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Bleeding

Pakistan

ICITAP

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Learning Objectives

Identify different types of bleeding

Identify different types of wounds

Learn First Aid steps to control external bleeding

Learn how to apply dressings and bandages

Learn the proper use of a tourniquet

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Introduction

As Police Officers, you will be exposed to bleeding injuries resulting from accidents, combat and blast injuries

The victim of bleeding must be treated at a medical facility as soon as possible

A knowledge of first aid can often mean the difference between life and death

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Introduction Blood is essential to life. Without enough

blood circulating you will quickly die.

Many people die as a result of bleeding and shock

These deaths ARE preventable with proper treatment

First Aid techniques can help either stop or reduce the flow of blood

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Bleeding

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Blood Each adult has about 6.6 liters of blood

Rapid loss of 2.2 liters of blood can cause death

Arteries carry blood AWAY from the heart

Veins return the blood TO the heart

Capillaries are smaller blood vessels that carry the blood directly to the body’s cells

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Types of Bleeding Bleeding can be External or Internal

External Internal

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Types of Bleeding

External: Blood coming from an open wound

Internal: Bruises Blood in vomit, in the stool, or in

urine

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Bleeding is often classified by the blood vessel that is bleeding:

Arterial bleeding (Artery) Venous bleeding (Vein) Capillary bleeding

Types of Bleeding

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Arteries and Veins Capillaries

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Inside of a Blood Vessel

Blood is made up of 90% liquid and 10% cells

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How does bleeding stop? Blood Clots

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Types of Bleeding Bleeding from the ARTERY (arterial)

Bright red blood, spurting from the wound

Blood loss is rapid and extensive

Arterial bleeding is the most difficult to control

Life-threatening and must be controlled

IMMEDIATELY!

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Arterial Bleeding

Injury to right side of carotid artery

Notice the size of the blood vessel

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Types of Bleeding Bleeding from the VEIN (Venous)Bleeding from the VEIN (Venous)

Dark red blood, often so dark it appears to be maroon

Bleeds in a steady flow without the spurts, but it can still be severe

Venous bleeding is easier to control than arterial bleeding

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Venous Bleeding

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Capillary Bleeding

Blood oozes from the bed of capillaries

The color of the blood is red, usually less bright than arterial bleeding

The blood flow is generally slow, as seen in minor cuts and scrapes to the skin

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Capillary Bleeding

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WOUNDS

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Types of Wounds

There are two classifications of wounds:

Open Closed

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Open Wounds Gunshots – penetration of the skin by a bullet, that may have

both an entrance and exit wound. It may cause massive bleeding and internal damage.

Lacerations – a cutting of the skin. It has jagged edges and tends to bleed.

Incision – caused by a sharp objects. The wound has clean, even edges.

Puncture/Penetration – has little bleeding on the surface. It is nearly impossible to determine the extent of bleeding under the skin. This poses greater danger for infection.

Avulsion – This skin is torn loose and sometimes torn completely from the body

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Entry wound Exit wound

Gunshot Wounds

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Lacerations

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Incision Wounds

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Puncture Wounds

Puncture wounds to the body may result in unseen internal injuries

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X-Ray of Puncture Wound

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Penetrating Wounds

If a knife or other penetrating object is still present in the wound,

DO NOT attempt to remove it

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Puncture/Penetrating Wounds

Penetrating Trauma on the left side

of the chest

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Penetrating Wounds The act of removing the object will often

cause further damage and complications

Immobilize object to prevent further injury

Apply pressure around the object in an effort to stop the flow of blood

The removal of the object must be left to qualified medical staff

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AvulsionsDegloving injury: skin came off

Degloved portion

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Direct Pressure Warnings

An ear or nose bleed may be from a may be from a skull fractureskull fracture

DO NOT attempt to stop the flow

Catch the blood/drainage with a loose dressing

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Direct Pressure Warnings

Eye injury – DO NOT use direct pressure on eye because this may cause permanent damage

Neck area - Special attention should be given when dressing and bandaging this area. Errors may result in possible airway problems.

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DO NOT BE FOOLED! The amount of blood that is present may

not a good indicator of how serious the injury really is

Serious injuries may not always bleed heavily

Some minor injuries may bleed heavily, for example: head and face area.

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Minor or serious injury?

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Closed (Internal) Wounds Bruises and Concussions are types of

closed wounds:

Bruise is the result of bleeding under

the skin Concussion is a type of bleeding or

bruising that occurs on the brain

With these types of wounds, it is difficult to

detect the amount of bleeding

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Internal Bleeding

Bruise Concussion

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Internal Bleeding Remember: closed wounds can be the cause of

serious internal injury

A patient can internally lose large amounts of blood A patient can internally lose large amounts of blood in one areain one area

This blood may travel to other areas, such as the This blood may travel to other areas, such as the lungs or abdominal area, causing further problemslungs or abdominal area, causing further problems

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Bandages and Dressings

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Conduct a rapid head to toe examination to determine if the victim has a severe life threatening bleed

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REMEMBER: BE SAFE!!

