Public First Aid Certificate Course (English)

Lecture 3Internal Bleeding &

Circulatory Problems

Mr. N. Tang 　

Learning Objectives

Upon completion of this session, participants

should be able to :

1. List 5 common signs and symptoms of internal bleeding.

2. State first aid of internal bleeding.

3. Name 3 common types of shock in first aid.

Learning Objectives4. List signs and symptoms and first aid of

4.1 fainting

4.2 angina pectoris

4.3 heart attack

4.4 cardiac arrest

5. Secure a dressing covering a bleeding wound in the following parts of the human body using a roller bandage:

5.1 Hand – dorsum and palm

5.2 Foot – dorsum and sole

6. Manage sprained ankle using a roller bandage.

Internal Bleeding

Classification of Bleeding

1. Types of blood vessel

- artery, vein, capillary

2. Types of bleeding

- external bleeding

- internal bleeding

Internal BleedingCauses

2. Trauma / injury

1.1 Fracture

e.g. pelvis, femur

1.2 Penetrated wound

e.g. the back, the chest

1.3 Direct blow

e.g. the abdomen

Pelvis

FemurFemur

Internal Bleeding2. Diseases 2.1 Lack of clotting factors e.g. haemophilia 2.2 Perforated internal organ e.g. bleeding peptic ulcer 2.3 Ruptured blood vessel e.g. in the brain 2.4 Others : * Piles (haemorrhoid) ** Ruptured aneurysm – abnormal permanent dilatation of a blood vessel e.g. cerebral blood vessel, abdominal aorta

Piles

Common Sites of Internal BleedingSource Cause Appearance of Blood

Lung Lung diseases or injury

Coughed-up : bright red & frothy blood

Oesophagus,Stomach

Perforation of varicosed vein or gastric diseases

Vomit : bright-red (from oesophagus) or dark-reddish brown blood as coffee-ground(from the stomach)

Ear Perforated ear drum

Fresh, bright red blood

Others: bleeding from the nose and the vagina – refer to the notes of lecture II

Common Sites of Internal BleedingSources Cause Appearance of Blood

Largeintestine

Disease or injury with bleeding

Black, tarry, offensive-smell stool (malaena)

Urethra Injury / diseases of the urinary system- kidney, bladder, urethra

Urine with red or smoky appearance +/- blood clots

Anus Piles, injury to the anus or the lower intestine

Fresh, bright red blood

Risks of Internal Bleeding1. Hypovolaemic shock

- severe loss of blood volume

　 -> decrease blood supply to vital organs and

affect its functions e.g. brain, lungs, kidneys,

heart, liver etc. -> shock

- lost more than 2 litres of blood

-> activate sympathetic nervous system

-> shock -> life-threatening condition

Risks of Internal Bleeding2. Pressure effect

- the escaped blood acts on nearby organs

-> impair its functions

e.g. bleeding in the

brain -> stroke

Blood clot

Signs of Internal Bleeding

- No external bleeding wound - Bleeding from the body orifices- “Pattern bruising” – in violent injury- Pain - Face : pale or cyanosis- Skin : cold and clammy - Pulse : rapid and weak- Thirst- Breathing : rapid and shallow, cyanosis- Mental status : confusion, restlessness, irritability and unconsciousness

Symptoms of Internal Bleeding

- History : drug, injury/disease, internal bleeding

- Pain and tenderness of the affected part

- Thirst

First Aid1. Save life

- DRABC

- Dial 999

- Control bleeding

from the orifices

- Treat shockAmbulance

First Aid2. Prevent condition from getting worse a. Conscious - lie down with legs elevated 20-30cm - loosen tight clothing - keep warm; not overheat - check RABC every 10 minutes - keep nil by mouth

b. Unconscious : recovery position, nil by mouth

3. Promote recovery - psychological support, send to hospital quickly 　

Bruising

- Internal bleeding under the skin

Causes

- Trauma : contusion

- Bleeding tendency

- Drug : anticoagulants

e.g. warfarin (taken orally)

First aid : cold compress (ice bag or ice pack) for at least 5 min.

