National Athletic Trainers Assn. Certified Athletic Trainer should always have written approval by supervising physician before using any of these management options and a written standard of practice on their technique to manage bleeding on file.    Management of traumatic superficial bleeding in a timely manner is a critical skill required by any Athletic Trainer or Physician working in the Sport of Wrestling. During a Wrestling Match, a wrestler that sustains a traumatic superficial bleeding injury can lose a match, if the bleeding is not controlled and further bleeding managed. This has become important safety decision to prevent cross contamination of blood borne pathogens. The Sports Medicine Professional working at mat side must:    · Stop the flow of blood  · Prevent the recurrent flow of blood  · Prevent cross contamination  · Prevent infection  · Clean and disinfect the mat surface  · Clean up any residue on wrestler or singlet    When a wrestler sustains a bleeding injury regardless of source of bleeding the referee will stop the match regardless of the match score or situation. The Referee will allow intervention to manage the bleeding for a period of time but this time is limited and in international events the rule is to only allow two stops to control bleeding. This creates a very stressful environment for the sports medicine professional to "get the job" done. In addition, some coaches will try to coach the athlete during the "break" and this can cause an additional distraction.    Common Bleeding Injuries in Wrestling:    Generally, Bleeding injuries occur because of contact with an opponent. The most common are:    · Nosebleeds  · Any skin lesion on face, elbow or knee  · Mouth or lip cuts  · Eyebrow lacerations  · Scalp lacerations  · Chin or "razor" cut  · Biting of tongue  · Mat burn or blister    Assessment of Injury    Determine the source of bleeding and determine if any other injury exist that would result in an injury default. Such as Concussion, fracture of nose or facial bone, broken tooth, compromised eye function, lacerated tendon etc.  If it is simply a bleeding wound apply direct pressure to the wound area. If the nose is bleeding have the athlete tilt head forward and pinch the nostrils closed. DO NOT HAVE THE ATHLETE TILT THE HEAD BACKWARDS. This can cause excessive bleeding into the pharynx and can result in nausea and vomiting. Often times move the athlete to a trach can and lean over the can and allow the blood to drip down. If the athlete becomes "lightheaded" sit them down and allow the blood to drip away from the pharynx.    Once you can visualize the injury, determine if the injury is minor. If the injury does not disrupt the subcutaneous tissue and direct pressure can stop the bleeding, there are several options to deal with the injury. MANAGING BLEEDING IS A LEARNED SKILL and effectiveness is based on practice.    Options    1. Direct Pressure and use of dressing  2. Cauterization using chemical preparation such as Silver Nitrate Applicators or Ferrous Subsulfate (Monsel's Solution)  3. Pharmaceutical intervention such as 1 to 10,000 Dilution of Epinephrine or Glyoxide  4. Use of Salve with Circulatory Depressant such as Hemorrhoidal Ointment  5. Use of a Blood Reactor such a QR Powder that produces a Hematix scab or Blood Clotter Spray.    Once Bleeding has been controlled, management of recurrent bleeding needs to occur. This may require use of dressing and tape to hold the dressing in place. If time allows cover the wound with an occulsive dressing such as BIOCLUSIVE, second skin and Stretch COVEROLL.     It is beyond the scope of this tip to discuss how to use the various options but stop by the HEALTHSOUTH Medical Area at the next tournament and we can show you how to use all the above mentioned options. For a list of sources to purchase the various supplies, simply write us at lasvegasoutreach@healthsouth.com. We would be happy to give you a list of suppliers.