Bleeding

Facts and Tips

The human body requires the correct amount
of blood and fluid to be transported around the body
in order to function properly. The blood transports
oxygen to every cell in the body and then transports
the waste products away from the cell.

• Blood volume of the adult human body

– Approximately 5 to 6 liters
– Loss of as little as 2 pints may cause shock.
 Introduction
• Bleeding is the loss of blood from the circulatory
system.
• It is the escape of blood from arteries, capillaries or
veins.
• The loss can range from minor external bleeding,
through to severe external bleeding, or internal
bleeding, which can range from minor to massive.
Injuries or trauma to the body can also result in
internal bleeding.
• A large amount of bleeding occurring in a short
amount of time is called hemorrhage.
 Introduction
• It is important to be able to:
– Recognize bleeding
– Understand how bleeding affects the body
• External bleeding, bleeding you can see coming
from a wound, is usually obvious because it is
visible.
• Internal bleeding, bleeding inside the body, is often
difficult to recognize.
• Uncontrolled bleeding, whether external or internal,
is a life-threatening emergency.
 What is Blood?
• Blood consists of liquid and solid components
and comprises approximately 7 percent of the
body’s total weight. The average adult has a
blood volume of between 10 and 12 pints.
• PLASMA - the liquid part of the blood.
• PLATELETS - the solid components include
red and white blood cells and cell fragments.
 What is Blood?

• PLASMA
~ makes up about half the total blood
volume.
 What is Blood?
• PLASMA
~
composed mostly of
water, plasma
maintains the blood
volume needed for
normal function of the
circulatory system.
~ contains nutrients essential for energy
production, growth and cell maintenance; carries
waste products for elimination; and transports the
other blood components.
 What is Blood?
• WHITE BLOOD
CELLS (WBC)
~ are a key
disease-fighting part of
the immune system.
~ they defend the
body against invading
microorganisms, or
pathogens.
~ they also aid in producing antibodies that help
the body resist infection.
 What is Blood?
• RED BLOOD
CELLS (RBC)
~ account for
most of the solid
components of the
blood.
~ they are
produced in the marrow in the hollow center of large
bones, such as the long bones of the arm (humerus)
and the thigh (femur).
~ number nearly 260 million in each drop of
blood.
 What is Blood?
• RED BLOOD
CELLS (RBC)
~ transport
oxygen from the
lungs to the body
cells and carbon
dioxide from the cells
to the lungs.
~ outnumber
white blood cells
about 1000 to 1.
 What is Blood?
• PLATELETS
~ are disk-
shaped structures in
the blood that are
made up of cell
fragments.
~ are an essential part of the blood’s clotting
mechanism because of their tendency to bind
together.
~ help stop bleeding by forming blood clots at
wound sites. Until blood clots form, bleeding must be
controlled artificially.
 Blood has three major
functions:

• Transporting oxygen, nutrients and wastes.

• Protecting against disease by producing
antibodies and defending against pathogens.
• Maintaining body temperature by circulating
throughout the body.
 The Blood Vessels:
• Blood is channeled through blood vessels.
• The three major types of blood vessels are
arteries, capillaries and veins (Fig. 8-2).
 The Blood Vessels

• ARTERIES
~ carry blood
away from the
heart
~ vary in size.
~ the smallest
ones carry
blood to the
capillaries.
 The Blood Vessels
• CAPILLARIES
~ are microscopic
blood vessels linking
arteries and veins.
~ they transfer
oxygen and other
nutrients from the
blood into the cells.
~ pick up waste
products, such as
carbon dioxide, from
the cells and move
them into the veins.
 The Blood Vessels
• VEINS
~ carry blood
back to the
heart.
~ also carry
waste products
from the cells to
the kidneys,
intestines and
lungs, where
waste products
are eliminated.
 When Bleeding Occurs
• When bleeding occurs, a complex chain of
events is triggered in the body.
• The brain, heart and lungs immediately
attempt to compensate for blood loss to
maintain the flow of oxygen-rich blood to the
body tissues, particularly to the vital organs.
 When Bleeding Occurs