Circulatory Problems

The Internal Structure of the Heart

Pulmonary arteries

Pulmonary veins

Left atrium

Left ventricle Valve

Descending aorta

Rt. ventricle

Inferior vena cava

Rt. atrium

Superior vena cava

Ascending aorta

Normal Circulation of the Blood Head, Neck & Upper Limbs

Lungs

Heart

Trunk and Lower Limbs

Oxygenated Blood

Deoxygenated Blood

Aorta

ArteryVeins

Fainting

FaintingPhysiological changes

- Temporary decrease cerebral blood flow to the brain -> brief loss of conscious (LOC)

-> rapid and complete recovery

Causes

. Posture-related e.g.squatting and raise up suddenly

. Physical inactivity e.g. prolonged standing

. Physical fatigue

. Pain, emotion, stress, fear, hunger, exhaustion

FaintingSigns and symptoms

- Deteriorate conscious level

-> fall to the floor

- Pale, cool and clammy skin

- Slow pulse (later normal)

First aid

- Lie down, fresh air, treat injury

- Observe vital signs, recovery position

- Dial 999

20-30 cm

Risk of falling if unattended

SHOCK

Shock

Introduction

- Progressive, life-threatening condition

- Require urgent medical interventions

Physiological changes

- Failure of the circulatory system to

maintain adequate blood perfusion of vital organs

-> organs lack of oxygen -> damage and death

ShockType Cause

Hypo-volaemic shock - Severe loss of body fluids or blood (>1.2 litres)

e.g. internal/external bleeding, severe diarrhoea, vomiting, intestinal obstruction, severe burns, fracture

Cardio-genic shock The heart : unable to pump the blood e.g. heart diseases

Anaphylactic shock Allergy

Neuro-genic shock Pain or fear

Septic shock overwhelming infection

Spinal shock spinal cord injury e.g. fracture

ShockOther causes:

1. Spinal shock – spinal cord fracture/injury

2. Hypo-glycaemia (low blood sugar level)

3. Low serum hormone

e.g. glucocorticoid

4. Hypothermia (≤35 degree C)

5. Drug overdose e.g. narcotics

Signs and Symptoms of Shock1. Early

- Rapid pulse

- Pale, cool and clammy skin

- Capillary refill of nail beds : longer than 2 sec.

6. Later – adrenaline effects

- Rapid & shallow breathing

- Cyanosis (grey-blue skin) – lips, finger nails

- Rapid, thready pulse

- Weak, dizzy, nausea, vomiting , thirst

Signs and Symptoms of Shock

3. Later (> 2 litres blood loss)

- impair cerebral blood flow

-> restlessness

-> aggressiveness

-> yawning, undetectable pulse

-> gasping for air

-> loss of consciousness

-> cardiac arrest

First Aid of Shock

• To Save life – DRABC, control blood / fluid loss

• To prevent condition from getting worse

- lie on a blanket, legs raised, keep warm,

not give hot water bottle, nothing to eat/drink

3. To promote recovery – dial 999, monitor vital signs closely, recovery position, not move him

Anaphylactic Shock

Anaphylactic ShockFacts

2. Severe abnormal immune response to allergens

2. Allergens : pollen, nuts, shellfish, eggs, wasps, bee sting, latex, drugs etc.

3. Presentations of allergic responses

. Mild itching of skin

. Swelling

. Wheezing

. Digestive problems

. Shock – occurs within minutes, hours or days

Anaphylactic ShockSigns and symptoms

- Anxiety, fear

- Rash, itchy, wheals

- Swelling (hand, feet, face)

- Puffiness/watery of the eyes

- Difficult breathing

- Wheeze or gasping for air

- Abd. pain, nausea, vomiting

- Hypotension, shock

First Aid Treatment

- dial 999 and state the condition

- sit-up, drug, oxygen, treat shock, CPR, send to hospital

Pulse

Sit-up

Loosen tight clothing

Heart Diseases

1. Angina pectoris

2. Heart attack

3. Cardiac arrest

Coronary Arteries

**

Aorta

Pulmonary trunk

Left coronary artery

Right coronary artery

Superior vena cava

Circumflex artery

Anterior inter-ventricular

artery

Marginal branch

Posterior interventricular

artery

Thrombosis: A condition in which a blood vessel is partially blocked

Thrombus- platelets, cholesterol, fat

Embolism- total blockage

Embolus (detached thrombus)

1. Angina PectorisCause

- Partial obstruction of coronary artery (thrombosis)