When giving aid to someone with an open wound, precautions should be taken to prevent the transmission of disease

Wear sterile gloves, or put layers of sterile gauze, or plastic wrap on the wound to prevent contact

Always wash your hands immediately after administering First Aid with someone with an open wound

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Dressings and Bandages

Dressings: Material that is placed directly on the wound with pressure from the hand or bandaging

Bandages: Holds dressings in place

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The purpose of dressings and bandages

Control bleeding

Prevent infection and contamination

Absorb blood and fluids coming out of the body

Protect the wound from further injury

Always use a dressing large enough to extend over the wound’s edges

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Control the Bleeding Place a clean dressing on the wound and apply direct pressure

Bandage the dressing

Elevate the wound above the level of the heart

If bleeding still continues, apply pressure to nearest Pressure Point

Apply Tourniquet only as a last resort

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Direct pressure

If patient bleeds profusely immediately apply direct pressure to the wound

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How to apply dressing

Open dressing

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How to apply dressing

Do not touch white sterile side of dressing

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How to apply dressing

Place white side of dressing on wound

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How to apply bandaging

Hold dressing in place

Wrap one tail around the injury and the other tail in opposite direction

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How to apply bandaging

Wrap tails of dressing to cover

all edges

This will also help keep wound clean

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How to apply bandaging

Tie knot on the outside of wound

You should be able to slip 1-2 fingers under knot

This will ensure proper circulation

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How to apply bandaging

Tuck any remaining tails inside to avoid catching them

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Elevation of affected area

Elevate extremity above level of the heart to help stop bleeding

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Apply pressure to pressure point

If the bleeding does not stop after 5-10 minutes, you will need to apply pressure on an artery or pressure point between the wound and the heart

Pressure points should ALWAYS be used with caution!

Release pressure every 5 minutes for a few seconds

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Pressure Points

شريان

Do not apply pressure to the neck (carotid) pressure point. It can cause a heart attack.

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Apply pressure to pressure point

Apply pressure to nearest pressure point between the wound and the heart

Hold for 3-5 minutes

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Reinforce the dressing If bleeding continues, DO NOT

remove original dressing

Reinforce wound with additional dressings and bandages

Apply additional dressings as needed

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Reinforce the dressing

Tie knot on top of dressing

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Reinforce the dressing

Tuck any remaining tails under to avoid catching them

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Reinforce the dressing

You should be able to slip 1-2 fingers under knot

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Signs of improper bandaging

Bandage is too tight if:

Fingernails and toenails turning blue

A feeling of numbness or cold in the affected area

Bandage is too loose if:

Bleeding is not controlled due to inadequate pressure

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Applying a Tourniquet

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Applying a tourniquet

If all methods to control bleeding have failed, the LAST resort is to apply a a tourniquet

Why?

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Using a tourniquet A tourniquet applies pressure against the

blood vessels, stopping the flow of blood

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Applying a tourniquet

Apply a tourniquet only if the victim is in immediate danger of dying from blood loss

Never use wire, or other material that will cut the skin

Once a tourniquet is applied, it should be removed only in a medical facility

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Applying a tourniquet

Material used for tourniquet should be between 5 and 10 centimeters wide

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Applying a tourniquet

Tourniquet should be placed 2 – 3 finger widths above the wound site

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Applying a tourniquet

Do not place tourniquet over a joint or over the wound

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Applying a tourniquet Use rigid object to

twist the cloth tight around the injured extremity

This will assist in controlling the blood flow

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Applying a tourniquet

TOURNIQUET SHOULD BE TIGHTENED ONLY UNTIL BLEEDING HAS STOPPED

Wound may still be bleeding slightly

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Applying a tourniquet

Twist the rigid object and secure it so it does not unwind

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Applying a tourniquet

Do not cover tourniquet

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Applying a tourniquet

Mark on patient’s forehead: T, and the time tourniquet was applied

This is done to inform medical personnel when the tourniquet was applied

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Applying a tourniquet

After tourniquet is in place, bandage the end of the amputation

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Remember, the person you are most likely to be saving is a colleague

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Review What type of bleeding is hardest to

control? Practice using dressings and bandages to

stop external bleeding What is a common sign of internal

bleeding? If initial bandaging does not control the

bleeding, what is the next step? When do you apply a tourniquet? Demonstrate proper use of tourniquet

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Questions?

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Class Practical Exercise

Practice some of the skills shared in this presentation