these things are wrong, or just not effective, and having to use them to pass this skills test to get to an interview.

Back to one of my earlier questions, when can you release the pressure point? If you let go as soon as the bleeding stops, won't it start up again? or is it like a tourniquet, where you can't let go until you get to the ER and let a doc do it

Edited to add: The service skills test are the exact same skills test that people in this state have to take to get certified as an EMT-B...

Edited August 8, 2010 by fakingpatience

[armymedic571]

Patience---

To answer your question. The point of the pressure point (no pun intended) is to reduce the flow of the bleed so that a clot can form. As we have already established and you already know, this is an antiquated procedure and has been replaced by more prompt tourniquet use which has oodles (that is a technical term ) of evidence to back it up.

From what I can recall, you were to release the pressure point every 5 minutes and attempt to control the bleed with direct pressure and elevation, or having more help arrive (which ever came first.

I did not find a specific reference for you, but an sure that one exists somewhere on the internet. Good luck to you and your quest for new employment.

AM 571

[rock_shoes]

Patience---

To answer your question. The point of the pressure point (no pun intended) is to reduce the flow of the bleed so that a clot can form. As we have already established and you already know, this is an antiquated procedure and has been replaced by more prompt tourniquet use which has oodles (that is a technical term ) of evidence to back it up.

From what I can recall, you were to release the pressure point every 5 minutes and attempt to control the bleed with direct pressure and elevation, or having more help arrive (which ever came first.

I agree that prompt tourniquet use is the way to go. That said, knowing the location of the major blood vessels is far from wasted in my opinion. In the event of a major bleed being able to apply a pressure point will buy you time while the tourniquet is applied as it takes nothing more than a gloved hand. I know it takes very little time to apply a tourniquet. It also takes very little time for a patient to bleed out when they sever their femoral artery.

[Richard B the EMT]

The way I was taught, it was always "Direct Pressure", then add "Elevation", "Pressure Point", and then the "Tourniquet". Don't stop one, when you go to the next.

As for Ice? Must be a local protocol, different than my local protocol. I don't say it's incorrect, I say, it's not the way I was taught. In my 'hood, it would be incorrect, but in yours, I'd be incorrect. So Be It!

As for releasing direct pressure? Nope, don't do it, and the same for after applying the Tourniquet. Resumed blood flow to the point of bleeding would 'wash away" any clotting that might have occurred, defeating the action of the application of the direct pressure or Tourniquet

[tniuqs]

I can't find the information anywhere in my EMT text book either

As always, any help is greatly appreciated!

Oh yes they are in your EMT books ... look under the topic ARTERIES.

[ERDoc]

Pressure points can be useful if you know your anatomy. A BP cuff makes a great tourniquet. Inflate it to a few tics above the systolic pressure (don't forget to follow your protocols).

[Chief1C]

Take a standard first aid course.