• The brain, recognizing a blood shortage,

signals the heart to circulate more blood and
to constrict blood vessels in the extremities.
 When Bleeding Occurs
• The brain signals the lungs to work harder,
providing more oxygen
• Platelets collect at the wound site in an effort
to stop blood loss through clotting.
• White blood cells prevent infection by
attacking microorganisms that enter through
breaks in the skin.
 When Bleeding Occurs
• Over time, the body manufactures extra red
blood cells to help transport more oxygen to
the cells.
• Blood volume is also affected by bleeding.
• Normally, excess fluid is absorbed from the
bloodstream by the kidneys, lungs, intestines
and skin.
• However, when bleeding occurs, this excess
fluid is reabsorbed into the bloodstream as
plasma.
 When Bleeding Occurs
• This reabsorption helps to maintain the
critical balance of fluids needed by the body
to keep blood volume constant.
• Bleeding that is severe enough to critically
reduce the blood volume is life threatening
because tissues will die from lack of oxygen.
• Life threatening bleeding can be either
external or internal.
Types of bleeding

External Bleeding
• External bleeding occurs when a blood
vessel is opened externally, such as
through a tear in the skin.
• External bleeding can be minor from small
cuts, abrasions and wounds, nose bleeds,
severe from major or deep cuts and wounds
or from amputation.
 Significance of External
Bleeding
• With serious external bleeding, it may be
difficult to tell the amount of blood loss.
• Presentation and assessment of the patient
will direct care and treatment.
• Body will not tolerate a blood loss greater
than 20% of blood volume.
 Significance of External
Bleeding
• Significant changes in vital signs may occur
if the typical adult loses more than 1 L of
blood.
– Increase in heart rate
– Increase in respiratory rate
– Decrease in blood pressure
 Significance of External
Bleeding
• Serious conditions with bleeding:
– Patient has a poor general appearance and is
calm.
– Signs and symptoms of shock
– Significant blood loss
– Rapid blood loss
– Uncontrollable bleeding
 Characteristics of External
Bleeding
• Arterial bleeding (bleeding from an
artery)
– Is often rapid and severe
– Pressure causes blood to spurt and
makes bleeding difficult for clots to
form.
– Typically brighter red and spurts in
time with the pulse. Arterial
– Because clots do not form as rapidly,
arterial bleeding is harder to control.
The high concentration of oxygen
gives arterial blood a bright red color.
 Characteristics of External
Bleeding
• Venous bleeding (bleeding from the
veins)
– Is generally easier to control than arterial
bleeding.
– Veins are damaged more often because they
are closer to the skin’s surface.
– Venous blood is under less pressure than
arterial blood and flows steadily from the
wound without spurting.
– Dark red, flows slowly or severely.
– Only damage to veins deep in the body, such
as those in the trunk or thigh, produces severe Venous
bleeding that is difficult to control.
– Because it is oxygen poor, venous blood is
dark red or maroon.
 Characteristics of External
Bleeding
• Capillary bleeding
– the most common type of bleeding.
– usually slow because the vessels
are small and the blood is under low
pressure.
– It is often described as oozing from
the wound.
– Clotting occurs easily with capillary
bleeding. Capillary
– The blood is usually a paler red
than arterial blood.
 Clotting

• Bleeding tends to stop rather quickly, within

about 10 minutes.
– When a person is cut, blood flows rapidly.
– The cut end of the vessel begins to narrow,
reducing the amount of bleeding.
– Then a clot forms.
– Bleeding will not stop if a clot does not form.
 Types of External
Bleeding (1 of 6)
• Lacerations

• Abrasions

• Puncture wounds

• Amputations

• Avulsions
Types of External Bleeding (2 of 6)
Laceration
Types of External Bleeding (3 of 6)
Abrasion
Types of External Bleeding (4 of 6)
Puncture Wound
Types of External Bleeding (5 of 6)
Amputations
Types of External Bleeding (6 of 6)
Avulsion
 To understand deeper about
external bleeding, watch this
video:

