Bleeding & Wounds
Prof. Nagwa M. El-Kobbia
Department of Anesthesia & Surgical Intensive Care, Faculty of Medicine Alexandria University
Bleeding
Blood carries essential oxygen around the body to the various organs. An average adult has about 6 litres of blood, if they lose a litre of this the amount of oxygen reaching vital organs will significantly decrease.
The severity of bleeding depends on the location, size and depth of the wound causing it. If the bleeding is severe, it can be dramatic and distressing. Bleeding may be external or internal.
Bleeding can occur internally, where blood leaks from blood vessels inside the body or externally, either through a natural opening such as the mouth, nose, ear or through a break in the skin A healthy person can endure a loss of 1015% of the total blood volume without serious medical difficulties
Bleeding may be from an ARTERY, a major blood vessel which carries oxygen-rich blood from the heart throughout the body. It may be from a VEIN, which carries blood back to the heart to be oxygenated or bleeding may be from a CAPILLARY, the smallest of our body's blood vessels.
ARTERIAL bleeding is characterized by spurts with each beat of the heart, is bright red in color (although blood darkens when it meets the air) and is usually severe and hard to control. ARTERIAL bleeding requires immediate attention! VENUS bleeding is characterized by a steady flow and the blood is dark. Venus bleeding is easier to control than Arterial bleeding. CAPILLARY bleeding is usually slow, oozing in nature and this type of bleeding usually has a higher risk of infection than other types of bleeding.
First aid aims
Stop blood coming out of the wound Minimise shock Prevent infection Prevent cross-infection between the casualty and yourself and, if necessary, arrange for casualty to go to hospital
Actions
Check whether there's an object embedded in the wound If there's an object embedded in the wound, push on either side of the object to stop blood coming out of the wound
How to control bleeding
If there's nothing embedded , Apply DIRECT PRESSURE on the wound. use a dressing, if available. if a dressing is not available, use a rag, towel, piece of clothing or your hand alone. ONCE PRESSURE IS APPLIED, KEEP IT IN PLACE. IF DRESSINGS BECOME SOAKED WITH BLOOD, APPLY NEW DRESSINGS OVER THE OLD DRESSINGS. THE LESS A BLEEDING WOUND IS DISTURBED, THE EASIER IT WILL BE TO STOP THE BLEEDING
If bleeding continues, and you do not suspect a fracture, ELEVATE the wound above the level of the heart and continue to apply direct pressure. If the bleeding still cannot be controlled, the next step is to apply PRESSURE AT A PRESSURE POINT e.g. For wounds of the legs, the pressure point is at the crease in the groin (femoral artery) The final step to control bleeding is to apply a PRESSURE BANDAGE over the wound.
Signs and symptoms of INTERNAL BLEEDING
bruised,swollen, tender or rigid abdomen bruises on chest or signs of fractured ribs blood in vomit wounds that have penetrated the chest or abdomen bleeding from the rectum or vagina abnormal pulse and difficulty breathing cool, moist skin
First aid
First aid in the field for internal bleeding is limited. If the injury appears to be a simple bruise, apply cold packs to slow bleeding, relieve pain and reduce swelling. If you suspect more severe internal bleeding, carefully monitor the patient and be prepared to administer CPR if required You should also reassure the victim, control external bleeding, care for shock ,loosen tightfitting clothing and place victim on side so fluids can drain from the mouth.
Nosebleeds
Nosebleeds aren't usually serious and can be easily treated
A nose bleed occurs when a small vein, along the lining of nose, bursts
Causes: Sneezing and blowing Infection High blood pressure Head injury Picking the nose
Blood-clotting disorders
Actions
Sit the casualty down, leaning forward Ask them to breathe through their mouth Pinch the soft part of their nose (or they can do it themselves) for ten minutes Reassure them
If the bleeding doesn't stop after ten minutes, pinch the nostrils again for two further periods of ten minutes. If the nosebleed is severe or the bleeding doesn't stop after 30 minutes, call 123.
Once the bleeding has been stopped, talking, walking and blowing the nose may disturb blood clots and allow the bleeding to resume. The victim should rest quietly until it appears the bleeding remains stopped. If it is suspected that the victim has suffered head, neck or back injuries DO NOT attempt to control the blood flow as they may cause increased pressure on injured tissue. All uncontrolled nosebleeds require prompt medical attention!
Wounds, Bruises, Cuts Grazes
Most cuts and grazes can be treated by a first aider. In medicine, a wound is a type of injury in which skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound.(
Classification
.1 Open Open wounds can be classified according to the object that caused the wound. The types of open wound are: Incisions or incised wounds, caused by a clean, sharp-edged object such as a knife, a razor or a glass splinter .
Lacerations, irregular tear-like wounds caused by some blunt trauma. The term laceration is commonly misused in reference to incisions. Abrasions (grazes), superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are often caused by a sliding fall onto a rough surface .
Puncture wounds, caused by an object puncturing the skin, such as a nail or needle . Penetration wounds, caused by an object such as a knife entering and coming out from the skin . Gunshot wounds, caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit, such is generally known as a through-and-through .
.2Closed Closed wounds have fewer categories, but are just as dangerous as open wounds. The types of closed wounds are are: Contusions, more commonly known as bruises, caused by a blunt force trauma that damages tissue under the skin . Hematomas, also called a blood tumor, caused by damage to a blood vessel that in turn causes blood to collect under the skin .
Crush injury, caused by a great or extreme amount of force applied over a long period of time . Chronic and Acute Acute or traumatic wounds are the result of injuries that disrupt the tissue . .3Chronic wounds are those that are caused by a relatively slow process that leads to tissue damage. Chronic wounds include pressure, venous, and diabetic ulcers. Typically, an insufficiency in the circulation or other systemic support of the tissue causes it to fail and disintegrate. Infection then takes hold of the site and becomes a chronic abscess .
Cleaning the wound
Wash wound gently with water and mild soap Remove any debris and dirt Press clean pad on wound to halt bleeding Cover with sterile adhesive bandage Inspect regularly and remove bandage when a scab has formed
Management
The treatment depends on the type, cause, and depth of the wound as well as whether other structure beyond the skin are involved involved. Treatment of recent lacerations involves examination, cleaning, and closing the wound . If the laceration occurred some time ago it may be allowed to heal by secondary intention due to the high rate of infection with immediate closure .
Minor wounds like bruises will heal on their own with skin discoloration usually disappears in 1-2 week . Abrasions which are wounds with intact skin usually require no active treatment except keeping the area clean with soap and water. Puncture wounds may be prone to infection depending on the depth of penetration. The entry of puncture wound is left open to allow for bacteria or debris to be removed from inside.
When to seek medical advice
See a doctor if: You're unable to clean all the dirt from the wound The cut is more than 1cm long, or is deep
Further action
Get help if: Bleeding persists Casualty shows symptoms of shock
Any cut, or even a small wound, such as a prick from a rose thorn, can become infected with the bacteria (germs) that cause tetanus. Make sure that tetanus immunization is up to date. If the person has not had the full number of tetanus injections, or if it is longer than 5 years since the last one, extra treatment may be needed.
