Bleeding
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 as the body will try and compensate for this loss. The body cannot compensate for blood loss greater than one-third so immediate action is required to prevent rapid deterioration and possible death.
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 provide differing signs and symptoms:
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
Slow, gentle oozing or trickle of blood. All wounds will have capillaries damaged so this is the most common kind of bleeding a first aider will see.
Treatment
Wear gloves if possible before treating the wound.
- Sit or lie the casualty down.
- Examine the wound quickly to identify anything inside (such as metal, glass etc).
- If there are no objects embedded in the wound, apply direct pressure with your hand. Put a sterile dressing over the wound if immediately available and apply the pressure.
- Maintain pressure for a minimum of 10 minutes. Apply pressure around the sides if there is an embedded object.
- Dress the wound with another dressing or tie off the initial dressing to maintain pressure.
- If blood soaks through the dressing and pressure was maintained for 10 minutes it is likely not enough pressure was applied, applied in the wrong place or the bleed is more serious. Take off the initial dressing and ensure you are applying pressure in the correct place.
- Call 999/112 if bleeding cannot be controlled and treat for life threatening bleeding as below.
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. Follow the guidance for bleeding above and apply pressure for a minimum of 10 minutes.
Life-threatening bleeding
Life-threatening or catastrophic bleeding occurs if a major artery or vein is ruptured. This can occur from bladed weapon attacks, gun shot or major trauma. The rapid loss of blood can cause unconsciousness and death in minutes. Every effort should be made to control the bleeding using whatever is available.
Wound Packing
To control life-threatening bleeding it is likely the wound will need packing.
Pack a wound with a dressing or bandage by pushing it into the wound tightly and maintaining pressure.
Haemostatic dressings contain a clotting agent to help stem bleeding and are more effective than a normal dressing, however you can use whatever is available.
- 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.
- DO NOT pack a wound in the abdomen or chest area with a dressing. It is important air in the chest can escape to prevent lung collapse.
Tourniquets
Tourniquets are bands that are wrapped tightly around a limb to stop blood flow. They can be used on legs and arms and can be manufactured devices such as in the image below, or improvised using whatever you have to hand.
Treatment
- 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. The amount of pressure required is great and will be extremely painful, but necessary to save life.
- If necessary, apply a second tourniquet parallel to the first.
- Note the time of application and inform medical staff. You should write the time on the tourniquet where possible.
- Do not remove the tourniquet once applied, only a medical professional should do this.
- A second tourniquet can be applied above the first if bleeding is still not controlled.
Amputation
The loss or partial loss of a limb, finger or toe is extremely distressing.
Treat for bleeding, which could be life-threatening, and dress the wound with a bandage and maintain pressure for 10 minutes.
Call 999/112.
If possible, try to recover the body part – wrap it in a dressing which has been moistened with water or saline and place in a sealed bag. Place this bag in another bag containing ice.
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.
Treatment
- 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.
