Unit Three
Bleeding Control and
Wound Management
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Objectives
After completing this chapter students
will be able to effectively control wound
and bleeding.
To meet this students should;
Define wound and bleeding
Identify the causes of bleeding and
wound.
Know the types of wounds and bleeding
Practice the different techniques used to
manage wound and bleeding.
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What is Bleeding ?
Bleeding – (Hemorrhage) is the escape
of blood from capillaries, veins, and
arteries.
Usually occurred through disease,
injury, or other physical conditions.
Uncontrolled bleeding, whether internal
or external, is life threatening.
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Causes of Bleeding
E.G
Rupture of veins or artery
Accidental injury
Post partum hemorrhage
Abortion
Cerebro vascular accident (intracranial
hemorrhage)
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Types of Bleeding
Types
Internal
External
Hemorrhage
Severe bleeding(Major cause of shock)
Mild bleeding
Most sensitive organs during bleeding
Brain
Spinal cord
Kidneys
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Source of Bleeding
Arterial
Bright red
Rich in oxygen
High pressure
Venous
Dark red (low in oxygen)
Maroon color
Capillary
Slow and oozing
Low pressure
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Source of Bleeding….
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1.External Bleeding
External bleeding occurs when a blood
vessel is opened externally, such as a
tear in the skin.
Signals of severe external bleeding
include—
Blood spurting from the wound.
Bleeding that fails to stop after all
measures have been taken to control
it.
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Patient Assessment—
Bleeding
Estimate amount of external blood loss
Triage (prioritize)
Predict potential shock
Control external bleeding
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Patient Care—External
Bleeding
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Measures to Control
External Bleeding
Direct pressure
Elevation
Indirect Pressure
Splinting
Tourniquet
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1.Direct Pressure and
Elevation
Direct pressure is the most
common and effective way
to control bleeding.
Apply pressure with gloved
finger or hand.
Elevating a bleeding
extremity above the heart
level often stops venous
bleeding while applying
direct pressure
Do not elevate if
musculoskeletal injury is
suspected
2.Pressure Points
If bleeding
continues, apply
pressure on
pressure point.
Pressure points are
located where a
blood vessel lies
near a bone.
Be familiar with the
location of pressure
points.
Location of Pressure
Points
3.Splints
Splints can help
control bleeding
associated with a
fracture.
Air splints can be
used to control
bleeding of soft-
tissue injuries.
4.Applying a Tourniquet
Use only on extremity injuries
Only used as a last option
Fold a triangular bandage into 4˝ cravat.
Wrap the bandage.
Write “TK” and time. Place on patient
Tourniquet Precautions
Place as close to injury as possible, but
not over joint.
Never use narrow material.
Use wide padding under the tourniquet.
Never cover a tourniquet with a
bandage.
Do not loosen the tourniquet once
applied.
2.Internal Bleeding
Internal bleeding is the escape of blood
from arteries, veins or capillaries into
spaces within the body.
Occur from injuries caused by blunt force
or a chronic medical condition.
Internal bleeding can also occur when an
object penetrates the skin and damages
internal structures.
Suspect internal bleeding in any serious
injury
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Severity of Internal Bleeding
Internal bleeding can result in severe blood
loss with resultant shock (hypoperfusion)
and subsequent death before you realize
the extent of their injuries.
Injured or damaged internal organs
commonly lead to extensive bleeding that
is concealed
Traumatized painful, swollen, and
deformed extremities, or long bone
fractures may also lead to serious internal
blood loss.
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Signs of Internal Bleeding
Injuries to surface of body
Bruising indicates bleeding into the skin
(soft tissues)
Painful, swollen, or deformed extremities
Bleeding from mouth, rectum, vagina, etc.
Tender, rigid, or distended abdomen
Nausea & Vomiting
Dark, tarry stools or bright red blood
Signs and symptoms of shock
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Patient Care—Internal
Bleeding
Administer high-concentration
oxygen via NRB
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Emergency
medical care
Casualties with severe external bleeding
and suspected internal bleeding must be
seen as soon as possible and evacuated
All casualties with external and internal
bleeding should be treated for shock.