-> insufficient oxygen supply to heart muscle

during physical exertion or excitement

1. Angina PectorisSigns and symptoms

- Chest pain with radiation

to the jaw, left and/or right shoulder(s), arm(s) and fingers

. occur during vigorous activities

or strenuous exercise

- Short and rapid breathing

- Weakness during body movement

- Anxiety

- Fainting

1. Angina PectorisFirst aid

- Rest, relaxation, comfort, reassurance and drug

(self-administer glyceryl trinitrate, TNG, or aspirin)

- Dial 999

- Vital signs

- CPR

Bendknees

Loosen tight clothing

Half-sitting Position

Stop all activities

2. Heart Attack (Myocardial infarction, MI)

Cause

- Sudden complete obstruction of coronary artery

- the affected muscIes : infarct (i.e. an area of coagulation necrosis)

- Ventricular fibrillation (VF)

- Heart stop beating (asystole / cardiac arrest)

AsystoleVF -------------------

2. Acute Heart Attack (Myocardial infarction)

Signs and symptoms

- Sudden onset of chest pain, occur even at rest

- Persistent chest pain, unrelieved by cardiac drug and rest

- Nausea, profused sweating, feel like indigestion

- Anxiety

- Dyspnoea, cyanosis, extreme gasping for air (air hunger)

- Rapid, weak or irregular pulse

- Giddiness, fainting

- A sense of impending death

- Shock and unconsciousness

- Ventricular fibrillation

- Death

2. Acute Heart Attack (Myocardial infarction)

First Aid

- Rest, dial 999 (inform suspected heart attack)

- Self-administered Aspirin (to dissolve clots ->

heart damage) or TNG, oxygen therapy

- Check vital signs

- CPR

- Send to hospital

immediately

Loosen tight

clothing

Bend knees

Half-sitting

The Patent AirwayA :

Basic Life Support of CPR (A,B,C)

Basic Life Support of CPR

B. Rescue breaths /Artificial breathing

C. External cardiac compressions

Defibrillation

Stay ClearBefore

Defibrillation

3. Cardiac ArrestMeaning

- The heart stops beating

Causes

- Acute heart attack

- Hypovolaemic shock

- Asphyxia

- Electrocution

- Drowning

- Hypothermia

- Anaphylactic shock

4. Cardiac ArrestSigns and symptoms

- No breathing and heart beat

-> damage the brain and heart muscle

- Ventricular fibrillation (VF)

- Loss of consciousness

First Aid treatment

- Dial 999

- CPR

- Defibrillation if VF

VF

Summary1. Five common signs and symptoms of internal bleeding.

2. First aid of internal bleeding

3. 5 common types of shock

4. Signs and symptoms and first aid of

4.1 fainting

4.2 angina pectoris

4.3 heart attack

4.4 cardiac arrest

Demonstration & Practice

- Use of Roller Bandage

Figure-of-Eight to HandSites :3.Hand – dorsum and palm

5.Foot : dorsum and sole

1. Gauzes & apply pressure

Support

3. Direct to the little finger

2. Begin fixation turn : at the wrist

4. Expose all nails

5.Build a triangle at the

base

Figure-of-Eight to Hand

6. Build a triangle

7. At least 3 layers – equal distance between 2 layers

Cover 2/3 width of the

previous turn, expose 1/3

width

Figure-of-Eight to Hand9. Supported by an

elevation sling after bandaging

8. Anchor the end of the bandage on the lateral aspect of the

wrist

(a) Palm mild bleeding

(b) Dorsum of hand mild bleeding

3. Figure-of-Eight to Foot & Sprained Ankle

1.Support the leg

2.Dressing& apply pressure

3. Use 3” bandage

6. Build 3 layers

5. Build a triangle

7. Elevate the foot after

bandaging

4. Start at the ankle

For sprained ankle, encircle the ankle with a soft pad before bandaging

References

St. John Ambulance et al (2009). First Aid Manual (9th ed., P.110 –

112, 116-117, 220 - 221, 227, 264-267, 278-279). London : Dorling

Kindersley.

Wilson & Waugh (1996). Anatomy & Physiology in Health & Illness .

(8th ed., P.180, 390). New York : Churchill Livingstone.

H. K. Sanatorium & Hospital (2004). Leaflet of Haemorrhoids.

尚曉峄 (2007). 《自由搏擊》 . ( 初版，第 105 頁 ). 香港 : 萬里機構。

香港聖約翰救護機構 (2007). 《急救證書課程手冊》 .( 第二 版 ,

第 82, 206-210 頁 ). 香港 : 香港聖約翰救護機 .