Bleeding First Aid PDF

**HAEMORRHAGE OR BLEEDING** **DEFINITION** Defusing or oozing or escape of blood from blood vessels. There are three main types of blood vessels: - Arteries - Veins - Capillaries [CAUSES OF HAEMORRHAGE] Haemorrhage may occur due to one of these: a\. Direct injury to the blood vessel wa...

**HAEMORRHAGE OR BLEEDING** **DEFINITION** Defusing or oozing or escape of blood from blood vessels. There are three main types of blood vessels: - Arteries - Veins - Capillaries [CAUSES OF HAEMORRHAGE] Haemorrhage may occur due to one of these: a\. Direct injury to the blood vessel wall as a result of a wound or surgical intervention b\. Disease of the blood vessel wall. This may be caused by infection or malignancy c\. Disease of the blood itself eg. Haemophilia (a disease characterized by delay in the clotting time of blood due to the lack of specific factors in the blood) [CLASSIFICATION OF BLEEDING] Bleeding is classified according to: a\. Source b\. The time of bleeding c\. Situation A. [BLEEDING ACCORDING TO SOURCE] - - - First Aid Lecture: Bleeding and Shock - ppt download Division of external bleeding in terms of the origin of the blood flow by vessel type B. [TIME OF HAEMORRHAGE] Hemorrhage may occur immediately or later. - - - - - Reactionary hemorrhage is likely to occur when the blood pressure returns to normal and the blood clot is pushed out. In hemorrhage of any extent there is also likely to be shock pressure and in this condition there is a lower blood pressure. After treatment of shock, the blood-pressure becomes high and again the clot may be pushed out by this pressure, and bleeding starts again. - C. [BLEEDING CLASSIFIED ACCORDING TO SITUATION] - Internal - External - This refers to leakage or loss of blood from blood vessels inside the body. Bleeding inside a body cavity may follow an injury, such as a fracture or a penetrating wound, but can also occur spontaneously, for example, bleeding from a stomach ulcer. It often has no outward indication. Note the type, amount and source of any blood loss from the body orifices. If possible, send a sample with casualty to the hospital. The main risk from internal bleeding is shock. In addition, blood can build up around organs such as the lungs or brain and exert damaging pressure on them. You should suspect internal bleeding if a casualty: - - - - - - **[How to recognize internal bleeding]** - - - - - - - - - - - **[First Aid Management of Internal Bleeding]** 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. **[External Bleeding]** This is the type of bleeding in which there is escape of blood unto the surface of the skin. It follows an open wound. It may lead to blood loss, contamination and infection. Possible causes include traumatic injury- gunshot wound, laceration, abrasions, etc. **[Signs and Symptoms]** - - - - - - - **[First Aid Management of External Bleeding]** a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. - - p. **[Note:] Application of tourniquet-** Due to its much damage, it is not advisable to use the tourniquet. However in instances where, the limb is badly crushed that it can be of no further use, a tourniquet application is possible. The following points are important when applying a tourniquet: 1. It must be tight enough to stop the bleeding. 2. There must be a piece of material between the tourniquet and the skin. 3. It must be above the wound. 4. It should be loosened every 15 minutes and replaced if the bleeding restarts. **Damage associated with tourniquet application** 1. 2. 3. 4.  **[SPECIAL TYPES OF BLEEDING]** - **EPISTAXIS** This is bleeding from the nose usually from a vein. The bleeding commonly occurs in one nostril. It is also known as nosebleed. **[Causes of epistaxis]** - - - - - - - - **[Signs and symptoms]** - - - **[First Aid Treatment]** 1. 2. 3. 4. 5. 6. 7. 8. - This usually occurs after tooth extraction whether intentional or accidental. **[Causes]** - - **[Signs and symptoms]** - - - - **[First Aid Management]** 1. 2. 3. 4. 5. 6. 7. 8. - It is the 'coughing' of blood from any part of the respiratory tract. Blood from this type of bleeding is bright red and frothy because it contains oxygen. **[Causes of hemoptysis]** - - - **[First Aid Management]** 1. 2. 3. 4. 5. - This is vomiting up of blood from the upper part of the gastrointestinal tract. It may occur as a result of bleeding from peptic ulcer, swallowing of coughed blood and fractured skull. The blood from this type of bleeding is dark in colour because of the presence of undigested food or gastric juice. It is sometimes referred to as coffee-ground sickness. **[Signs and symptoms]** The casualty may become: - - - **[First Aid Management]** 1. 2. 3. 4. 5. 6. 