Comment:

Dr. Smith: The caustic nature of alkali exposure to the cornea remains a threat to vision hours after irrigation. Large-volume irrigation and immediate evaluation in the emergency department are critical.

Control of Bleeding (FA 530)

Recommendation Author: Zachary Lipsman, MD
Dr. Lipsman is a member of the Emergency Medicine Residency Training Class of 2019 at Warren Alpert Medical School of Brown University.
Question: Among adults and children with bleeding, (P), does ice, elevation, and/or proximal pressure (I) versus direct pressure (C) change mortality, hemostasis, major bleeding, complications, or hospital length of stay (O)?

Results: For cold compression versus compression alone, there was very-low-quality evidence: One RCT was identified for the outcome of hemostasis comparing femoral hematoma after percutaneous coronary intervention (PCI), and one RCT was identified for the outcome of major bleeding following total knee arthroplasty. This study also addressed deep vein thrombosis formation and was deemed very-low-quality evidence. No evidence was identified addressing mortality or hospital length of stay.

Outcomes: Significant hematoma reduction was found using cold-pack compression versus compression alone following PCI. A significant decrease in total blood loss and extravasation volumes, and a nonsignificant decrease in DVT, was found using cold compression versus compression alone following knee arthroplasty.

Discussion: Caution must be used when applying postsurgical principles to first aid settings. Hypothermia is unlikely from using cold therapy, even in children, when applied to a small, closed area of bleeding.

Recommendation: Localized cold therapy with or without pressure may be beneficial in hemostasis for closed bleeding in extremities. There’s inadequate evidence to recommend the use of proximal pressure points, cold therapy for external bleeding, or elevation for control of bleeding.

Comment:

Dr. Mell: You can use ice for small bruises, but the idea of controlling bleeding with elevation or pressure points isn’t recommended. Direct pressure is the best method overall. A separate recommendation (FA 768) advocates tourniquet use when conventional methods fail to control bleeding.