UNIT IV.
Wounds and
Bleeding
Introduction
The heart and blood vessels are collectively known
as the circulatory system. This system keeps the body supplied
with blood , which carries oxygen and nutrients to all body
tissues. The techniques described in this section show how you
can help to maintain an adequate blood supply to the heart and
brain following injury that affects the circulatory system.
Treatments for all types of wound are covered in
this chapter.
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The Heart and Blood Vessels
The heart and the blood vessels make up the circulatory system.
These structures supply the body with a constant flow of blood,
which brings oxygen and nutrients to the tissues and carries
waste products away.
BLOOD – pumped around the body by rhythmic contractions of
the heart muscle. Composition of blood
There are about 6 liters (10 pints), or 1 liter per 13 kg of
body weight, of blood in the average adult body.
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Bleeding and Types of Wound How wounds heal
Injured tissue cells at the site of the wound, together with
TYPES OF BLEEDING specialized blood cells called platelets, then trigger a series of
1. If an artery is damaged, bleeding will be profuse. Blood will chemical reactions that result in the formation of a substance
spurt out with each heartbeat.
that creates a mesh.
2. If a large or varicose vein is damaged, blood will flow from
the wound profusely and blood volume can fall rapidly.
3. Bleeding from capillaries occurs with any wound. At first,
bleeding may be brisk, but blood loss is usually slight.
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Stages of Wound Healing
The clot releases a fluid known as serum, which contains
antibodies and specialized cells. Fibroblast cells form a plug
within the clot.
Fibroblast
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Later, this dries into a crust that seals and protects the site of
the wound until the healing process is complete
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crust/scab
TYPES OF WOUND
1. Incised wound
o caused by a clean surface cut from a sharp-edged objects
such as a razor
o Structures such as tendons or nerves may be damaged
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TYPES OF WOUND
2. Laceration
o These wounds may bleed less profusely than incised wounds,
but there is likely to be more tissue damage.
o often contaminated with germs, so the risk of infection is
high.
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TYPES OF WOUND
3. Abrasion (graze) 4. Contusion (bruise)
o This is a superficial wound in which the topmost layers of o A blunt blow can rupture capillaries beneath the skin,
skin are scraped off, leaving a raw, tender area. causing blood to leak into tissues.
o often caused by a sliding fall or a friction burn. o Extensive contusion and swelling may indicate deeper
o They can contain embedded foreign particles that may cause damage, such as a fracture or an internal injury
infection.
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TYPES OF WOUND
5. Puncture wound 6. Stab wound
o An injury such as standing on a o This is a deep incision caused by a sharp or bladed
nail or being pricked by a needle. instrument, usually knife, penetrating the body.
o It has a small entry site but a deep
track of internal damage.
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TYPES OF WOUND
5. Gunshot wound
o This type of wound is caused by a bullet or missile being
driven into or through the body, resulting in serious internal
injury and sucking in clothing and contaminants from the air.
o The entry wound may be small and neat; any exit wound may
be large and ragged.
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WHAT TO DO
SEVERE EXTERNAL BLEEDING
1.
Apply direct pressure over the wound with your fingers using
a sterile dressing or clean, non-fluffy pad. If you do not have a
dressing, ask the casualty to apply direct pressure himself.
2. Ask a helper to call 911 for emergency help. Tell him or her
When treating severe bleeding, check first whether there is an to give ambulance control details of the site of the bleeding
object embedded in the wound; do not press directly on the and the extent of the bleeding.
object. Do not let anything to eat or drink as he may need an
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anesthetic later.
WHAT TO DO WHAT TO DO
3. Secure the dressing with a bandage that is firm enough to 5.
If bleeding shows through the dressing, apply a second one
maintain pressure, but not so tight that it impairs circulation.
on top of the first.
Call 911 for emergency help if this has not been done already.
6. Support the injured part in with a sling and/or bandage .
Check the beyond the bandage every ten minutes.
4.
As shock is likely to develop, help the casualty to lie down –
on a rug or blanket if there is one, as this will protect him from
the cold. Raise and support his legs so that they are above the
level of his heart.
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WHAT TO DO SPECIAL CASE IF THERE IS AN OBJECT IN THE WOUND
7. Monitor and record the casualty’s vital signs – breathing, 2.
To protect the wound, drape a piece of gauze over the object.
pulse and level of response – while waiting for help to arrive.
Build up padding on either side, then carefully bandage over
the object and pads without pressing on the object.
