CONTROL OF EXTERNAL BLEEDING Responsibility Never hesitate to call 911 Life Safety is most important! It is the responsibility of every individual to learn to recognize the warning signs of a medical emergency. Warning Signs and Symptoms Difficulty breathing, shortness of breath Chest or upper abdominal pain/pressure lasting two minutes or more Fainting, sudden dizziness, weakness Changes in vision Difficulty speaking Confusion or changes in mental status, unusual behavior, difficulty waking Any sudden or severe pain Uncontrolled bleeding Severe or persistent vomiting or diarrhea Coughing or vomiting blood Suicidal or homicidal feelings Unusual abdominal pain Situation Assessment Assess the situation: If the person is conscious ask them to tell you if anything hurts. If unconscious, gently inspect the person for obvious signs of injury. Do not move the person (especially if they indicate any pain) unless they are in imminent danger of further injury, e.g., an approaching fire. Call 911 if the person is injured. Do not hang up until the dispatchers hang up. You may render first aid, but medical attention should be done by qualified medics. Do not provide or administer any medicines, and get out of the way once emergency personnel arrive. Limit your conversation with the person to reassurances. Do not discuss their injury if at all possible. Do not discuss the accident or what circumstances might have contributed to its cause. Do not discuss insurance matters. Uncontrolled bleeding initially causes weakness. If bleeding is not controlled within a short period, the victim will go into shock (described in the next section), and finally die. The average adult has about 5 liters of blood. Because the loss of just 1 liter poses a risk of death, it is critical that excessive bleeding be controlled in the shortest amount of time possible. There are three main types of bleeding. The type can usually be identified by how fast the blood flows. Arterial Bleeding. Arteries transport blood under high pressure. Therefore, bleeding from an artery is spurting bleeding. Venous Bleeding. Veins transport blood under low pressure. Bleeding from a vein is flowing bleeding. Capillary Bleeding. Capillaries also carry blood under low pressure. Bleeding from capillaries is oozing bleeding. If you cannot control the bleeding using one method, try another, or a combination of methods Method Direct Local Pressure Elevation Pressure Points Procedures Place direct pressure over the wound by putting a clean pad over the wound and pressing firmly. Maintain compression by wrapping the wound firmly with a pressure bandage. Elevate the wound above the level of the heart. Put pressure on the nearest pressure point to slow the flow of blood to the wound. A pressure point is a pulse point for a major artery. Use the: o Brachial point for bleeding in the arm. o Femoral point for bleeding in the leg. There are other pressure points that your instructor may demonstrate. Serial # 201408331 Reference Only Not for Copy or Resale All Rights Reserved www.emergencyplan.com 1 of 6
Procedures for Controlling Bleeding Ninety-five percent of bleeding can be controlled by direct pressure combined with elevation. POINT POINT Brachial Pressure Point Femoral Pressure Point An illustration of the three main methods to control bleeding is shown in the figure below. DIRECT ELEVATION POINT Methods for Controlling Bleeding Serial # 201408331 Reference Only Not for Copy or Resale All Rights Reserved www.emergencyplan.com 2 of 6
If none of the other methods for controlling bleeding is successful, a tourniquet may be necessary. A tourniquet is rarely required and should be used only as a last resort a life or limb situation. Tourniquets are considered appropriate treatment for crushing-type injuries and for partial amputations. Using a tourniquet can pose serious risks to the affected limb, so it should not be used unless not using it will endanger the person s life from excessive blood loss. The most serious dangers in tourniquet use stem from: Incorrect materials or application, which increases the damage and bleeding. If narrow materials are used or the tourniquet is too tight, nerves, blood vessels, and muscles may be damaged. Damage to the limb from a tourniquet. Survival of a limb is almost never possible after a correctly applied tourniquet is left in place too long. Only a physician should remove a tourniquet. If you apply a tourniquet, leave it in plain sight (don t bandage over it), and attach an adhesive label to the victim s forehead stating the time the tourniquet was applied. External Bleeding Tourniquet Blood consists of red cells (erythrocytes), which convey oxygen throughout the body; white cells (leucocytes), which fight introduced infection; platelets (thrombocytes), which assist in the clotting process; and plasma, the fluid portion of blood. There are between five and seven litres of blood in the average adult body. Blood is moved around the body under pressure by the cardiovascular system - the heart and blood vessels. Without an adequate blood volume and pressure, the human body soon collapses. Bleeding, or hemorrhage, poses a threat by causing both the volume and the pressure of the blood within the body to decrease through blood loss. Serial # 201408331 Reference Only Not for Copy or Resale All Rights Reserved www.emergencyplan.com 3 of 6
