Caleb Causey

Self Defense Medicine Session 8: Pressure Dressings

Caleb Causey
Duration:   14  mins

Description

This session provides you a detailed explanation of two common Pressure Dressing products, the Israeli Dressing and the OlaesĀ® Modular Bandage. Each allows you to maintain targeted pressure to a wound. You will see how to properly open, deploy, and self-apply these pressure dressings in order to stop severe bleeding from a puncture wound or laceration.

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Let's talk about pressure dressings. There's several different kinds of pressure dressings. Just like a tourniquet, several different makes and models and manufacturers of them. There's also different types and sizes of them as well. You'll notice that we've got a couple of different sizes here.

We've got, with Israeli and the OLAES bandage, we've had a four-inch and a six-inch wide. And typically, we're talking about a modern day pressure dressing, we're talking about those two sizes, a four-inch and a six-inch. Now, as far as, is there really any pros and cons to whether a six-inch versus a four-inch? No. Maybe if you're talking about your individual first aid kit, you can only fit a four-inch pressure dressing inside that kit, well, then that's what you're gonna use.

If you're carrying an aid bag or, hey, your IFAK, or a med kit does allow for more room, then sure, I'd recommend absolutely going with the larger pressure dressing. So we've got a couple different options here, but let's first talk about what is it exactly that a pressure dressing does, and how does that work when we're talking about penetrating trauma. Now, penetrating trauma, I'm talking about anything that cuts through the skin, whether it's something that's impaled or a small cut. So let's talk about maybe a gunshot wound, for example. We've got that hole in the skin.

Well, blood is gushing out of there. Well, we've got to actually either reach pressure that's either equal or greater than the amount of pressure that's, of force that's being squirted out of the body. So that's where our pressure dressings and these bandages come into play. We're actually gonna take the dressing part of it and we're going to apply directly to there. But also as we start wrapping it around the limb or the body, the torso, the body part, it's actually recruiting that muscle tissue and the adipose tissue or that fat tissue, the bone sometimes too as well, and actually creating a lot more pressure around that wound to help combat or if not be equal or greater than the amount of pressure that the artery's pushing the blood out.

One option we've got for pressure dressing is the Israeli dressing. These are very common on the market. You can find them in a lot of different places and there's a lot of pros and cons to these, but they happen to be one of my favorite dressings as well. One thing I always look at a pressure dressing is, one, how is it packaged? If you've noticed some of the first aid equipment and some of the gauze and bandages you find, say at a local drug store, they're designed to sit on a hospital shelf or designed to sit in a medicine cabinet at your house.

Well, that may be fine for that environment, but where we're out in our vehicle around the shooting range or if we're dealing with a violent altercation and we've got this stuffed in say our go bag or in our med kit or IFAK, then we need something that's a little bit beefier, packaged a little bit beefier. So they did a really good job with the Israeli dressing here. The Israeli dressing, again, it comes in the four and a six-inch-wide version. We've got a six-inch-wide version here. And there is a right and a wrong way to actually open these.

And I'll demonstrate how we actually tear it from the short end to the short end. And what I mean by that is actually grab it from this end and tear it down from this end, as opposed to the long direction, okay? And the reason for that is so I can use the extra wrapper that it came in, I may need to use that for an additional dressing later. After you open it from the outer container, you end up with this clear plastic one you've got to pay attention to this part. This is kind of one of those cons that I look at, and I notice, okay, maybe they could have done this a little better.

The way you open this next is there's a little, tiny perforated edge right there. I don't know if you can see that, but that's where you start to tear it in half. And once you start tearing it there, it'll filet right open. And this is what you end up with. Okay, now you've got a couple of different pieces of this.

Okay, first off, you've got the dressing portion, this white dressing, cotton portion of it. The next is this elastic bandage here, okay, almost like an ACE wrap of some sort. All right, that's the bandage portion. On the other side, it's got this clamp on here, this plastic piece here. That's there to add more direct pressure to the wound site.

And we'll show you how to do that when we do applications of these dressings. So one thing about the Israeli that you really gotta pay attention to is maintain positive control of this tail, of this tail end. Notice, if I were to let go of it, it would completely come undone. And we don't want that to happen while we're trying to apply this to our patient or to ourselves. All right, we want to be sure and try to keep as, keep this dressing as clean as possible, but if it falls in the dirt or if we drop it on the ground, we can still use it because the idea is, we're gonna fight life now, we'll treat infection later.