To play the video,

click Esc then,
double click
this icon:
Care for External Bleeding
• External bleeding is usually easy to control.
Generally, the pressure created by placing a
sterile dressing and then a gloved hand, or
even a gloved hand by itself, on a wound
can control external bleeding. This technique
is called applying direct pressure.
 Direct Pressure

• Most effective way to control external

bleeding.
• Pressure stops the flow of blood and
permits normal coagulation to occur.
• Apply pressure with your gloved fingertip or
hand over the top of a sterile dressing.
 Care for External Bleeding

• Pressure placed on a wound restricts the

blood flow through the wound and allows
normal clotting to occur.
• Pressure on a wound can be maintained by
applying a bandage snugly to the injured
area. A bandage applied snugly to control
bleeding is called a pressure bandage.
 DRESSING

Any material used to cover a

wound that helps control
bleeding and also aids in the
prevention of additional
contamination.
 BANDAGE
Any material use to hold a dressing in
place.
A way of holding dressing in place over a
wound, to create pressure over a bleeding
wound for control of hemorrhage, to
secure a splint to an injured part of the
body, and to provide support to an injured
part.
 Pressure Dressing

• Firmly wrap a sterile, self-adhering roller

bandage around the entire wound.
• Cover the entire dressing above and below
the wound.
• Stretch the bandage tight enough to control
bleeding.
– You should still be able to palpate a distal pulse.
 Parts of the
Triangular Bandage

 Base
 Side
 Apex
 Face
 OPEN PHASE
Head Bandage
Face Bandage
Chest Bandage
Arm sling
 CRAVAT PHASE
• Forehead • Hip bandage
bandage
• Knee Bandage
• Neck bandage
• Palm Bandage
• Jaw bandage
• Sprained Knee
• Shoulder Bandage
Bandage
• Leg bandage
• Elbow Bandage
THE DIFFERENT BANDAGING
VIDEOS ABOUT STEPS IN BANDAGING
1. Face
Bandage
2. Head 3. Bandaging
(topside) the Back of
Bandaging the Head

6. Bandaging 4. Forehead
of the Shoulder Bandage
5. Bandaging
Technique_ Ear,
Cheek, Jaw
 1

To play the videos,

click Esc then, 3
double click
the ff. icon:
4

6
THE DIFFERENT BANDAGING
VIDEOS ABOUT STEPS IN BANDAGING
7. Regular
Arm Sling
8. Bandaging 9. Bandaging
of the chest. of the hip.

12. Narrow
10. Foot
Cravat Sprained
Bandaging Ankle Shoe On
11. Hand
Bandaging
 7

To play the videos,

click Esc then, 9
double click
the ff. icon:
10

11

12
The Arm Sling
• In some cases, direct pressure may not
immediately control bleeding. This is an
indication of severe external bleeding.
• Signals of severe external bleeding
include—
- Blood spurting from the wound.
- Bleeding that fails to stop after all
measures have been taken to control it.
Tourniquet (1 of 4)

• If direct pressure
fails, apply a
tourniquet above
the level of
bleeding.
• It should be
applied quickly and
not released until a
physician is
present.
Tourniquet (2 of 4)

Tourniquet Application

• Place tourniquet between the

heart and wound
• Wrap tourniquet around
extremity
• Tighten UNTIL BLEEDING
STOPS
 Tourniquet (3 of 4)

• Observe the following precautions:

– Do not apply a tourniquet directly over any joint.
– Make sure the tourniquet is tightened securely.
– Never use wire, rope, a belt, or any other
narrow material.
– Use wide padding under the tourniquet.
Tourniquet (4 of 4)

