Bleeding

Blood is normally contained within the circulatory system: the heart, arteries, capillaries and veins. When these are torn or damaged, bleeding occurs. This can be on the outside of the body through a visible wound or on the inside of the body (internal bleeding).Blood carries oxygen from the lungs to the heart along the arteries to the tissues and through the tissues in the capillaries where the oxygen is made available for use. Veins carry the deoxygenated blood back to the heart.

Types of bleeding
Bleeding is classified according to the blood vessel that has been damaged. This may be identified by observing the colour and flow of the blood.

Arterial
Bright red blood that rhythmically spurts from the body in time with the heart beating. This is very serious bleeding and can rapidly lead to collapse and death.

Venous
Dark red blood that may ooze from a wound. If a large vein is damaged the oozing is copious and can rapidly lead to collapse and death.

Capillary
This is the trickling of blood seen with minor cuts and wounds. It is not serious.

Serious bleeding
This is bleeding that is extremely profuse and may be arterial (bright red blood) or venous (dark red blood). You will notice large amounts of blood on and around the casualty.

TREATMENT
If the casualty is unconscious, give Resuscitation
Put direct pressure with your hands on to the wound. If it is possible, do this using a sterile or clean pad- but do not waste time looking for first aid materials.: If there is something sticking out of the wound, press down firmly on either side of the protrusion without dislodging it and bandage around.
Lay the casualty down.
Raise the injured part above the level of the casualty's heart.
As soon as first aid kit is available, apply a sterile dressing
Keep the limb elevated, using an elevation sling for forearm and hand wounds.
Call for an ambulance.
Treat the casualty for shock
Check the dressing frequently to ensure that the bleeding is controlled.

Serious bleeding that will not stop
Do not remove the original dressing.
Apply further sterile dressings over the original one.
Continue to apply direct pressure and maintain the limb elevation.

Site of bleeding	Type of bleeding	Cause
NOSE/EAR	Thin, watery blood loss	Escape of cerebro-spinal fluid
MOUTH	Frothy, bright red bloodThat is coughed up Altered blood that isVomited up looks like Coffee grounds Fresh blood	Bleeding in the lungs Bleeding in the upper gut/ stomach Bitten tongue or lip
ANUS	Fresh blood Digested blood passed as a black, sticky stool with a strong offensive odour	May be piles or a bleed from within the lower bowel Bleeding from the upper part of the gut
VAGINA	Heavy bleed when Period is not expected	Possible miscarriage/ injury to the womb or vagina
URETHRA	Bloodstained urine	Bleeding within the urinary system.Possible kidney injury/infection

Obviously, if any of these symptoms occur, medical advice needs to be sought. If the casualty has signs of an internal bleed or shock, an ambulance should be called for immediately.

Less serious bleeding
Where the bleeding is not profuse and life is not endangered, the same principles still apply.
Apply direct pressure (the casualty may be able to assist you in this respect).
Elevate the limb.
Lay the casualty down.
Apply a sterile dressing and an elevation sling if dealing with forearm or hand wound.
Call for an ambulance if needed.
In some less serious instances you may decide that an ambulance is not required. If you decide to transport the casualty to hospital by car, It is sensible for him/her to travel in the back of the vehicle in these circumstances, preferably with a third person to give support and assistance. Remember to take a bucket (or similar) with you in case the casualty feels sick. Do not transport a casualty in a private vehicle merely because you feel that it will be quicker than waiting for an ambulance.

Problem areas
Bleeding from certain parts of the body can cause problems due to their shape and position. The principles of direct pressure still apply but with variation when it comes to applying a sterile dressing.

Cuts to the scalp and face
These tend to bleed profusely, but rarely endanger the casualty's life. However, superficial scalp and facial wounds can cause distress as the blood gets into the casualty's eyes, nose, and mouth. If the casualty is unconscious, you must ensure that the airway is not obstructed by blood - putting the casualty into the recovery position alleviates this problem.
If the bleeding is copious, apply a sterile dressing as best as you can, being careful not to obstruct the casualty's vision unless absolutely necessary, and then provide plenty of explanation and reassurance. If the bleeding is not profuse, use a dressing held in place by a light bandage. Always ensure that the casualty can breathe and the bandage is not too tight.

Always be aware when treating a casualty for scalp and facial wounds that there may be an underlying fracture .

Cuts in the palm
This area will bleed profusely and other structures (tendons and nerves) may be damaged. The basic principles of direct pressure and elevation apply, then:
Using a sterile dressing, place the pad on the injured palm and ask the casualty to grip on to this.
Bandage around the wrist once and then come up and over the fingers so as to apply firm pressure on the wound. Repeat this until the fingers are fully enclosed.

Enclose all the fingers in this way and secure the bandage by trying it over the fingers.
Support the injured hand in an elevation sling.