So try to keep it as clean as you can, but be sure you maintain positive control of this, of the tail end here, of this rolled up bandage portion of it. The next portion, or next bandage I'd like to talk about is the OLAES bandage. This is the four-inch version and we've had a six-inch version here. Again, I always look at the packaging. How is it packaged?

It's pretty stout packaging. Both are shrink wrapped down. Again, we're gonna open this from short end to short end. Okay, once you open it short end to short end, inside, that's all you really have to open. There's not another bag or another piece of plastic.

You simply tear this white piece of paper off and this is what you end up with, is your, the bandage. You'll notice I've got the dressing portion again, this white portion. I've also got the tail end here. And on the other side, I've got a little bit different pressure bar, if you will. Okay, and that adds, again, adds direct pressure.

And we'll talk about how that works when we talk about application of them. Now, the cool thing about the OLAES bandage is this is almost kind of like five bandages in one. So if you're gonna pick one bandage to put in your IFAK or your med kit or in a vehicle somewhere, I'd probably recommend this one. Again, we've got the exterior wrapper here that could be used for additional bandaging or another medical, or excuse me, it could be used for additional injuries. On the inside here of this bandage, of the OLAES, if you flip this open, you'll notice, inside, we've got a couple of things.

One I've got additional gauze in here that I can either pull out all the way or I can leave in there. So think of it like this, where, why would I need two? Well, if I have an, perhaps an entrance wound, I may have an exit wound. So we'll want to use the bulk dressing here on whichever wound of that gunshot is larger, okay? Also, on the inside here, I actually have another piece of plastic here that we can use for chest injuries if we need to, as a last ditch option there for sucking chest winds and stuff.

And we'll talk about that a little bit later. On the inside, there's still enough gauze, if you can see, there's still enough gauze here, sewn in on the inside so we can still use it and still make it a formidable pressure dressing. Again, you don't have to pull the guts out of it. You can still leave them in there and you can use it. Perhaps, maybe you've got more than one injury.

So now I've technically got two bandages there I can use. Cool thing about this OLAES bandage is if I let go and I don't maintain positive control of this tail, of the bandage portion of it, this elastic portion, it's Velcroed in every so often intermittently. So that way, if I do let go, I don't lose the whole thing. So that's really nice when you're under stress and you've got a lot of outside stressors affecting you in your performance of trying to apply this bandage. So, those are some different options of a pressure dressing.

Remember, you've got a four-inch and a six-inch. We've got the Israeli here and the OLAES here. Make sure you've got them with you when you need them. Let's talk about how we apply these pressure dressings to some of the injuries that we may encounter during a violent altercation. First, let's start with the head.

We're gonna open up our pressure dressing. And for the head, I want you guys to remember, the head is very vascular, okay? If you don't believe me, just think of a MMA or a boxer, MMA athlete or a boxer, when they're in that ring and they get their head split open and there's blood all over the ring and then they, at the end of the round, they go back to their cup man in their corner. And the cup man literally takes their thumb and maybe one Q-tip and just puts it on top of their forehead and stops the bleeding. And it wipes all the excess blood away.

And you're like, wow, that was it? We expected to see some huge, you know, gash into their scalp and to look into their brain. Okay, but the head's very, very vascular and those blood vessels are really close to the skin. So even though it's bleeding really bad, it may not be near as bad as you think. The flip side is, don't take it for granted that, oh, it's a head wound, it's not bleeding that bad.

So the best thing we can do is apply direct pressure, but we're not exactly gonna, when we're self-aiding, we may not want to go ahead and apply a lot of pressure wrapped around the brain. That may cause further injury as well, especially if there's been a lot of head trauma or a lot of blows to the head, say with a club or something to that extent. Okay, depending on this mechanism of injury, we may just get by with having to apply this dressing straight up to the head. Let's say I'm cut right above my right eye, and just sitting there and holding it there. Okay, and I can hold it with either hand.

If I need to, if you really wanted to, you could start wrapping it around. The problem with that is, with it being self-aid, you might not get it tight enough or too loose or too tight and it's just not gonna work out that well. So as long as you can sit here and hold it and keep that there until the ambulance arrives, that's probably gonna be your best bet. Now let's talk about, what about abdominal wounds? Well, abdominal wounds can be kind of different as well.