• Precautions
(cont’d):
– Never cover a
tourniquet with a
bandage.
– Do not loosen the
tourniquet after you
have applied it.
To give first aid for external bleeding,
follow these general steps:
1. CHECK scene, then CHECK person.
2. Obtain consent.
3. Cover with a sterile dressing.
4. Apply direct pressure until bleeding stops.
5. Cover dressing with bandage.
6. If bleeding does not stop—
• Apply additional dressings and bandages and
continue to apply pressure.
• Take steps to minimize shock, monitor the ABCs.
• CALL 9-1-1 if not already done.
• Place direct pressure on the
wound with a sterile gauze
pad or any clean cloth, such
as a washcloth, towel or
handkerchief. Press hard.
Using a pad or cloth will help
keep the wound free from
germs and aid clotting. Place
your gloved hand over the
pad and apply firm pressure
(Fig. 8-3, A). If you do not
have disposable gloves or an
appropriate barrier, have the
injured person apply
pressure with his or her
hand.
• Apply a pressure bandage to hold the gauze
pads or cloth in place (Fig. 8-3, B).
• If blood soaks through the bandage, add more pads
and bandages to help absorb the blood.
• Continue to apply pressure. Do not remove any
blood-soaked pads. This can interfere with clotting.
• Make sure to call 9-1-1 or the local emergency
number.
• Continue to monitor the victim’s airway, breathing
and circulation. Observe the victim closely for
signals that may indicate that his or her condition is
worsening, such as faster or slower breathing rates,
changes in skin appearance and restlessness. Give
additional care as needed.
 Types of bleeding

Internal Bleeding
Internal bleeding can result from trauma
or occur spontaneously resulting from
disease. If a casualty is suffering from internal
bleeding, you may not be able to see actual
evidence of the blood loss, as the blood loss
may be contained within one of the body
cavities. However, signs of shock will be
obvious (pale, cold and clammy skin).
 Internal Bleeding
Internal bleeding is the escape of
blood from arteries, capillaries or veins into
spaces in the body.
Severe internal bleeding can occur from
injuries caused by a blunt force, such as a
driver being thrown against the steering wheel
in a car crash, or a chronic medical condition,
such as an ulcer. Internal bleeding may also
occur when an object, such as a knife or
bullet, penetrates the skin and damages
internal structures.
 Internal Bleeding
A fractured bone, such as a rib, could
penetrate and damage vital organs. In any
traumatic injury, you should always suspect
internal bleeding. For example, if a motorcycle
rider is thrown from a bike, you may not see
any serious external bleeding; however, you
should consider that the impact may have
caused internal injuries.
 Internal Bleeding

• Possible conditions causing internal

bleeding:
– Stomach ulcer
– Lacerated liver
– Ruptured spleen
– Broken bones, especially the ribs or femur
– Pelvic fracture
Internal Bleeding
Injured Internal Organs
• Bleeding is not always caused by
trauma.
• Nontraumatic causes include:
– Bleeding ulcers
– Bleeding from colon
– Ruptured ectopic pregnancy
– Aneurysms
• Frequent signs
– Abdominal tenderness
– Guarding
– Rigidity
– Pain
– Distention
• In older patients, signs include:
– Dizziness
– Faintness
– Weakness
• Ulcers or other internal problems may
cause:
– Vomiting of blood
– Bloody diarrhea or urine
 Signs and Symptoms of
Internal Bleeding
• Pain (most common)
• Swelling in the area of bleeding
• Distention
• Bruising
• Bleeding from any body opening
• Broken ribs, bruises over the lower part of
the chest, or a rigid, distended abdomen
 Care for Internal Bleeding
• First aid for controlling internal bleeding
depends on the severity and site of the
bleeding. For minor internal bleeding, such
as a bruise on an arm, apply an ice pack or
a chemical cold pack to the injured area to
help reduce pain and swelling. Always
remember to place something, such as a
gauze pad or a towel, between the source
of cold and the skin to prevent damage to
the skin.
 Care for Internal Bleeding
• If you suspect internal bleeding caused by
serious injury, call 9-1-1 or the local
emergency number.
• You can do little to control serious internal
bleeding effectively. Activating the EMS
system is the best help that you can give.
EMS personnel must rapidly transport the
victim to the hospital.
 Care for Internal Bleeding
• Usually, the victim needs immediate surgery. While waiting for
EMS personnel to arrive, follow the general care steps for any
emergency.
• Do no further harm.
• Monitor breathing and consciousness.
• Help the victim rest in the most comfortable position.
• Keep the victim from getting chilled or overheated.
• Reassure the victim.
• Give any specific care needed.
Shock
 SHOCK
• If you lose too much blood,
you go into shock. This is not
the kind of shock you get at a
sudden surprise. This is
clinical shock, where your
body starts to shut down…
• In medicine and first aid the
term ‘shock’ refers to a loss of
effective circulating blood
volume.
 SHOCK
• Often results from an injury or
pain;
• Can result from emotional
trauma of being scared;
• Can be caused by deep
stress.
SIGNS & SYMPTOMS

