Bleeding

Blood carries oxygen from the lungs to the tissues around the body, and then takes waste carbon dioxide back to the lungs for expiration.

The amount of blood in the body depends on the size of the person. Anyone losing more than 10% of their blood will need to be treated for shock; the body cannot compensate at blood loss greater than one-third so immediate action is required for someone suffering heavy bleeding.

Bleeding from the arteries and veins can be life threatening very quickly. Bleeding from the capillaries – which happens in all wounds – is more easily controlled.

Signs & Symptoms

Different types of bleeding:

Arterial

Blood under direct pressure from the heart will pump out in squirts. Blood will be bright red.

Venous

Blood coming from the veins will be more of a steady flow, but the overall rate will be the same as that from the arteries.

Capillary

A trickle.

Treatment

Wear gloves if possible before treating the wound.

Sit or lie the casualty down.
If there are no objects embedded in the wound, apply direct pressure. Apply pressure around the sides if there is an embedded object.
Use a sterile, non-sticky dressing. If blood soaks through take off the dressing and ensure you are applying pressure in the correct place.
Once bleeding is controlled, secure the bandage. Check circulation by pressing the skin by the bandage until it is pale, then release and ensure that skin colour returns. Call 999/112 if bleeding cannot be controlled.

Penetrating object

Some wounds may have a penetrating object, which could be external such as glass, a nail or a knife, or internal, such as a protruding bone.

If there are objects embedded, do not attempt to remove them, but apply pressure around the sides instead.

Life-threatening bleeding

Haemostatic dressings contain a clotting agent to help stem bleeding when pressure alone is not sufficient. They are particularly useful for abdomen, neck and groin areas.

Call 999/112.
Pack the wound with the dressing and compress for 10 minutes. (If you don’t have a haemostatic dressing, packing with an improvised dressing can still help).
Leave the packing inside the wound and cover with another dressing to hold in place.

Tourniquets

Tourniquets are bands that are wrapped tightly around a limb to stop blood flow before it gets to the wound. They should only be used by people who have been trained to use them and only in cases of life-threatening blood loss.

They can be manufactured or improvised using whatever you have to hand.

Call 999/112.
Apply the tourniquet 5-7cm above the wound, directly to the skin, but not over the elbow or knee.
Tighten it until the bleeding stops or slows to a trickle.
If necessary, apply a second tourniquet parallel to the first.
Note the time of application and inform medical staff. You could write the time on the tourniquet.
Do not remove the tourniquet, only a medical professional can do this.

Nose bleeds

A bang to the nose or excessive nose blowing can cause a nose bleed. Sometimes more serious issues like a fractured skull could result in a nose bleed so it is important to check the mechanism of the injury.

Sit the casualty down.
Get the casualty to lean forward.
Pinch the soft part of the nose beneath the bridge for at least 10-15 minutes.
Seek medical advice if the bleeding doesn’t stop.

Internal bleeding

Internal bleeding can be difficult to diagnose because there is no obvious blood present. It can be the result of an injury, particularly to the torso (eg a blow to the abdomen or a fractured rib) or head.

Alternatively, there may be no obvious cause – such as a burst ulcer.

Signs & Symptoms

Shock – despite there being no obvious injury.
Pain or tenderness at the site.
Bruising/swelling.

There may be other symptoms depending on the site of the bleeding – eg difficulty breathing if the bleeding is in the lung.

Treatment

Call 999/112.
Treat for shock.

Amputation

The loss or partial loss of a limb, finger or toe is extremely distressing.

Treat for bleeding – which is likely to be life-threatening – and dress the wound with a low-adherent dressing.

Call 999/112.

If possible, try to recover the body part – wrap it in plastic and then place it on some ice, taking care that it does not come into direct contact with the ice.