There's, you got your different organs inside your abdominal region. Okay, and that's, we're talking about, abdominal region would be anything from, say, below the ribs down to the pelvic region, okay? And you've got a lot of hollow organs in there. You've got some solid organs in there. But the thing to remember is that the skin is very elastic.

Well, so are, as well as some of those organs as well. So where you may have one bullet hole or a stab wound, it may or may not bleed a lot on the outside but on the inside, it's bleeding. Well, if it's internal bleeding, there's not a whole lot we can do at this point. Okay, that's gonna be a surgeon in the OR that's gonna be able to treat that and solve that problem for us. However, we're bleeding externally, we can certainly solve that problem by taking our pressure dressing and applying it simply, say it's right here in the middle of my stomach.

I can sit here and apply pressure and hold that there until the ambulance arrives. Remember, we've only got about that nine to 12 minutes, maybe 15, 20 on the high side, maybe, but I can sit here and hold that and still use one hand. Should another threat present itself, hey, then I can go to one-handed manipulation if I need to. Let's talk about, what about an injury on the leg? Now, we talked about tourniquets earlier.

Well, maybe that, hey, I put a tourniquet on there. Well, if they get a tourniquet on the arms and legs, it's a good idea to go ahead and make sure you get a pressure dressing on that wound as well. Okay, so if we're talking self-aid, let's talk about a leg injury. I've already applied my tourniquet. I still need to go ahead and cover that up with a pressure dressing.

The way I'm gonna do that is let's say my entry was this point right here above my knee. And it's just only one wound. I, let's not, I'm not gonna, I don't have an exit wound necessarily here, or another additional wound. So I'm gonna apply this. And I'm gonna take my support hand here and actually apply direct pressure and hold that tight there.

I'm not wanting to grab both edges because what happens is, people let go of this, and our students in our classes under stress and duress end up letting go of that and it flies open. Blood goes everywhere and it's, doesn't look as cool. So what we're gonna do is apply direct pressure with that support hand there. Our other hand, notice, I'm keeping it pretty close to the body here. I'm not taking this roll, undoing it all the way out here, and coming back under.

A prime example of this is those athletic trainers with the NFL. When they're wrapping up one of those players' ankles, they don't undo that gauze or that tape all the way out. They keep it really close, in a close-in workspace. And you can see I'm still choking up on this, keeping it as tight as I can and as wide as I can directly over that pressure cup. Now, I put that pressure cup directly over where my wound is.

And you'll notice, it's right over my top of my wound. I'm going to cup, go once around. And now I'm gonna cover up the edges here, these white edges. I want to make sure I cover those up, okay? Maintaining, still maintaining a lot of, plenty of pressure here.

I'm gonna keep going. Okay, now what you're thinking, well, what do I do once I get to the end? Well, for demonstration purposes, I'm gonna loosen this up just a bit so we end up where we can see it on film. And if you look, we've got these anchor hooks, okay? And they've got these little one-way teeth on them, okay?

All we've got to do is find an edge or somewhere in the middle and anchor them, feed them through there. And now it doesn't require any tape, it doesn't require those little metal pieces to anchor them on there. Those will stay on there pretty tight. And you notice, I've covered up the edges, and for training purposes, I shouldn't be able to slide this back and forth up and down. It shouldn't be loose.

It should be pretty snug. Now let's go ahead and look at how we actually apply this to our arm using self-aid. We've got our bandage here opened. Now, if we, wherever our laceration or our wound may be, one thing, it could be very difficult to actually start wrapping this with one hand. Sure, you could probably figure it out, but in reality, by yourself waiting for the ambulance to arrive, it's just as easy to sit here and hold it on there and hold it tight.

Okay, don't forget, you can always recruit bystanders or a friend or a loved one that's nearby. Maybe they can sit here, after you've applied direct pressure to it, maybe they can assist you in wrapping it completely and creating that really tight pressure dressing. So to summarize, be sure you've got either your Israeli or your OLAES pressure dressing, but be sure you apply, use direct pressure, and apply a lot of direct pressure with that support hand first. Not so much worried about the wrap itself or the ACE wrap or the elastic part of it, but you put that pressure dressing and that dressing portion directly over there, but don't forget about exit wounds or additional injuries where you may have to utilize one bandage for several different injuries.

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