Bleeding And Shock

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Bleeding And Wounds
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Sources of External Bleeding

• Arteries
• Veins
• Capillaries

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Arterial Bleeding

• Most serious / arteries are usually deep in the
  body
• Rapid and profuse blood loss
• Bright red / spurts
• Less likely to clot
• Must use external means to stop blood flow

4
Venous Bleeding

• Steady flow / bluish-red
• May be profuse
• More easily controlled
• Veins are closer to the body surface
• Can be serious

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Capillary Bleeding

• Easily controlled
• Blood oozes
• Road rash

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Blood Vessel Spasm

• Severed arteries
• Artery draws back into the tissue
• Artery constricts and slows bleeding
• Partially severed arteries
• Associated with greater blood loss
• Example amputations

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Definitions

• Hemorrhage Rapid blood loss
• Adult 1 quart may lead to shock
• Child 1 pint loss of blood
• Dressing
• A protective covering for a wound
• Bandage
• A material used to hold a dressing in place

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Dressings

• Used to control bleeding
• Prevents contamination
• Dressings should be
• Sterile
• Larger than the wound
• Thick, soft, compressible
• Lint free (no cotton balls)

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Types of Dressings

• Gauze pads
• Adhesive strips
• Trauma dressings
• Improvise
• Donut shaped

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Dressings

• Application
• Wash hands
• Dressing should extend over edges of wound
• Do not touch dressing surface that is to be next
  to the wound
• Place medications directly onto pad
• Cover with a bandage
• Removal of Dressings
• Soak stuck dressing in warm water

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Bandages Are Used For

• Holding dressings in place
• Applying pressure
• Prevent or reduce swelling
• Provide support or stability

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Application of Bandages

• Leave toes and fingers exposed if possible
• Bandage too tight? Check for color, circulation,
  temperature
• Wrap towards the heart
• Small end of bone to large end

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Types of Bandages

• Roller gauze
• Improvised
• Triangular
• Cravat
• Adhesive / paper tape
• Adhesive strips
• Tourniquets are rarely recommended
• Damage to nerves and vessels

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Someone Has A Cut Leg What Should You Do?
(external bleeding / depends on severity)

• Call for help when necessary
• Protect yourself from bodily fluids
• Expose the wound
• Apply sterile gauze pad (dressing)
• Apply constant, direct pressure for 10 minutes
  (dont peak)

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Cut Leg

• If dressing becomes blood soaked
• do not remove dressing, add others over it
• After 10 minutes, if bleeding persists
• apply pressure harder and over a wider area for
  10 more minutes (seek help)

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Additional Options

• Elevate limb above heart level
• Apply pressure at a pressure point
• When bleeding stops
• Apply pressure bandage (roller gauze)
• Wrap towards the heart

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Problem Bleeders

• Hemophiliacs
• Aspirin

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When Not To Apply Direct Pressure

• Protruding bone
• Skull fracture
• Embedded object
• May use a donut shaped pad

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Types of Open Wounds

• Abrasion scrape
• Incision smooth edged cut (not in text)
• Laceration jagged irregular edges
• Puncture deep, narrow stab wound
• High rate of infection (animal bites)
• Should heal from inside out
• Gently press on wound edges to promote bleeding
  rinse wound -dress
• Avulsion flap of skin torn loose
• Amputation cutting off a body part

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Minor Open Wounds What To Do

• Wear gloves and expose wound
• Control bleeding
• Clean wound
• To prevent infection
• Wash shallow wound gently with soap and water
  (betadine)
• Wash from the center out / Irrigate with water
  for 5 minutes
• Severe wound? Control bleeding and get help

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Wound Care

• Do not close wound with steri-strips
• Use roller bandages (or tape dressing to the
  body)
• Keep dressings dry and clean
• Change at least daily
• More frequently if wet or dirty
• Use antibiotic ointments for shallow wounds only

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Wound Care 2

• Do not apply
• Mercurochrome, merthiolate, iodine, alcohol, or
  hydrogen peroxide
• Do not make dressing air tight
• If dressing sticks? soften with warm water prior
  to removal

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Signs of Wound Infection

• Swelling, redness, pain, warmth
• Fever / chills
• Swollen lymph nodes
• Red streaks
• Tetanus (lock jaw)
• Receive injection in first 72 hours
• Throbbing
• Pus

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When To Seek Medical Attention Indicates High
Chance of Infection

• Arterial or other uncontrolled bleeding
• Deep incisions, lacerations, avulsions
• Severe injury in bend
• Wound gapes open (stitches)
• Large or deeply imbedded objects
• Significant debris (bike wreck, chainsaw,
  tattoo
• Animal bites, ragged wounds
• Large or deep puncture wounds

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When To Seek Medical Attention 2

• If scarring would be significant
• Eyelids (prevent drooping)
• Slit lips
• Extremely dirty
• Injury to bone, joint, tendon
• Any situation in doubt
• (ear ring)
• If no tetanus shot in past 10 years
• 5 years for dirty wound
• Significant infection

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Amputations

• Crushing
• Poor chance of reattachment
• Guillotine
• Clean cut
• Good chance of reattachment
• (fingertips of kitchen counter)
• De-gloving
• Skin peeled off

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Amputation What To Do

• Control bleeding
• Treat for shock
• Recover body part
• Transport

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Care For Amputated Part

• Wrap in dry clean cloth
• Do not wrap in wet dressing
• Place in waterproof container
• Place bag on bed of ice
• Transport immediately

