Dealing with Wounds and Bleeding
A wound can be defined as an abnormal break in the continuity of the tissues of the body. Any wound will to some extent result in bleeding, either internally or externally. If blood loss is severe, this could result in shock, so urgent treatment would be necessary.
Types of wound and basic treatment
Contusion
A bruise can be caused by ruptured capillaries bleeding under the skin. This may have been the cause of a blunt blow, or bleeding from underlying damage, such as a fracture.
- Cool the area with an ice pack or running water as soon as possible.
Abrasion
An abrasion/graze is when the top layers of skin are scraped off, usually due to a friction burn or sliding fall. Often containing particles of dirt, which could cause infection.
- Dirt that is not embedded should be removed using clean water and sterile swabs.
- Clean from the centre of the wound outwards, so as not to introduce more dirt into the wound.
Laceration
A rip or tear of the skin. More likely to have particles of dirt than a clean cut, although usually bleeds less.
- Treat for bleeding and prevent infection.
Incision
A clean cut. Usually caused by a sharp object such as a knife. Deep wounds may involve complications such as severed tendons or blood vessels. This type of wound could ‘gape open ‘ and bleed profusely.
- Treat for bleeding and prevent infection.
Puncture
A stabbing wound. Could be a result of standing on a nail or being stabbed. The wound could be very deep and yet appear very small in diameter. Damage may be caused to underlying organs such as the heart or lungs and severe internal bleeding may occur.
- Dial 999 for an ambulance if you suspect damage to underlying organs or internal bleeding.
- Never remove an embedded object – it may stem bleeding and further damage may result.
Gun Shot
Caused by a bullet or other missile, which may be travelling at such speed as to drive into and then exit the body. A small entry wound could be accompanied by a large ‘crater’ exit wound.
Severe bleeding and damage to organs usually results.
- Dial 999 for Police and Ambulance.
- Treat Airway and Breathing problems first.
- Pack the wound with dressings and try to prevent bleeding.
Amputation
The complete or partial severing of a limb.
De-gloved
Severing of the skin from the body, resulting in ‘creasing’ or a flap of skin, leaving a bare area of tissue.
Caused by the force of the injuring object sliding along the length of the skin.
- Put the skin back in place if possible.
- Arrange urgent transport to the hospital.
Blood Loss and How It Effects Us
How much blood do we have?
The amount of blood in our body varies in relation to our size. A rough rule of thumb is that we have approximately one pint of blood per stone in body weight (0.5 litre, per 7kg), so the average adult has between 8 and 12 pint’ (4.5 to 6.5 litre,) of blood, dependent on their size (but the rule doesn ‘t work for someone who is overweight).
Remember that children have less blood than adults, and as much cannot afford to loose the same amount – a baby only has around 1 pint of blood, ‘a can only loose 1/3 of a pint before the blood pressure falls (see below).
Types of Bleeding
Arterial
Blood in the arteries is under direct pressure from the heart pumping and spurts in time with the heart beat. A wound to a major artery could result in blood ‘spurting’ several metres and the blood volume will rapidly reduce. Blood in the arteries is rich in oxygen and is said to be ‘bright red’, however this can be difficult to assess. The most important factor is how the wound bleeds.
Venous
Veins are not under direct pressure from the heart, but veins carry the same volume of blood as the arteries. A wound to a major vein may cause profusely
Capillary
Bleeding from capillaries occurs in all wounds. Although the flow may appear fast at first, blood loss is usually slight and is easily controlled. Bleeding from a capillary could be described as a ‘trickle’ of blood.
Effects of Blood Loss
The table below show the effects, signs and symptoms of blood loss. Volumes of blood lost are given as a percentage, because we all have different amounts of blood.
As you can see, a loss of 300/0 of blood volume is critical – the patient’s condition rapidly deteriorates from this point onwards. Blood vessels cannot constrict any further and the heart cannot beat any faster, so blood pressure falls, resulting in unconsciousness and then death.
How To Treat External Bleeding
The aims of treatment for external bleeding are firstly to stop the bleeding, preventing the casualty from going into shock, and then to prevent infection.
S.E.E.P. will help you to remember the steps of treatment:
Sit or Lay
Sit or lay the casualty down. Place them in a position that is appropriate to the location of the wound and the extent of their bleeding.
Examine
Examine the wound. Look for foreign objects and note how the wound is bleeding. Remember what it looks like, so you can describe it to medical staff when it’s covered with a bandage.
Elevate
Elevate the wound. Ensure that the wound is above the level of the heart, using gravity to reduce the blood flow to the injury.
Pressure
Apply direct or indirect pressure to stem bleeding.
Direct pressure
The best way to stem bleeding is by applying direct pressure over the wound. Immediate pressure can be applied with the hands, however you should take precautions to prevent yourself from coming into contact with the patient’s blood, preferably by wearing disposable gloves. The pressure should be continuous for 10 minutes. A firm bandage (not so tight as to stop circulation to the limb altogether!) is usually sufficient to stop bleeding from most minor wounds. If there is an embedded object in the wound, you may be able to apply pressure at either side of the object.
Indirect Pressure
If direct pressure for a wound on a limb is not possible or effective, indirect pressure can be used as a last resort. Pressure can be applied to the artery supplying the limb, squashing it against a bone and reducing the blood flow. Apply indirect pressure for a maximum of 10 minutes.
The two main indirect pressure points are
Dressing
A dressing should be sterile and just large enough to cover the wound. It should be absorbent and preferably made of material that won’t stick to the clotting blood (a ‘non adherent’ dressing).
A firmly applied dressing is sufficient to stem bleeding from the majority of minor wounds, but the dressing should not restrict blood flow to the rest of the limb.
Extra pressure ‘by hand’ and elevation may be necessary for severe bleeding. If the dressing becomes saturated with blood, keep it in place and put another larger dressing on top. If this doesn’t work take the dressings off and start again.
Dealing With Embedded Objects
Objects embedded in a wound
An object embedded in a wound (other than a small splinter) should not be removed as it may be stemming bleeding, or further damage may result.
Use sterile dressings and bandages to ‘ build up’ around the object. This will apply pressure around the wound and support the object. Send the casualty to the hospital to have the object removed.
First Aid Lessons and Help
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