Page 225 - 2023 SMOG Digital

o In pelvic wounds – utilize pelvic binding to limit capacity for hemorrhage (tie
pelvis with sheet/commercial binder).
o For external hemorrhage of the head and neck where the wound edges can
be easily re-approximated, the iTClamp may be used as a primary option for
hemorrhage control. Wounds should be packed with a hemostatic dressing or
XStat, if appropriate, prior to iTClamp application. DO NOT APPLY on or near
the eye or eyelid (within 1cm of the orbit).
 The iTClamp does not require additional direct pressure, either when
used alone or in combination with other hemostatic adjuncts.
 If the iTClamp is applied to the neck, perform frequent airway
monitoring and evaluate for an expanding hematoma that may
compromise the airway. Consider placing a definitive airway if there is
evidence of an expanding hematoma.
o Administer IVFs as per guideline – use care with internal bleeding so as not to
raise SBP above 80mmHg. MAP should be greater than >60mmHg.
o Consider 2g TXA if significant blood loss.
Document procedure, results, and vital signs.
***Clear endpoints for fluid resuscitation remain unclear. Resuscitation should be
geared towards patient response to therapy. A MAP greater than 60mmHg or a systolic
BP between 70-80mmHg is a reasonable goal in trauma patients without a head injury.
A MAP between 80-110mmHg or systolic pressure between 110-160mmHg is a
recommended goal in patients with a head injury.
MAP= Mean Arterial Pressure: MAP = [(2 x diastolic BP) + systolic BP] / 3)
Hemorrhage Classification (ATLS)
Class I Class II Class III Class IV
Estimated Blood <750 750-1500 1500-2000 >2000
Loss (mL) 15% 15-30% 30-40% >40%
Heart Rate Normal to Mild Tachycardia Tachycardia Tachycardia
(min) slightly elevated >100-119 120-140 >140
Respiratory Rate Normal Mild Tachypnea Tachypnea Tachypnea
(min) 12-20 20-24 24-40 24 - >40
Blood Pressure Normal or SBP with mild SBP decreased* SBP decreased
(from baseline) slightly elevated decline (<90mmHg)
Urine Output Normal Slight decrease Decreased Negligible
(mL/hr > 30 20-30 5-15 <5
Capillary Refill 1-2 seconds 2 seconds >2 seconds > 3 seconds
Mental Status Normal or Mildly anxious, Anxious, Confused,
and Skin slightly anxious skin may confused, skin lethargic, skin
(color/texture) become cool, cool, clammy will be cool/cold,
clammy pale

225