control of hemorrhage, the limitation or cessation of the flow of blood from a break in the wall of a blood vessel. ▪ METHOD: Some of the methods for controlling hemorrhage are direct pressure, use of a tourniquet, and application of pressure on pressure points proximal to the wound. Direct pressure with a thick compress is applied in such a way that the edges of the wound are drawn together. A tourniquet is applied proximal to the site of bleeding only in the most extreme emergency, for the limb may then have to be removed as a result of tissue anoxia stemming from the use of the tourniquet. Firm manual pressure is applied to a pressure point over the main artery supplying the wound. Points used to obtain the pulse may be used as pressure points to stop hemorrhage. ▪ INTERVENTIONS: Blood flow to an area is limited by restricting activity, elevating the part, and applying pressure. Specific treatment depends on the cause of the hemorrhage and the patient’s condition. In addition to IV infusion equipment and fluids, the nurse may anticipate the need for vasopressor drugs, ventilatory assistance, central venous pressure monitoring equipment, and materials for obtaining and recording the blood pressure and urinary output. If signs of shock are present, the patient may be placed supine at a 45-degree angle to the pelvis, with the knees straight and the pelvis slightly higher than the chest. The head may be supported with a pillow. The person may be given oxygen, and the central venous pressure may be measured to determine the need for replacement of fluid volume. Sudden, severe hemorrhage with signs of shock usually is treated with IV infusion of fluids and transfusion of blood. The application of additional warmth to the skin is not recommended because heat increases the metabolism and the need for oxygen. ▪ OUTCOME CRITERIA: Signs of continued bleeding, tachycardia, cold sweat, decreasing blood pressure, and patient anxiety alert the nurse to the probability that bleeding has begun again or that replacement fluids administered after the hemorrhage are not adequate. The person is kept calm and quiet. If the fluid balance is promptly restored, recovery is usual. Excessive loss of blood leads to hypoxia of all the tissues of the body, including the brain and vital organs, and causes death.