SPECIAL CASE IF THERE IS AN OBJECT IN THE WOUND
1.
Control bleeding by pressing firmly on either side of the
embedded object to push the edges of the wound together. Do
3.
Call 911 for emergency help. Monitor and record vital signs –
not press directly on the object, or try to remove it. breathing, pulse and level of response – while waiting for help
to arrive.
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INTERNAL BLEEDING
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Possible Signs of Internal Bleeding
IMPALEMENT
Site Appearance of Blood
Mouth • Bright red, frothy, coughed-up
blood If someone has been impaled, for example by falling on to
• Vomited blood, red or dark
reddish-brown, resembling coffee
railings, never attempt to lift the casualty off the object
grounds
Ear • Fresh, bright red blood involved since this may worsen internal injuries.
• Thin, watery blood
Nose • Fresh, bright red blood
• Thin, watery blood
Anus • Fresh, bright red blood WHAT TO DO
• Black, tarry, offensive-smelling
tool (melaena)
1. Call 911 for emergency help.
Urethra • Red or smoky appearance to urine,
occasionally containing clots 2. Support the casualty’s body weight until emergency
Vagina • Either fresh or dark blood
services arrive and take over.
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WHAT TO DO
AMPUTATION
1.
Control blood loss by applying direct pressure and raising the
injured part above the casualty’s heart
2.
Place a sterile dressing or a non-fluffy, clean pad on the
wound, and secure it with a bandage. Treat the casualty for
shock.
3.
Call 911 for emergency help.
4.
Wrap the severed part in kitchen film or a plastic bag. Wrap
A limb that has been partially or completely severed can, in many
the package in gauze or soft fabric and place it in a container
cases, be reattached by microsurgery.
full of crush ice. Mark the container with the time of injury and
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the casualty’s time.
WHAT TO DO
CRUSH INJURY
1.
If you know the casualty has been crushed for less than 15
minutes and you can release him, do this as quickly as
possible. Control bleeding, steady and support any suspected
fracture and treat him for shock.
2.
If the casualty has been crushed for more than 15 minutes,
or if you cannot move the cause of injury, leave him in the
A crush injury may include a fracture, swelling and internal position found and comfort and reassure him.
bleeding. The crushing force may also cause impaired circulation.
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WHAT TO DO BRUISING
3. Call 911 for emergency help, giving clear details of the
incident to ambulance control.
4. Monitor and record vita signs – breathing, pulse and level of
response – while waiting for help to arrive.
Caused by bleeding into the skin or into tissues beneath the
skin, a bruise can develop rapidly or emerge a few days after
injury. Bruising can also indicate deep injury.
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WHAT TO DO BLISTERS
1. Raise and support the injured part in a comfortable position
for the casualty
2. Place a cold compress over the bruise for at least ten minutes
Blisters occur with skin is repeatedly rubbed against another
surface when it is exposed to heat. The damaged area of skin
leaks tissue fluid that collects under the top layer of the skin,
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forming a blister.
WHAT TO DO SCALP AND HEAD WOUNDS
1.
Wash the area with clean water and rinse. Gently pat the area
surrounding skin dry thoroughly with a sterile gauze pad. If it
is not possible to wash the area, keep it as clean as possible.
2.
Cover a blister caused by a friction with an adhesive dressing;
make sure the pad of the plaster is larger than the blister.
Ideally use a special blister since this has a cushioned pad that
provides extra protection and comfort.
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WHAT TO DO WHAT TO DO
1. 3.
If there are any displaced flaps of skin at the injury site, Keep the pad in place
carefully replace them over the wound. with a roller bandage to
2.
Cover the wound with a secure the pad and
sterile dressing or a clean, maintain pressure.
non-fluffy pad. Apply firm,
direct pressure on the pad to
4.
help control bleeding to Help the casualty to lie down with her head and shoulders
reduce blood loss, and slightly raised. If she feels faint or dizzy or shows any signs of
minimize the risk of shock. shock, call 911.
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WHAT TO DO
EYE WOUND
1.
Help the casualty to lie on his back, and hold his head to
keep it as still as possible. Tell him to keep both eyes still.
2. Give the casualty a sterile
dressing or a clean, non-
fluffy pad to hold over the
affected eye.
All eye injuries are potentially serious because of the risk to the
casualty’s vision.
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3. Arrange to take or send the casualty to hospital
WHAT TO DO
BLEEDING FROM THE EAR
1.
