First aid - Bleeding

Overview:

Bleeding is the loss of blood from the circulatory system. Causes can range from small cuts and abrasions to deep cuts and amputations. Injuries to the body can also result in internal bleeding, which can range from minor (seen as superficial bruising) to massive bleeds.

First aid for severe external or internal bleeding is critical in order to limit the loss of blood until emergency medical aid arrives. First aid actions to manage external bleeding include applying direct pressure to the wound, maintaining the pressure using pads and bandages, and, raising the injured limb above the level of the heart if possible.

However, bleeding may be severe and life threatening if a large vein or artery has been injured – e.g. the jugular vein in the neck.

Some wounds are associated with other injuries beneath the skin – e.g. an organ injured by a stabbing; broken bones which have pierced the skin.

Symptoms and signs – Not all may be present

a wound with, or without, an embedded foreign object

pain from skin surface wounds

bruising or discoloration of the skin

loss of normal function in the injured area

pale, cold, sweaty skin

External bleeding:

Apply direct pressure to the bleeding wound

Apply firm pressure over the wound. Use a sterile or clean bulky pad and apply it firmly with hand pressure. Apply a bandage to keep the dressing in place.

If bleeding is severe, DO NOT waste time looking for suitable padding, but be prepared to use the patient’s hand or your hand to hold the wound together if the patient is unable to do this unaided.

Raise the injured area

If the wound is on a limb, raise it in a supported position to reduce blood flow to the injured area.

If an arm is injured, you could apply an arm sling or elevation sling.

Try to avoid any direct contact with the patient’s blood or other body fluids. Use disposable gloves if possible. If gloves are not available, place your hands inside a plastic bag.

If there has been any contact with blood or any other body fluids, wash your hands or any blood splashed on the skin thoroughly with soap and water as soon as possible after the incident.

If you are concerned about a possible risk of infection, obtain advice from your doctor as soon as possible.

EXTERNAL BLEEDING

Definition:

This is where the blood vessels and the skin are cut and blood is escaping the body.

Causes:

Damage to the skin caused by trauma. Can be a laceration (clean cut), abrasion, or convulsion (with skin still hanging).

Helping:

If it’s a minor bleed allow some bleeding to take place as this will help clean the wound. Then wash with warm water and soap, apply a dressing to keep it clean, change the dressing every few hours, and monitor for signs of infection.

If the bleeding is severe than apply the RED principle:

Rest: make sure the person is resting so as to decrease the heart rate and blood pressure.

Elevate: raise the injured limb above the heart to slow down the bleeding.

Direct Pressure: put pressure directly over the wound to help control bleeding, tie the dressing in place. But, do not make the dressing too tight so as to restrict blood flow. Do not remove the dressing. Get medical help.

Notes: If there is an impaled object do not remove it as this can cause more bleeding. Instead, apply a dressing around the object then tie it in place to control bleeding. Take extra care not to move the object.

An infection has occurred if over the next few hours the wound becomes red, swollen, and fluid is produced. The infection needs to be taken care of before it becomes worse. If it has progressed to the point where the area around the wound is turning dark red or blue, or the blood vessels are changing color, medical help is needed immediately. This is now a life threatening emergency.

Different types of wounds

Rough Laceration Smooth laceration Abrasion

Bandaging:

Bandaging is something you would do to control severe bleeding. Ideally you want to use sterile dressings but they may not be readily available so use whatever you have (e.g. towels, clothing). The idea is to put constant pressure over the cut to control bleeding. You want to tie with enough pressure to control the bleeding but not so much so that blood does not get through to the remainder of the limb. If you restrict blood flow that area may die and may require amputation, so be very careful. Once you’ve tied the dressing you need to check to make sure you did not make it too tight, and check this every couple of minutes.

For example, if you’ve bandaged a forearm here’s how you check for circulation:

Compare both hands to make sure they are similar in temperature and color.

Check the hand to make sure it is not swelling or turning blue.

Ask the person if the hand feels numb or tingly.

If they lose sensation then it’s too tight. Do not remove the bandage but loosen it a bit.

If the first dressing becomes soaked with blood then simply put another one on top. Do not remove the original one as you will be reopening the wound.

Notes:

Always use caution when dealing with bodily fluids. Wear gloves and wash your hands immediately after.

Keep in mind that the injured person may go into shock.

Severe Bleeding:

When bleeding is severe, it can be dramatic and distressing. If someone’s bleeding isn’t controlled quickly, they may develop shock and lose consciousness. Shock does not mean emotional shock, but is a life-threatening condition, often caused by loss of blood.

If someone’s bleeding from their mouth or nose, they may find it hard to breathe, so you should keep a close eye on them in case they become unconscious.

If there’s an object in their wound, don't press directly onto it, as it will hurt, but leave it in there and bandage around it.

With all open wounds, there’s a risk of infection, so wash your hands and use gloves (if you have any) to help prevent any infection passing between you both.

For severe bleeding, take these actions immediately:

Remove any obvious dirt or debris from the wound. Don't remove large or deeply embedded objects. Don't probe the wound or attempt to clean it yet. Your first job is to stop the bleeding. Wear disposable protective gloves if available.
Stop the bleeding. Place a sterile bandage or clean cloth on the wound. Press the bandage firmly with your palm to control bleeding. Maintain pressure by binding the wound tightly with a bandage or a piece of clean cloth. Secure with adhesive tape. Use your hands if nothing else is available.

Raise the injured part above the level of the heart.

Special cases:
- Don't put direct pressure on an eye injury or embedded object.
- Don't re position or put pressure on displaced organs. Cover the wound with a clean dressing.
Help the injured person lie down, preferably on a rug or blanket to prevent loss of body heat. If possible, elevate the legs.
Don't remove the gauze or bandage. If the bleeding seeps through the gauze or other cloth on the wound, add another bandage on top of it. And keep pressing firmly on the area.

Tourniquets: A tourniquet is effective in controlling life-threatening bleeding from a limb. Apply a tourniquet if you're trained in how to do so. When emergency help arrives, explain how long the tourniquet has been in place.
Immobilize the injured body part once the bleeding has stopped. Leave the bandages in place and get the injured person to the emergency room as soon as possible.

Amputation (e.g. a finger):

Treat the injured body part as you would any other cut. Then take the amputated body part and place it in a clean plastic bag. Take that first bag and place it in a second plastic bag containing ice. Make sure it goes to the hospital with the person, as they can sometimes reattach the body part.

NOSE BLEEDS:

Have the person rest, have them pinch their nose just below the bone, and lean slightly forward. If the bleeding is severe, if it does not stop in about 10-15 minutes, or if there was an injury to the head or face, medical attention is needed. Do not have the person lean their head back, as all this does is have them swallow their blood, which is not desired.

SLING:

A sling is something you use to keep the hand/arm elevated above the heart and to make it more secure and comfortable for the injured person. It should only be used if it does not cause more pain or discomfort.