• When a casualty loses a large amount of

blood or fluid they will usually have an
increased pulse rate, a fall in blood pressure
and feel thirsty, dizzy and cold. The tongue of
the casualty will look pale instead of the usual
red/pink colour. In severe cases, the ear lobes
and lips can have a tinge of blue colour.
• They may also experience muscle weakness,
anxiety, restlessness, nausea, and shortness
of breath.
• When shock occurs, the body attempts to prioritize
its needs for blood by ensuring adequate flow to
the vital organs. The body reduces the amount of
blood circulating to the less important tissues of
the arms, legs and skin. This reduction in blood
circulation to the skin causes the skin of a person
in shock to appear pale or ashen and feel cool. In
later stages of shock, the skin, especially the lips
and under the nails, may appear blue from a
prolonged lack of oxygen. Increased sweating is
also a natural reaction to stress caused by injury
or illness, which makes the skin feel moist.
• If the heart is damaged, it cannot circulate
blood properly. If blood vessels are
damaged, the body cannot adjust blood flow.
• Regardless of the cause, when body cells
receive inadequate oxygen, the result is
shock.
• Table 9-1
summarizes
common
types of
shock and
their causes.
 Signals

• Although you may not always be able to

determine the cause of shock, remember
that shock is a life threatening condition. You
should learn to recognize the signals of
shock.
• The signals of shock include—
 pale, cold
clammy skin

feels like fast, shallow

throwing up breathing

how to spot
shock
thirst restlessness

feels weak blueness

and dizzy around lips or
ear lobes
• Shock is a life-threatening condition. If any of
these signals are present, assume the victim
has a potentially life-threatening injury or
illness. Give appropriate care.
FIRST AID

• Follow the emergency action steps:

CHECK— CALL—CARE.

• CHECK the scene for safety and

then the victim.
FIRST AID

• CALL 9-1-1 or the local emergency

number.

• CARE for the conditions you find.

 FIRST AID
• For giving care, follow the steps:

1. Any specific care you give for

life threatening conditions will
help to minimize the effects of
shock. Make the victim as
comfortable as possible. Helping
the victim rest comfortably is
important because pain can
intensify the body’s stress and
accelerate the progression of
shock..
 FIRST AID

2. Keep the victim from

getting chilled or
overheated. (In cooler
environments this
includes insulating the
victim from the ground.)
Watch for changes in the
victim’s level of
consciousness,
breathing rate and skin
appearance.
 FIRST AID

• You can further help

the victim manage the
effects of shock if
you—
~ Help the victim lie
down on his or her back.
~Elevate the legs about
12 inches to help blood
circulate to the vital
organs
FIRST AID

Do not elevate the legs—

• If the victim is nauseated or having trouble
breathing.
• If you suspect head, neck or back injuries or
possible broken bones involving the hips or legs.
• If moving causes more pain. If you are
unsure of the victim’s condition or if it is painful for
him or her to move, leave the victim lying flat.
 FIRST AID

• Do not give the victim anything to eat or drink,

even though he or she is likely to be thirsty. The
victim’s condition may be severe enough to
require surgery, in which case it is better if the
stomach is empty.
QUESTIONS