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Blisters

• Prevention
• (hike up mountain)
• Duct tape
• Donut shaped moleskin
• Spenco second skin
• Do not remove roof

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Open or Painful Blister

• Clean blister site treat as a minor wound
• To drain a blister
• Sterilize needle
• Make several holes at blister base
• Apply antibiotic ointment and dressing
• Change daily
• Check for infection

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Impaled Object

• Do not remove
• Control bleeding
• Stabilize object
• Shorten object only if necessary
• One exception
• If impaled in cheek and gt l hour from help
• Control bleeding
• Dressings inside and outside of cheek
• (frog gig)
• Houston, TX, Dec. 2000
• Child with pencil

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Impaled Eye

• Do not apply pressure to eye
• Place padding around object
• Stabilize object
• Paper cup
• Cover both eyes
• Explain to victim
• Seek medical attention

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Blow to the Eye

• Call 911 or transport if
• Eye is bleeding
• Eye is leaking fluid
• Cold Pack
• Do not remove contacts

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Particles in the Eye

• Do not rub
• Flush with water
• Potentially, brush out particle with a sterile
  dressing

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Chemical Burn to the Eye

• Flush 20 minutes with low pressure water
• Milk or other non-irritating liquid
• Remove contacts
• Flush outward
• Roll eyeball
• Loosely bandage both eyes with cold, wet
  dressings
• Seek medical attention

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Dry Chemical Burns

• Dust off chemical
• Protect yourself
• Then rinse 20 minutes

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Eye Avulsion

• Do not replace in socket
• Cover loosely with moistened sterile dressing
• Pad around area
• Cover with paper cup etc.
• Cover uninjured eye
• Medical attention

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Unconscious Victims Eyes

• Keep eyes closed by
• Taping
• Cover with moist dressings

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Ear Injuries

• Insect in ear (cricket)
• Irrigate pour lukewarm water into ear and try
  to float it out
• Do not try to float out a bean or popcorn
• (Wooden bead in ear)

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Bleeding from within the Ear

• Watery blood could mean a skull fracture
• Allow victim to sit up and tilt the affected ear
  lower to let blood drain out
• Cover ear with loose dressing but DO NOT apply
  pressure

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Nosebleeds

• Prevention
• Humidifier, vaporizer, vaseline
• Types
• Anterior
• Posterior

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Nosebleeds First Aid

• Sitting position
• Tilt head slightly forward
• Pinch nose 10 minutes
• Bleeding persists?
• Repeat pressure for 10 more minutes
• Ice bridge of nose
• If available, spray with Afrin or Neo-Synephrin

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When to Seek Medical Attention for Nosebleeds

• Second attempt to control bleeding fails
• Bleeding keeps reappearing
• Posterior bleeding
• Weakness or faintness
• Taking anticoagulants / aspirin
• Other health problems (son)

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Foreign Objects in Nose

• Peanuts, beans, french fries
• (little sister smelled)
• Do not have a child try to blow an object
  outGently blow
• Tweezers? Possibly for adults not children

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Broken Nose

• Ice pack
• Treat as nose bleed
• (nephew)

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Dental Injuries

• Knocked out tooth
• Broken tooth

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Knocked Out Tooth

• Rinse mouth / rinse tooth if dirty
• Place roll of gauze in the socket
• Do not scrub or use alcohol or mouthwash on the
  tooth
• Never touch root
• Transport in cold, whole milk

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Broken Tooth / Fractured Jaw

• Broken tooth?
• Clean area
• Cold compress
• Remote area? Candle wax, gum
• See dentist
• Fractured jaw?
• Immobilize
• Medical attention
• (mom w undiagnosed broken jaw)

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Scalp Wounds

• Suspect spine injury
• Profuse bleeding
• Skull or brain exposure?
• Indentation in skull?
• Control bleeding

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Scalp Wounds 2

• Depressed skull fracture?
• Use donut shaped dressing
• Apply pressure around edges of wound
• Elevate head and shoulders if appropriate
• Lessens bleeding
• Do not remove impaled objects
• Immobilize with bulky dressings

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Skull Fractures

• Signs and symptoms
• Penetrating wound
• Point tenderness
• Deformity

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Skull Fractures 2

• Bleeding from ears or nose
• Leakage of clear or pink watery fluid from ears
  or nose (CSF fluid)
• Halo effect
• Discoloration under eyes or behind ears
• Unequal pupils
• Profuse bleeding

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Skull Fracture What To Do

• Monitor ABCs
• Apply dressing
• Control bleeding as best as possible
• Stabilize neck (elevate head if appropriate)
• Do not clean open skull fracture
• Do not stop CSF flow
• Medical attention

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Fish-hook Removal

• Do not remove if near eye or other problem areas
• Tape in place, transport
• Otherwise
• Ice area
• Push hook through
• Cut off barb and back hook out

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Internal Bleeding

• Look for abdominal
• Pain
• Tenderness
• Rigidity
• Bruises

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Internal Bleeding

• Look for
• Black stools
• Bright red stools
• Cough or vomit with blood
• Fractured ribs or bruises

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Internal Bleeding What To Do

• Monitor ABCs
• Lay on side if appropriate (expect vomiting)
• Treat for shock
• Raise legs 8-12 inches (if conscious)
• Cover victim
• Bruises Ice, ace wrap, elevate