This may be due to a burst eardrum, an ear infection, a blow Help the casualty into a half-sitting position, with, with his
to the side of the head or an explosion. Symptoms include sharp head tilted to the injured side to allow blood to drain from the
pain, earache, deafness and possible dizziness. ear.
2.
Hold a sterile dressing or a clean, non-fluffy pad lightly in
place on the ear. Do not plug the ear. Send or take the casualty
to hospital.
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WHAT TO DO
NOSEBLEED
1.
Tell the casualty to sit down and tilt his head forward to allow
the blood to drain from the nostrils. Ask him to breathe through
his mouth and to pinch the soft part of his nose for up to ten
minutes.
2.
Advise the casualty not to speak, swallow, cough, spit or sniff
since thus may disturb blood clots that have formed in the
A nosebleed can be serious if the casualty loses a lot of blood. In
nose. Give him a clean cloth or tissue to mop up any dribbling.
addition, if bleeding follows a head injury, the blood may appear
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thin and watery.
WHAT TO DO WHAT TO DO
3. 5.
After ten minutes, tell the casualty to release the pressure. If If bleeding stops and then restarts, help the casualty to reapply
the bleeding has not stopped, tell him to reapply the pressure pressure
for two further periods of ten minutes.
6. If the nosebleed is severe, or if it lasts longer than 30 minutes,
4.
Once the bleeding has stopped, and with the casualty still arrange to take or send the casualty to hospital.
leaning forwards, clean around his nose with lukewarm water.
Advise him to rest quietly for a few hours. Tell him to avoid
exertion and in, particular, not to blow his nose, because this
could disturb any clots.
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WHAT TO DO
BLEEDING FROM THE MOUTH
1.
Ask the casualty to sit down, with her head forwards and
Cuts the tongue, lips or lining of the mouth range from minor tilted slightly to the injured side, to allow blood to drain from
injuries to more serious wounds. The cause is often the her mouth. Place a sterile gauze pad over the wound. Ask the
casualty’s teeth or dental extraction. Bleeding from the mouth casualty to squeeze the pad between finger and thumb and
may be profuse and can be alarming. There is a risk that blood press on the wound for ten minutes.
may be inhaled into the lungs, causing breathing problems.
2.
If bleeding persists, replace the pad. Advise her to avoid
drinking anything hot for 12 hours.
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WHAT TO DO
FINGER WOUND
1.
Press a sterile dressing or clean non-fluffy pad on the wound
and apply direct pressure to control bleeding.
2.
Raise and support the injured hand and maintain pressure on
the wound until the bleeding stops.
3.
When the bleeding has stopped, cover the wound.
A cut to a finger may go through the skin only or it can cut
4.
Seek medical help if necessary
through blood vessels, nerves and tendons that lie just under the
skin.
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2.
WOUND TO THE PALM Raise and support the hand. Bandage
A deep wound to the palm may severe tendons and nerves in the the casualty’s fingers so that they are
hand and result in loss of feeling or movement in the fingers. clenched over the pad; leave the thumb
free so that you can check circulation.
WHAT TO DO
Tie the ends of the bandage over the
1. Press a sterile dressing or
top of the fingers to help maintain
clean pad firmly into the
pressure.
palm and ask the casualty to
clench his fist it or grasp his
3. Support the arm in an elevation sling. Check the circulation
fist with his other hand.
in the thumb every ten minutes.
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WHAT TO DO
ABDOMINAL WOUND
1.
Help the casualty to lie down on a firm surface, on a blanket
if available. Loosen any tight clothing, such as belt or shirt.
2. Cover wound with a sterile dressing, and hold it firmly.
3. Call 911 for emergency help. Treat the casualty for shock.
Monitor and record vital signs while waiting for help to arrive.
A stab wound, gunshot or crush injury to the abdomen may cause
a serious wound. Organs and large blood vessels can be
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punctured, lacerated or ruptured.
WHAT TO DO
VAGINAL BLEEDING
1.
Allow the woman privacy and give her a sanitary towel.
The bleeding is most likely to be menstrual bleeding, but it can Make her as comfortable as possible in which whenever
also indicate a more serious condition such as miscarriage, position she prefers.
pregnancy, recent termination of pregnancy, childbirth or injury 2. If she has a period pains, she may take the recommended
as a result of sexual assault. dose of paracetamol or her won painkillers.
If a woman has been sexually assaulted, it is vital to preserve the
evidence if possible. Gently advise her to refrain from washing or
using the toilet until a forensic examination has been performed.
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END
