Bleeding

1. Bleeding

2. objectives By the end of this lecture, the students would be able to: • Determine type of bleeding. • Describe how to control bleeding. • Identify common signs of internal bleeding. • Describe how to control epistaxis.

3. Bleeding (hemorrhage) is the escape of blood from capillaries, veins, and arteries. • Bleeding can be external (i.e., outside the body), internal (i.e., inside the body), or external and internal. Note: • Uncontrolled bleeding (massive bleeding), whether external or internal, is life threatening.

4. Bleeding also has three types: • Arterial Bleeding: The bright red blood "spurts" from the wound. Arterial bleeding is life-threatening and difficult to control. • Venous Bleeding: The dark red (reddish purple) blood flows in a steady stream. • Capillary Bleeding: A slow blood "oozes" from the wound site.

5. Notes: • Capillary bleeding is usually not serious and can easily be controlled. • Arterial and Venus bleedings are more serious and can be life-threatening.

6. Methods to Control Bleeding • There are four methods to control bleeding: • Direct Pressure, • Elevation, • Indirect Pressure, and • The Use of a Tourniquet.

7. 1. Direct Pressure • Direct pressure is the first and most effective method to control bleeding. • In many cases, bleeding can be controlled by applying pressure directly to the wound. • Place a sterile dressing or clean cloth on the wound, tie a knot or adhere tape directly over the wound, only tight enough to control bleeding. • If bleeding is not controlled, apply another dressing over the first or apply direct pressure with your hand or fingers over the wound.

8. 2. Elevation • Elevation of an injured arm or leg (extremity) above the level of the heart will help control bleeding. • Elevation should be used together with direct pressure. • Do not elevate an extremity if you suspect a broken bone (fracture) until it has been properly splinted.

9. 3. Indirect Pressure • In cases of severe bleeding when direct pressure and elevation are not controlling the bleeding, indirect pressure must be used. • Bleeding from an artery can be controlled by applying pressure to the appropriate pressure point. Pressure is applied with the fingers, thumb, or heel of the hand. • Pressure points are areas of the body where the blood flow can be controlled by pressing the artery against an underlying bone.

10. Indirect Pressure Points

11. Indirect Pressure Points

12. Notes: • Indirect pressure is used in addition to direct pressure and elevation. • Pressure points should be used with caution. • Indirect pressure can cause damage to the extremity due to inadequate blood flow. • Do not apply pressure to the neck (carotid) pressure points, it can cause cardiac arrest. • The brachial artery is used to control severe bleeding of the lower part of the arm. • The femoral artery is used to control severe bleeding of the thigh and lower leg.

13. 4. The Use of Tourniquet • A tourniquet should be used only as a last resort to control severe bleeding after all other methods have failed and is used only on the extremities. • Tourniquets cause tissue damage and loss of extremities when used by untrained individuals. • Tourniquets are rarely required and should only be used when an arm or leg has been partially or completely severed and when bleeding is uncontrollable. • A tourniquet can be a strap, belt, towel, or other similar item. Never use wire, cord, or any material that will cut the skin.

14. Application of Tourniquet • Leave at least 2 inches (5 cm) of uninjured skin between the tourniquet and wound. • Place a pad (roll) over the artery. • Wrap the tourniquet around the extremity twice. • Never cover a tourniquet. • Identify the time in which tourniquet was applied.

15. Internal Bleeding • Internal bleeding, although not usually visible, can result in serious blood loss. • A victim with internal bleeding can develop shock before you realize the extent of their injuries. • Bleeding from the mouth, ears, nose, rectum, or other body opening (orifice) is considered serious and normally indicates internal bleeding.

16. Common Causes of Internal Bleeding • Deep chest or abdominal wound. • Any cut into muscle or fracturing of bone. • Bleeding ulcers.

17. Signs of Internal Bleeding • Anxiety and restlessness. • Excessive thirst (polydipsia). • Nausea and vomiting. • Cool, moist, and pale skin (cold and clammy). • Rapid breathing (tachypnea). • Rapid, weak pulse (tachycardia). • Bruising or discoloration at site of injury (contusion).

18. If you suspect internal bleeding, do the following: • Apply ice or cold pack, with cloth to prevent damage to the skin, to reduce pain and (edema) swelling. • Call local emergency or medical personnel. • Monitor circulation, airway, and breathing (CAB). • Treat for shock. • Place the victim in most comfortable position. • Maintain normal body temperature. • Reassure the victim.

19. Epistaxis (nose bleeding) It is hemorrhage from the nose, due to mainly spontaneous rupture of minute vessels.

20. Common Causes • Trauma due to (1) blow on the nose, and (2) foreign body. • Violent sneezing. • Blood diseases. • Hypertension.

21. First Aid Treatment • Apply pressure by pinching the nostrils for 5-10 minutes. • Keep the patient in a sitting, leaning forward position. • Apply ice over the nose. • Keep the patient quite.

22. Hospital Emergency Care • Simple packing of the nose • Use of adrenaline nasal pack • In hypertension cases: sedation and decreasing blood pressure • Check for blood coagulative disorders.