Haemorrhage Control

Source: Close, A. "Emergency Care", 2001.

Damage to any circulatory vessels (arteries, veins, capillaries) result in haemorrhage (bleeding). Bleeding can be of two types:

1) Internal Bleeding: Normally concealed inside the body and hard to detect, clues indicating internal bleeding may be the signs and symptoms of shock, pain, swelling, and tenderness. If suspected, patient needs treatment and hospitalisation.

2) External Bleeding: Easily found and can, in most circumstances, be controlled by the First Aider.

Types of Wounds

- Abrasions: shallow wound where bleeding presents as ooze due to capillary blood vessel damage. Abrasions are caused by sliding on rough surfaces that are contaminated by things such as gravel, dirt and sand.

- Laceration: an opening or cut in the body caused by blunt or sharp objects, such as a knife or chainsaw. Results in jagged uneven edges.

- Incision: similar to lacerations, but are the result of a sharp edged object cutting the skin. Results in a straight and clean wound.

- Penetrating Wound: wounds which have small openings through the skin and very little external bleeding. They may be misleading, however, as even though the wound is slight, it may be very deep. Puncture wounds are often the result of stabbings or shootings, but also include things such as nail guns, or flying fragments from explosions. Prompt medical attention is needed because of the high risk of surgical amputation due to infection and tissue damage.

- Amputation: where a part of the body is completely torn or cut away. If tissue still connects the stump to the amputated part, this is called partial amputation. The amputated part must be found and taken with the patient for reattachment.

- Avulsion: is where a flap of skin is torn or cut loose from the surrounding and underlying tissue. A common injury is caused by blunt trauma to the skull causing the scalp to be torn away in a large flap.

Control of Bleeding

- Ensure area is safe
- Protect yourself from blood with latex gloves
- Rest and reassure patient by lying or sitting them down
- Elevate and support the wound site above the height of the heart
- Sit the patient up slightly if they have a wound on the head
- Expose the wound: quickly, find the main bleeding point(s) and any foreign bodies
- Apply direct pressure to the site of the bleeding
- The patient can assist with this pressure by squeezing the wound edges together
- Apply sterile or clean dressing pad(s) and bandage firmly over the bleeding site, tight enough to stop the flow of blood and allow clotting, but not enough to restrict circulation
- Check the circulation below the wound site

If the bleeding is not controlled by the first pressure dressing:
- Increase the elevation and apply additional pad(s) and bandage(s) over the bleeding site.

If the initial pressure dressings are not stopping the bleeding they may need repositioning.
- Maintain elevation then reapply direct and indirect pressure whilst the bandage is removed
- Inspect the wound and reposition the bandage to provide the best pressure on the bleeding site
- Reapply the crepe bandage and support in an elevated position
- Check the circulation below the wound site

Control of Severe Bleeding

If bleeding is severe and still not controlled then consider the following:
- Apply indirect pressure to the artery supplying the site to reduce blood flow
- Elevate the wound site whilst applying initial or extra dressing pads and bandages
- Check the circulation beyong the wound site
- In extreme, uncontrollable bleeding such as shark bite, a tourniquet may be necessary

Control of Bleeding - Foreign Bodies

- Do not remove embedded objects from a wound. Removing the object may cause further tissue damage, dislodge blood clots and unseal blood vessels causing bleeding to increase
- Do not apply direct pressure over or to the object
- Foreign bodies if they are small and sitting on the surface may be brushed off with a sterile pad
- Pressure should be applied to the sides of the wound, holding the wound together
- Pad around the object to hold pressure on the wound edges and secure wiht a diagonal bandage

Control of Bleeding - Indirect Pressure

If the bleeding is not controlled by direct pressure, elevation and dressings, then pressure on the artery that supplies the bleeding area can be used, thus stopping blood flow at wound sites and allowing more time for more dressings and pressure.

Checking Circulation after Bandaging

The circulation check ensures that the pressure bandage has not stopped the blood flow to the area beyong the wound site. Checking distal pulses will indicate it. Other indicators are warmth, color of skin, numbness or tingling. Another test is "capillary refill" - squeeze the nail bed on the injured side and look for the speed of return of normal colour, then compare to the uninjured site. If blood flow has stopped at the wound site, the bandage will need to be loosened.

Amputations

Amputee patients will often loose a lot of blood and therefore present in shock - rapid pulse, pale clammy skin, rapid breathing and altered conscious state. When dealing with amputated body parts, handle them gently, place them in sealed airtight plastic bags and then in a container of iced water (the amputated part must not come in contact with the ice).

Nose Bleed (Epistaxis)

- Place the patient in a comfortable position, sitting down with head slightly forward
- Pinch the soft part of the nose together for 10 minutes
- Tell the patient to avoid blowing their nose
- Encourage the patient to spit the blood out. Swallowing it can cause vomiting.
- An ice pack may be used on the nose to assist in stopping the flow of blood.

Summary of Bleeding Control

To control bleeding the First Aider must act:
- Promptly, to prevent loss of blood and to minimise shock
- To stop blood flow at the injury site enabling clotting to take place (direct pressure, elevation and dressing)
- Carefully, to protect against contamination to the wound or the First Aider
- To consider other implications of the injury, for example, a fractured skull.