Includes IV fluids to maintain peripheral
perfusion.
Maintain airway - provide artificial
ventilation
Continue reassessments, pulse oximetry, if
available
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Complications
of bleeding
Wound
Contamination – infection
Septicemia
Shock
Cardiac arrest
Death
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SPECIAL SITUATIONS
NOSE BLEED
Direct pressure
Have the victim lean forward
Pinch the nostrils together until bleeding stops.
INSIDE CHEEK
Place folded dressing inside the mouth
-
against the wound.
OUTSIDE CHEEK
Use dressings to apply pressure directly to the
wound and bandage so as not to restrict
breathing.
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SPECIAL SITUATIONS….
TOOTH
Place a sterile dressing directly in the space left
by the tooth.
Tell the victim to bite down.
Place tooth in milk or water and take with victim.
IMPALED OBJECT
DO NOT remove
Bandage bulky dressings around the object to
support it in place.
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Wound Management
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Introduction
Goal
• To aid the natural body process to
functional and cosmetic result.
For rapid and complete healing with
minimal scar.
In managing wounds, care should be taken
not to overlook life threatening conditions
by concentrating on less important
wounds.
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Wound
Wound is any abnormal break in the continuity
of the tissue of the body either internal and
external.
A break in the continuity of the skin mucous
membrane, bone and any body organ.
Any abnormal opening in the skin is a wound.
A wound is any disruption in the skins
intactness.
It may be accidental or intentional
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Types of wound
Wound can be divided in to two broad
categories based on the mechanism of
injury.
1.Accidental – unintentional injury such
as knife, gunshot, burn
2.Surgical – planned therapy such as
surgical incision, needle introduction
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Accidental wound
Abrasions
Laceration
Puncture
Incision
Contusion
Avulsion
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Accidental wound…
Types Cause Characteristics Chance of
bleeding
Incision knife, any piece Straight edges rapid and heavy.
of straight, to the wound
sharp metal, or margins
a piece of glass.
Laceration sharp edges to Broken objects rapid and
the wound extensive.
margins
Puncture Sharp objects Penetrating Cause internal
penetrate the trauma bleeding
tissue & skin
layer
Abrasion Scraping (Road affecting only Minimal
rash) the surface bleeding
layers of
the epidermis.
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Contusion Injury No breaking of Limited blood
6.Avulsion
Avulsion: A full thickness laceration-type
wound, often semi-circular in shape.
Avulsions often occur in mechanical
accidents involving fingers (sometimes
referred to as degloving, and on a more
serious note
May affect the orbit of the eye or
the abdominal cavity, exposing the
internal visera.
Heavy and rapid bleeding.
It occurs in accidents such as motor vehicle,
32 explosions, animal bites.
1,Laceration,2.Abrasions,3.Cont
ustion 4.Avulsion wounds
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Surgical Wound
Surgical :- Surgical wounds vary from
simple and superficial (thyroidectomy
incision) to deep and contaminated
(such as an abdominal incision done for
septic peritonitis)
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Types of wound
Classification based on the skin integrity
of the wound
1.Open – Break in or mucus membrane;
may bleed with tissue damage, infection
risk.
2.Closed – No break in skin integrity, but
soft tissue damage present, may have
internal injury and bleeding
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Types ….
Based on the time length of the wound
1.Acute: heals in approximately 2 weeks to 6
months
Is a clean cut wound closed by sutures or
staples,
e.g. After surgery or a laceration.
2. Chronic: Takes 6 months or more
is an open wound extending into at least the
second layer of the skin(dermis)
Needs to be filled with new tissue, e.g. an
ulcer or pressure sore.
Delayed healing and may be involved
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complex wound care
ACUTE WOUND CHRONIC
WOUND
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Types ….
Classification based on the risk of
infection
1. Clean :is a wound which is not infected with
microorganisms and doesn’t have pus.