7. - This is referred to as 'blood in stool'. It is usually bleeding from the lower part of the gastrointestinal tract. It is black in colour because of the addition of the intestinal juices to the blood and stool is usually very offensive. When the colour is bright red, then it is from the lower end of the large intestines. **[Causes]** Bleeding from: - - - - - **[First Aid Management]** 1. 2. 3. 4. - It refers to any bleeding from the uterus that is not associated with the menstrual period. The commonest cause of uterine bleeding is threatened abortion or miscarriage. **[First Aid Management]** 1. 2. 3. 4. 5. 6. - It is usually referred to as 'blood in urine'. It occurs as a result of bleeding from any part of the urinary tract due to injury or disease. The blood is usually bright red in colour. **[First Aid Management]** 1. 2. 3. 4. - It refers to any bleeding that occurs at the inferior colon up to the rectum which is the last region of the large intestines. It may be caused by hemorrhoids, a rectal fissure or a direct pressure (injury) to veins around the rectum. The blood linked with rectal bleeding can vary in colour from black to bright red depending on the location of the intestine where the blood originated. **[Signs and symptoms]** - - **[First Aid Management]** 1. 2. 3. 4. 5. 6. 7. - These are enlarged, twisted veins most commonly found on the legs and thighs. It is also common in pregnant women. This occurs most of the time when the valves within the blood vessels are damaged. **[Causes]** 1. 2. 3. 4. **[Signs and symptoms]** 1. 2. **[First aid management]** 1. 2. 3. 4. 5. 6. 7. 8. **[POINTS TO NOTE]** https://image1.slideserve.com/2964472/first-aid-for-bleeding-is-intended-to-stop-the-bleeding-prevent-infection-prevent-shock-n.jpg  Lessons from a Stop the Bleed class - cleveland.com **CHAPTER FOUR** **WOUNDS** **[Definition]** A wound is a break in the continuity of the skin or mucous membrane. OR [A wound ](https://www.slideshare.net/sadrumohamed/wounds-47466389#3)is a type of physical trauma whereby the integrity of the skin or of any tissue is compromised.  It can also be defined as a separation or discontinuity of the skin, mucous membrane or tissue caused by physical, chemical or biological means. **[Classification of wounds]** Wound can be classified as: 1\. Open wounds 2. Closed/ concealed wounds **[Open wound]** An open wound is a cut or break in the skin or the mucous membrane, permitting the entry of foreign material into the tissues. The break in the skin's continuity is visible which allows blood to escape from the body. **[Closed/ concealed wounds]** In closed wounds, the skin remains intact, the damaged tissues are not exposed to permit the entry of foreign material into the tissues. This usually allows bleeding into the tissues or under the skin. **[Types of open wounds]**  - **Incisions or incised wounds** Caused by a clean, sharp-edged object such as a knife, or razor. They can be very deep; Arteries, veins and nerves may be cut resulting in profuse bleeding. This type of wound can be cleaned easily and satisfactorily. The wound heals easily leaving a fine scar. It usually heals by first intention. - **Laceration** Irregular tear-like wounds caused by some blunt trauma. Lacerations and incisions may appear linear (regular) or stellate (irregular). Bleeding may be less than in incised wounds, because the torn blood vessels contract more effectively. - **Abrasion (Graze)** They are superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are often caused by a friction, sliding fall onto a rough surface or when the skin is scraped against a hard surface. Such wounds are often contaminated with foreign bodies and infection can result. - **Avulsions** Tissue is forcibly separated or torn from the victim\'s body. - **Puncture wounds** This is caused by sharp pointed objects like nails piercing skin layers. These vary in depth and severity according to the cause. Punctured wounds can be very serious if from a stab, with a knife. Such wounds can cause serious damage to deep blood vessels, nerves or internal organs. There is the danger of internal haemorrhage and shock. - **Gunshot wounds** Caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit, generally referred to as a \"through-and-through.\" The point of entry of the bullet is usually small but very extensive damage is caused internally and creating a larger opening at the point of exit of the bullet. The wounds are usually penetrating in nature. There is severe bleeding internally and externally, and these are easily infected. Healing may not be by first intention. **Types of closed wound** - **Contusion (Bruise)** This is a closed wound which is associated with bruising and has no direct contact with the external environment. It usually allows bleeding into the tissues or under the skin. It is usually caused by a blunt injury to blood vessels within the tissues resulting in tenderness, swelling and discolouration.  - **Haematomas** It is caused by damage to a blood vessel that in turn causes blood to collect under the skin. - **Crush injuries** A crush injury is when the tissue is squashed. They are caused by a great/extreme amount of force applied over a long period of time. It can also result from an accident at a building site or a car crash and possible injuries include fractures and internal/external haemorrhage. IMG\_256 **GENERAL SIGNS AND SYMPTOMS OF WOUND** - Redness - Excessive swelling in the wound area - Throbbing pain or tenderness in the wound area - Pus or watery discharge collected beneath the skin or draining from the wound - Tender lumps or swelling in your armpit, groin or neck - Foul odour from the wound - Generalized chills or fever  **FIRST AID MANAGEMENT OF WOUNDS** 1. Reassure the casualty 2. Call for help 3. Place the casualty in a suitable position supine or recovery 4. Elevate the bleeding part except in the case of a fractured limb 5. Expose the wound to gain some idea of the severity of bleeding and arrest it immediately by applying and maintaining pressure 6. Treat for shock if any or necessary 7. Do not disturb any blood clot already formed 8. Clean the wound. Wash the affected area with a clean water (under pressure) if it is dirty / bleeding profusely. 9. The wound should be washed for 10-15 minutes 10. Make sure you remove all dirt and debris 11. Do not remove any foreign body that is firmly or deeply seated in the wound e.g., broken glass but rather apply a ring pad around the wound and bandage it lightly 12. Apply a dressing or pad to prevent infection 13. Immobilize the injured part. When the wound is near a joint, immobilize the whole joint using splints if necessary 14. Apply dressing and bandage the dressing firmly in position 15. Keep the casualty on his back and shoulders slightly raised and supported in this position, when internal organs such as the intestines protrude through the wound. 16. Make no attempt to replace organs, but cover the area with a large piece of a soft clean towel and bandage lightly. 17. Keep the casualty warm, avoid pressure to the abdomen Support the abdomen if the casualty is vomiting or coughing 18. Do not give anything by mouth 19. Cover the wound with a (sterile) dressing and pad 20. Bandage the wound dressing firmly in position 21. Send the casualty to the hospital as quickly as possible **Wound healing** Wound healing is a process of repairing the damaged skin and tissues after an injury. **Forms of healing** - First intention or primary union - Second intention or granulation - Third intention or secondary suture - **First intention** Incised wounds such as surgical wounds heal by first intention. This is characterized by little scar formation, the healing is fast, less damage to the skin with invisible granulation tissue, less infection, and straight edges after wound healing. - **Second intention** Wounds from gunshot, stabbing usually heal by second intentíon. This is characterized by irregular edges of the wound, the formation of pus, delayed healing due to infection, scar formation and visible granulation. - **Third intention** Delay in the suturing of deep wounds and gaped wound can cause healing by third intention. This is characterized by hyper granulation tissue growth, delayed healing of wound, presence of pus, formation of deep and wider scars and high infection rate. **Signs and Symptoms of Wound Infection** 1\. Increased pain in the wound area 2\. Fever 3\. Redness and/or the warmth of the wound area 4\. Pus drainage from the wound 5\. Foul odour from the wound 6\. Swelling and feeling of heat around the injury **Factors that Promote Wound Healing** - Adequate balance diet - Application of heat - Prescribe antibiotics - Elevation of part - Rest part involved - Blood transfusion. - Aseptic wound dressing - Debridement **Factors Impeding Wound Healing** - Low immunity. - Anaemia. - Wound Infection - Infection in the blood - Drugs - Dehydration. - Hypoxia - Advancement in age - Malnutrition - Lack of rest - Disease conditions - Hemorrhagic shock - Hematoma - Unprofessional suturing - Foreign body in wound **Complications of wounds** 1\. **Haemorrhage:** This occurs when blood vessels are involved. Bleeding may be slight or severe depending on the nature of the wound. 2\. **Shock**: This depends on the amount of blood lost or the extent of damage. 3\. **Sepsis / Infection**: This is a complication caused by infection with germs. It usually occurs some few days after the accident. Sepsis may be localized i.e., confined to the wound itself or generalized (affecting the whole body). 4\. **Injury to serious organs:** This is another serious complication of wounds especially punctured wounds and gunshot wounds. Damage can be done to organs like the liver, kidney and the heart. 5\. Fracture 6\. Keloids 7\. Scar formation 8\. Contractures 9\. Evisceration- protrusion of body content 10\. Dehiscence- split opening of the wound