Internal bleeding
Internal bleeding may be completely hidden, in which case, the casualty will appear to be shocked without any obvious cause. Such bleeding can occur as a result of an accident or spontaneously and without any warning.

You may notice.
Cold clammy and pale skin.
Rapid, weakening pulse.
Discomfort or pain.
Thirst.
'Air hunger' (the casualty yawns frequently).
Restlessness and irritability.
Confusion.
Drowsiness,even lapsing into unconsciousness.

TREATMENT
Lay the casualty down, and provided there are no lower rib fractures, raise the legs.
Protect the casualty from the cold. Try to place a blanket (or similar) underneath as well as on top.
Loosen tight clothing at the neck, chest and waist.
Call for an ambulance.
If the casualty becomes unconscious, perform Resuscitation .

Cuts in the mouth
Mouth injuries can be serious. While not life-threatening, they can cause considerable discomfort and have long-lasting effects. Very often the injuries sustained are caused by the casualty's teeth.

Ask the casualty to sit down and to lean forward to allow the blood to drain.
Place a piece of gauze over the wound and ask the casualty to squeeze it from the outside and inside with a pincer movement of his/her finger and thumb.
This should be done for 5-10 minutes.
If the bleeding persists, repeat.

:Ask the casualty not to swallow any blood as this is likely to cause sickness.

If the wound is minor and does not require medical attention, advise the casualty to avoid hard, chewy foods and hot drinks for 12 hours.
Seek medical aid if the wound is large or if bleeding has not stopped after 20-30 minutes.

Bleeding from the ear
If a casualty has bleeding from the ear, medical advice will be need.
If the bleeding is part of a thin, watery loss then you should suspect a head injury .
Do not plug the ear.
Sit the casualty with the head inclined to the injured side.
Cover the ear with a lightly secured sterile dressing .
Arrange for the casualty to go to the hospital.

Bleeding from the nose
This is very common following,or during, a cold or as a result of a blow to the nose. If the bleeding is part of a thin, watery loss you should suspect a head injury .

Do not plug the nose.
Sit the casualty down with the head tipped well forward.
Ask the casualty to pinch the soft part of the nose (just below the upper bony part) and to breathe through the mouth.
Pressure should be applied for at least 10 minutes. If bleeding continues, reapply pressure.
If available, an ice pad can be applied to the outside of the nose in addition to the above.

1. Seek medical aid if bleeding continues for 20-30 minutes.
2. When bleeding stops, advise the casualty not to blow the nose for 4-6 hours.

Bleeding from the vagina
A woman suffering unusual or heavy bleeding from her vagina will feel embarrassed and may not seek first aid for some considerable time. Bleeding, when not associated with a normal period, may be due to miscarriage or other gynaecological problems.

TREATMENT
At all times respect the woman's feelings and arrange, if possible, for privacy.
Provide a sanitary pad or a folded hand towel (or similar).

Make the woman comfortable, sit her up with her knees propped up on a couple of blankets ( or similar).
If the bleeding is severe,call for an ambulance.

SEXUAL ASSAULT
If the woman has been sexually assaulted, you must be most careful to preserve any evidence .

Wherever possible, a female should render first aid to a woman with vaginal bleeding. If this is not possible, the male first aider should try to arrange for a female person..

Gunshot wounds
There will be bleeding but due to the nature of gunshot wounds, underlying fractures and internal injuries must always be expected.
Depending on the type of weapon involved, the wounds can vary considerably. High-velocity weapons may cause catastrophic internal damage while leaving only a small entrance wound.
Low-velocity weapons cause less severe internal in injuries. Air guns may inflict nasty injuries, particularly if the eye is involved, but otherwise generally cause only minor flesh wounds.

TREATMENT
Approach the casualty only if you are sure that it is safe to do so.
If the casualty is unconscious check whether to give Resuscitation and act accordingly.
Stop any life-threatening bleeding by applying direct pressure on the wound .
If an underlying fracture is suspected, immobilise the part .
Protect the casualty from the cold.
Do not probe the wounds for the bullet.
Remember to check for exit wounds.
They can be more serious than the entry wound.
Call for an ambulance and police.

Blisters
Blisters are thin 'bubbles' that form on the skin. They occur when the skin is damaged by friction, such as when wearing new shoes or as a consequence of a bur/scald .
Under the 'bubble' there is fluid called serum. During the healing process a new skin layer forms. The serum is absorbed before the dead skin peels off.

TREATMENT
Do not burst the blister.Cover the blister with a plaster or small dressing (p 44). Ensure that the pad extends well beyond the edges of the blister.

IF THE BLISTER HAS BURST
·Clean the area.
·Do not attempt to peel or cut away the loose skin.
-Cover the area with plaster or small dressing.