2. Clean contaminated: a wound involving normal
but colonized tissue
3. Contaminated: a wound containing foreign or
infected material
4. Infected: a wound with pus present.
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Causes of wound
Accidental falls
Handling of sharp objects
Gunshot
Burn
Vehicle accident
External force
Mishandling of closed fracture
Infection
Animal bite ------------ etc
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Assessment of wounds.
- HistoryAssess clients condition (ABC)
- Mechanism of injury.
- Time of injury.
- Identification of possible contamination &
foreign bodies.
- wound examination
- Extent of wound & configuration of the
wound.
- Ass. neurovascular or tendon injury.
-bleeding
- Identification of risk factors that might affect
healing.
Factors affecting wound
healing
Vascular changing associated with aging
Nutrition
Life style
- Regular exercise can increase
healing
- Smoking cigarette ↓ healing
Debris
Infection
Foreign body in the wound
Chronic illness like DM
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Complications
Local:
Hematoma
Seroma
Infection
Dehiscence
Granuloma formation
Scar formation
Contracture leading to loss of joint
function etc
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Complications…..
Systemic:
- Systemic manifestations of hemorrhagic
shock due to massive bleeding
- Bacteremia and sepsis from a source of
locally infected wound
- Death may occur if un controlled sepsis
or hemorrhage
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Responsibilities during
wound Mgt
Prevent infection
Advise the patient to take balanced diet
Observe sign of internal bleeding
Control bleeding
Observe for sign of dehiscence
Clean wounds
Take a specimen of any drainage
Assist / do debridement (the removal foreign
material or dead tissue from a wound,
discourage the growth of mol and promote
healing.
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General management
1. Hemostasis
A bleeding wound should be elevated
and a pressure pad applied.
Do not put Clamps blindly
All hematomas within wounds carefully
evacuated and any remaining bleeding
sources controlled.
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General Management……
2. Anesthesia
Lidocaine (0.5 to 1%) or bupivacaine (0.25 to
0.5%) combined with a 1:100,000 to
1:200,000 dilution of epinephrine provides
anesthesia and hemostasis
Epinephrine should not be used in wounds of
the fingers, toes, ears, nose, or penis due to
the risk of tissue necrosis (end arterioles)
3. Hair removal
potentially increase wound infection
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General Management……
4. Irrigation
To visualize all areas of the wound and
remove foreign material
Best accomplished with normal saline
(without additives).
Iodine, hydrogen peroxide, and
organically based antibacterial
preparations should not be used .
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5. Debridement
Removal of nonviable tissues and any
remaining foreign bodies
Irregular, macerated, or beveled wound
edges should be débrided in order to provide
a fresh edge for re-approximation.
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6.Wound closure
Timing - The choices are:
1. Close at the time of initial presentation
2. Allow the wound to heal on its own.
3. Delay closure until after a period of healing or
wound care
Methods - The closure methods available
include:
1. Primary closure by direct
approximation
2. Delayed primary closure
3. secondary closure - left to heal on its
own.
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Cont’d
Use to:-
Restore skin integrity
Reduce risk of infection
Reduce scaring
Reduce bleeding
Types :-Suture, staples, tissue adhesive, etc
Wound dressing
- maintaining a moist clean environment.
- prevent pressure and mechanical trauma.
- hemostasis and reduce edema
- stimulates repair.
- comfort .
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Tetanus Prophylaxis
Accordingly, all wounds, regardless of cause
or severity, must be considered tetanus
prone, and the patient's tetanus
immunization status must always be
considered.
-Puncture wounds with
devitalized tissue
-Wounds contaminated with soil,
manure or other
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-Extensive burns
Cont’d
Rabies Prophylaxis
Bite wounds in which the animal's saliva
(carnivores and bats) penetrates the dermis
are the most common cause of exposure.
Postexposure treatment consists of wound
care, infiltration of rabies immune globulin into
the wound, and administration of vaccine.
Thank you!!!!
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