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Internal Bleeding - Raising the legs


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My first aid manual claims that for treatment of internal bleeding I should lay the patient and raise the legs or bend the knees. Is that because that way the circulation that way is slower and therefor let blood is injected by the ruptured vein/artery into the body?

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well...sorta...not really...no.....

Raising the legs has a couple of goals. One is that by raising the legs you allow the remaining blood to pool in the thorax where it is closest to vital organs. Blood returns to the heart via muscle contractions that in a nutshell squeezes blood thorugh your veins, and that blood is prevented from going back to the extremeties by valves in you veins. Problem being that when your laying down not moving, you dont have the muscle contraction in you limbs to move it. Laying them down with legs up circumvents this a bit as its return is gravity fed and not dependent up movement.

the other tid bit is that by raising the legs you increase peripheral vascular resistance, or the pressure your heart is forced to pump against. I ownt flood you with the equation, but increasing resistance within reason increases blood pressure and perfusion.

Now, for the truth...

Raising legs in hypotension has been shown in several to vary between no improvement in B/P to minor (about 10mmHg) to changes that are statisically insignificant. Also, internal bleeding and increasing B/P can be quite counter productive bleeding + high B/P = more bleeding. Personally, i dont raise legs in trauma patients, dont see the point as if i need to raise B/P ive got more effective means of doing it.

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Raising legs in hypotension has been shown in several to vary between no improvement in B/P to minor (about 10mmHg) to changes that are statisically insignificant. Also, internal bleeding and increasing B/P can be quite counter productive bleeding + high B/P = more bleeding. Personally, i dont raise legs in trauma patients, dont see the point as if i need to raise B/P ive got more effective means of doing it.

Yep, also you limit the the bodies own blood coagulation to work its way, or, by a raise of the BP you could destroy the clots that have already established themselves.

The permissive hypotension replaced the aggressive fluid therapy of older times, meaning you tolerate a mild hypotension (low blood pressure) in order not to enhance the blood flow. A good tip is to tolerate on the peripheral pulses. You will want to give just enough fluid (or vasopressors) to have palpable peripheral pulses.

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Yep, also you limit the the bodies own blood coagulation to work its way, or, by a raise of the BP you could destroy the clots that have already established themselves.

The permissive hypotension replaced the aggressive fluid therapy of older times, meaning you tolerate a mild hypotension (low blood pressure) in order not to enhance the blood flow. A good tip is to tolerate on the peripheral pulses. You will want to give just enough fluid (or vasopressors) to have palpable peripheral pulses.

"orientate yourself" - is what I wanted to right. Couldn`t edit it any more...:rolleyes2:

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My first aid manual claims that for treatment of internal bleeding I should lay the patient and raise the legs or bend the knees. Is that because that way the circulation that way is slower and therefor let blood is injected by the ruptured vein/artery into the body?

Your "last aid" Manuel is old as dirt, read the thread http://www.emtcity.com/index.php/topic/20453-did-you-ever-use-a-tourniquet/page__st__20

page 3.

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Just out of curiosity - what kind of first-aid-manual is this?

I`ve done a first aid course here primarily before getting my drivers license and I can`t remember being taught anything about internal bleeding, not about how to diagnose it, let alone how to treat. Seems a bit far fetched for first-responders. That being said, in the most cases there would be nothing more to do for a first responder than dial 911.

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While waiting for the ambulance you can raise the legs 6 – 10 inches and cover the patient with a blanket to keep them warm.

Contraindications elevating legs are suspected spinal trauma and closed head injuries with altered mental status.

Here is a link to signs and symptoms of internal bleeding.

http://www.survival-...staid/bleed.htm

As stated above, the advantage of raising legs in such a case is controversial. That being said, keeping the pat. warm with a blanket is basic first aid, whatever the diagnose may be. I don`t see any special therapy first-aiders could apply for internal bleedings, therefore, I can`t see the need to learn them this specific knowledge.

The only thing I would update is in the case of external bleeding that can't be controled with direct pressure apply a touniquet and write the time of of intervention on patients forehead. Do not cover or bandage over the touniquet.

See tniuqs link above and read the comments, there are some good reasons why tourniquets shouldn`t be in the hand of first responders.

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Yep, but if vorenous is old enough to get a drivers license the knowledge could be useful in a true emergency situation.

No need to adress me using the 3rd person - believe me I`m not that important. And I`m not only old enough to drive a vehicle, I`m also old enough to work as a provider in the EMS. :rolleyes:

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Just out of curiosity - what kind of first-aid-manual is this?

I`ve done a first aid course here primarily before getting my drivers license and I can`t remember being taught anything about internal bleeding, not about how to diagnose it, let alone how to treat. Seems a bit far fetched for first-responders. That being said, in the most cases there would be nothing more to do for a first responder than dial 911.

AHA 2005 taught the shock position to include lying the person on his/her back, raising the legs 10-12" and covering to keep him/her warm until additional help arrived. You weren't diagnosing it per se but if you knew someone had been in an accident and was cool, clammy and possibly altered, this was the best position to put them in. Then you call 911. So, not far fetched at all.

However, AHA 2010 has changed that and raising the legs is no longer indicated.

Toni

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I was not trying to disparage you age but to imply your decision capabilities in hemorrhage control. Where do you work?

I work in Germany with the Red Cross (here, it is one of the main emergency care providing organisations).

AHA 2005 taught the shock position to include lying the person on his/her back, raising the legs 10-12" and covering to keep him/her warm until additional help arrived. You weren't diagnosing it per se but if you knew someone had been in an accident and was cool, clammy and possibly altered, this was the best position to put them in. Then you call 911. So, not far fetched at all.

However, AHA 2010 has changed that and raising the legs is no longer indicated.

Toni

Yep, that`s all I meant.. The typical shock symptoms you stated above and the treatment for first responders, that`s all clear. My point was, that I couldn`t imagine being taught specific symptoms of internal bleeding in a first-aid-course, in the original post of the thread it sounded like that (maybe I misunderstood it).

Anyway, it`s not that important, I was just wondering...

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