External bleeding is usually associated with wounds, those injuries that are caused by cutting, perforating or tearing the skin. Serious wounds involve damage to blood vessels. As arteries carry oxygenated blood from the heart, damage to a vessel is characterised by bright red blood which 'spurts' with each heartbeat. Damage to veins appears as a darker red flow. Capillary damage is associated with wounds close to the skin and is of a bright red 'ooze' from below the surface. TYPES OF WOUNDS Incision is the type of wound made by 'slicing' with a sharp knife or sharp piece of metal. Laceration is a deep wound with associated loss of tissue the type of wound barbed wire would cause. Abrasion is a wound where the skin layers have been scraped off. Puncture wounds are perforations, and may be due to anything from a corkscrew to a bullet. Amputation is the loss of a digit or limb by trauma. CARE AND TREATMENT LIFE THREATENING BLEEDING Quickly check the wound for foreign matter Immediately apply pressure over the wound to stop any bleeding Call 911 for an ambulance Apply a non-adherent dressing Apply a pad Lay the individual down Raise and support the injured part above the level of the heart if possible Apply a firm roller bandage Treat for shock if required If unable to stop the bleeding consider a constrictive bandage. Constrictive bandages are a measure of last resort, and should only be used in a life threatening situation where all else fails. INCISIONS and LACERATIONS. Quickly check the wound for foreign matter Immediately apply pressure to stop any bleeding Apply a non-adherent dressing Apply a firm roller bandage Immobilise and elevate the injured limb if injuries permit ABRASIONS Check the wound for foreign matter Swab with a diluted antiseptic solution Apply a non-adherent dressing or a light, dry dressing if necessary PUNCTURE WOUND Check the wound do not remove any penetrating object Apply pressure to stop any bleeding Stabilise with a ring pad and non-adherent dressing Apply a firm roller bandage Rest and elevate injured limb if injuries permit AMPUTATION Apply immediate pressure to stop any bleeding Apply a large pad or dressing to the wound Treat for shock Rest and elevate injured limb if possible Serial # 201408331 Reference Only Not for Copy or Resale All Rights Reserved www.emergencyplan.com 4 of 6
Collect amputated part keep dry, do not wash or clean Seal the amputated part in plastic bag or wrap in similar waterproof material Place in iced water do not allow the part to come in direct contact with ice. Freezing will kill tissue. Ensure the amputated part travels to the hospital with the individual Care should be taken to obtain medical advice for prevention of tetanus. REMEMBER so as not to disturb clotting on the wound, do not remove the initial dressing. If bleeding continues and seeps through the bandage and padding, remove and replace these, leaving the initial dressing in place. NOSE BLEED Have the individual pinch the fleshy part of the nose Lean slightly forward Advise individual not to swallow blood Maintain this posture for approximately ten minutes Apply cool compress to neck and forehead If bleeding persists, obtain medical aid Advise the individual not to blow or pick nose for several hours Internal Bleeding Internal bleeding is classified as either visible, in that the results of the bleeding can be seen, or concealed, where no direct evidence of bleeding is obvious. Internal bleeding is always to be considered as a very serious matter, and urgent medical aid is necessary. In most instances, obtaining an adequate history of the incident or illness will give the first aid provider the necessary clue as to whether internal bleeding may be present. Remember that current signs and symptoms, or the lack of them, do not necessarily indicate the individual's condition. Certain critical signs and symptoms may not appear until well after the incident due to the stealth of the bleed. VISIBLE INTERNAL BLEEDING Visible internal bleeding is referred to this way because the results are visible: Bleeding in the lungs frothy, bright red blood coughed up by the individual. Anal or vaginal bleeding usually red blood, mixed with mucous. Bleeding in the stomach dark 'coffee grounds', or red blood, in vomitus. Bowel, or intestinal bleeding dark, loose, foul smelling stools. Bleeding in the urinary tract - dark or red colored urine CONCEALED INTERNAL BLEEDING In these cases, the first aid provider is heavily reliant on history, signs and symptoms. Judgment and experience play a part, but it may come down to a first aider's 'gut feeling'. If you are unsure, assume the worst and treat for internal bleeding. SIGNS AND SYMPTOMS Pale, cool, clammy skin Thirst Rapid, weak pulse Rapid, shallow breathing 'guarding' of the abdomen, with fetal position if lying down Pain or discomfort Nausea and/or vomiting Serial # 201408331 Reference Only Not for Copy or Resale All Rights Reserved www.emergencyplan.com 5 of 6
Visible swelling of the abdomen Gradually lapsing into shock CARE AND TREATMENT Call 911 for an ambulance Position the individual supine, with legs elevated and bent at the knees (only if conscious) If unconscious, side position with support under the legs to elevate them Reassurance Treat any injuries Give nothing by mouth Close Document to Return www.emergencyplan.com Serial # 201408331 Reference Only Not for Copy or Resale All Rights Reserved www.emergencyplan.com 6 of 6