External Bleeding

 

Bleeding is a common reason for the application of first aid measures and can be internal or external. The principle difference is whether the blood leaves the body – external bleeding can be seen, whereas in internal bleeding, no blood may be present.

Causes of external bleeding fall in to seven main categories.

  • Abrasion – Also called a graze, caused by rubbing action of a foreign object against the skin.
  • Excoriation – Simular with abrasion, caused by mechanical destruction of the skin, although it usually has an underlying medical cause.
  • Laceration – Irregular wound caused by blunt impact to soft tissue overlying hard tissue or tearing.
  • Incision – A clean surgical wound, caused by a sharp object, such as a knife.
  • Puncture Wound – Caused by penetrating the skin and underlying of skin, with nail, needle or knife
  • Contusion – Also known as a bruise, this is a blunt trauma damaging tissue under the surface of the skin
  • Gunshot wounds – This may include two external wounds (entry and exit) and a internal wound.

Recognizing external bleeding is usually easy, as the presence of blood should alert you to it. It should however be remembered that blood may be underneath or behind a victim. It may be difficult to find the source of bleeding, especially with large wounds or (even quite small) wounds with large amounts of bleeding.

Treatment

Caution
Put gloves on before coming into contact with any blood or body fluids.

All external bleeding is treated using three key techniques

  • Rest
  • Elevation
  • Direct pressure

Rest

In all cases, the less movement the wound undergoes, the easier the healing process will be, so rest is advised.

Elevation

Elevation only works on the peripheries of the body (limbs and head). You should ask the victim to hold their wound as high as possible. You should assist them to do this if necessary, and use furniture or surrounding items to help support them in this position. If it is the legs affected, you should lie them on their back, and raise their legs.

Direct Pressure

Rescuer applying direct pressure

The most important of these three is direct pressure. Simply placing pressure on the wound by using a dressing, such as a sterile gauze pad.

Direct pressure is usually enough to stop most minor bleeds, but for larger bleeds, it may be necessary to elevate the wound above the level of the heart. This decreases the blood flow to the affected area.

If the blood starts to come through the dressing you are using, add additional dressings to the top.

Dressing

Once the bleeding is slowed or stopped, or in some cases, to assist the slowing of the blood flow you should consider dressing the wound properly.

To dress a wound, use a sterile low-adherent pad, which will not stick to the wound, but will absorb the blood coming from it. Once this is in place, wrap a crepe or conforming bandage around firmly. It should be tight enough to apply some direct pressure, but should not be so tight as to cut blood flow off below the bandage. A simple check for the bandage being too tight on a limb is to hold the hand or foot (dependent on what limb is injured) above the level of the heart and firmly pinch the nail. If it takes more than 2 seconds for the pink color to return under the nail, then the bandage is likely to be too tight.

If the blood starts to come through the dressing you have applied, add another on top, to a maximum of three. If these are all saturated, remove the top two, leaving the closest dressing to the wound in place. This ensures that any blood clots that have formed are not disturbed; otherwise, the wound would be opened anew.

Special cases

Nosebleeds

If a person has nosebleed, have them pinch the soft part of the nose firmly between thumb and forefinger, just below the end of the bone. If necessary, do this yourself, but it is preferable to have them do it themselves if they are able to do it effectively.

The victim should lean their head slightly forward and breathe through their mouth. You can also leave the head in a neutral position, but never tilt the head back. Tilting the head forward ensures that blood isn’t ingested (as it can cause vomiting) or inhaled (choking hazard).

If you are unsuccessful at stopping the bleeding after 10 minutes of direct pressure, you should assess the blood flow. If the blood flow is minor, you could consider using an ice pack on the bridge of the nose to help stem the flow. If the nose continues to bleed with a fast flow, you should seek medical assistance

Embedded Objects

If there is something embedded in the wound, do not remove it. Instead, apply pressure around the object using sterile gauze as described above. Rolled bandages are perfect for this. Be careful not to disturb the object, as moving it may exacerbate the bleeding. This doesn’t apply to superficial splinters and such.

Stab, Puncture or Gunshot Wounds to the Body

These wounds are life threatening, and after assessing the ABCs of the victim, you should immediately call 911 or your local emergency number.

As with all embedded objects, ensure you do not remove the object from the body.

Blood in the body will go to the lowest point, allowing the heart and lungs to work as efficiently as possible. You should also lean them to the injured side, keeping the healthy side free from incursion by blood.

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