Bleeding (haemorrhage) is classified by the type of blood vessel
that is damaged.
If an artery is damaged, bleeding will be profuse. Blood will spurt
out with each heartbeat. If a main artery is severed, the volume
of circulating blood will fall rapidly
Blood from veins, having given up its oxygen into the tissues, is
darker red. It is under less pressure than arterial blood, but vein
walls can widen greatly and the blood can “pool”
Bleeding from capillaries occurs with any wound. At first,
bleeding may be brisk, but blood loss is usually slight.
A blow may rupture capillaries under the skin, causing bleeding
into the tissues (bruising)
SEVERE EXTERNAL BLEEDING
1) When bleeding is severe, it can be dramatic and distressing. If
bleeding is not controlled shock will develop and the casualty may
no longer be responsive.
Bleeding from the mouth or nose may affect breathing.
When treating severe bleeding, check first whether there is an object
embedded in the wound
take care not to press directly on the object.
Do not let the casualty have anything to eat or drink as he may need
an anaesthetic later.
MANAGEMENT: EXTERNAL BLEEDING
CAN BE CONTROLLED BY:
2. Direct pressure.
Elevation.
Indirect pressure on
pressure points.
Splinting.
Inflatable splinting.
Blood pressure cuff.
Tourniquet.
DIRECT PRESSURE:
CAN BE APPLIED BY:
• First aider`s hand
• Dressing & First aider`s hand
• Pressure dressing
• Pressure to be applied for 10 to 30 minutes.
• After control, apply firm bandage
•NEVER REMOVE EXISTING BANDAGE IF
BLEEDING RECURS. APPLY ANOTHER OVER IT.
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.
If there is an object in the wound, apply pressure on either side of the
object (opposite).
2) Ask a helper to call 108 for emergency help.
Tell him or her to give ambulance control details of the site of the
bleeding and the extent of the bleeding
ELEVATION:
• Gravity helps to lower
blood pressure & bleeding is
slowed.
• NOT to be used in cases of
fractures & spinal injuries.
PRESSURE POINTS:
• Pressure point is a site where main artery lies near the surface of the body,
directly over a bone.
• Pulsation can be felt in these areas.
• There are 22 pressure points(11 on each side).
• Of these 11 are used to control profuse bleeding.
• Brachial artery - for bleeding from upper limb.
• Femoral artery - for bleeding from lower limb.
• Carotid artery - for bleeding from neck.
• Temporal artery - for bleeding from scalp.
• Facial artery - for bleeding from face.
• Sub clavian artery - for bleeding from chest wall & armpit
3. Tourniquets
• Early use of a tourniquet in the setting of forceful arterial bleeding, such
as an amputation, may be life- saving
Apply the tourniquet between the heart and injury.
Place your tourniquet around the injured limb, between the open wound
and the heart (or proximal to the wound) — the purpose is to cut off the
strong blood flow within arteries leaving the heart, not the more superficial
veins returning blood back to the heart.
More specifically, place your tourniquet about 2-4 inches away from the
edge of the wound.
Don't place it directly over the wound because the arteries upstream from
the injury will still drain into and out from the open wound.
• For wounds that are just below a joint (such as the elbow or knee), place
your tourniquet just above and as close to the joint as you can.
• Your tourniquet should have some padding underneath it to prevent
skin damage, so use the victim's clothing (pant leg or shirt sleeve) to place under it
if you can.
• If your tourniquet is long enough, wrap it around the injured limb
numerous times, keeping it as flat as possible. You want the tourniquet to stop blood
flow in the arteries, but not cut into and damage any soft tissues
Secure the dressing with a bandage that is firm enough to maintain pressure, but not
so tight that it impairs circulation . Call 108 for emergency help if this has not been
done already.
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.
If bleeding shows through the dressing, apply a second one on top of the first. If blood
seeps through the second dressing, remove both and apply a fresh one, ensuring that
pressure is applied accurately at the point of bleeding.
6 Support the injured part in with a sling and/or bandage. Check the circulation
beyond the bandage every ten minutes (p.243). If the circulation is impaired, loosen
the bandage and reapply.
Monitor and record the casualty’s vital signs – breathing, pulse and level of response –
while waiting for help to arrive.
INFECTED WOUND
RECOGNITION
Increasing pain and soreness at the site of the wound
Swelling, redness, and a feeling of heat around the injury
Pus within, or oozing from, the wound
Swelling and tenderness of the glands in the neck, armpit, or groin
Faint red trails on the skin that lead to the glands in the neck,
armpit, or groin
If infection is advanced:
Signs of fever, such as sweating, thirst, shivering, and lethargy
An open wound can become contaminated with microorganisms
(germs). The germs may come from the source of the injury, from
the environment, from the mouth, the fingers, or from particles of
clothing embedded in a wound (as may occur in gunshot
wounds). Bleeding may flush some dirt away; remaining germs
may be destroyed by the white blood cells. However, if dirt or
dead tissue remain in a wound, infection may spread through the
body. There is also a risk of tetanus . Any wound that does not
begin to heal within 48 hours is likely to be infected. A casualty
with a wound that is at high risk of infection may need treatment
with antibiotics and/or tetanus immunization
WHAT TO DO
Cover the wound with a sterile dressing or large clean, nonstick
pad, and bandage it in place.
Raise and support the injured part with a sling and/or bandages.
This helps reduce the swelling around the injury.
Advise the casualty to seek medical advice. If infection is
advanced (with signs of fever, such as sweating, shivering, and
lethargy), take or send the casualty to the hospital
