BLEEDINGBLEEDING

Learning outcomes Learning outcomes

• Identify three types of bleeding.• Describe the types and severity of

bleeding. • Explain the effect of severe blood

loss on an infant and a child.• To identify the signs of internal

bleeding.• Demonstrate how to control

external bleeding.

TYPES OF WOUNDSTYPES OF WOUNDS• What types of wounds can you think of?What types of wounds can you think of?

• BRUISES OR CONTUSIONSBRUISES OR CONTUSIONS• LACERATIONSLACERATIONS• INCISIONSINCISIONS• GRAZESGRAZES• PUNCTURE PUNCTURE • GUN SHOTGUN SHOT

TYPES OF BLEEDINGTYPES OF BLEEDINGArterialArterial

VenousVenous

CapillaryCapillary

from an artery under direct pressure from an artery under direct pressure from thefrom the heart. Rich in oxygen said to be bright heart. Rich in oxygen said to be bright red, red, spurts from a wound… spurts from a wound… not under direct pressure form the heart but not under direct pressure form the heart but may may carry same volume of blood as arteries. carry same volume of blood as arteries. Depleted of Depleted of oxygen so is said to be dark red, may ‘ooze’ oxygen so is said to be dark red, may ‘ooze’ profusely. profusely. occurs in all wounds, although blood loss occurs in all wounds, although blood loss may may start off quite fast at first, blood loss is start off quite fast at first, blood loss is usuallyusually slight. slight.

BLEEDING CONT..BLEEDING CONT..

HOW MUCH BLOOD DO WE HAVE?HOW MUCH BLOOD DO WE HAVE?

• Varies in relation to our size…Varies in relation to our size…• Rule of thumb 1 pint per stone in body Rule of thumb 1 pint per stone in body

weight…average weight 70kgsweight…average weight 70kgs• Average adult 8-12 pints (4.5 to 6.5 Average adult 8-12 pints (4.5 to 6.5

litres)…litres)…• Children have less so they cannot afford Children have less so they cannot afford

to loose the same amount…to loose the same amount…• An infant only has around 1 pint of blood, An infant only has around 1 pint of blood,

so they can only loose 1/3 of a pint so they can only loose 1/3 of a pint before the blood pressure falls.before the blood pressure falls.

How much blood loss is criticalHow much blood loss is critical

The body can compensate if it is losing The body can compensate if it is losing blood.blood.

It does this by : It does this by : • Closing down the blood supply to non-Closing down the blood supply to non-

emergency areas of the body (including emergency areas of the body (including the skin and digestive system)the skin and digestive system)

• Speeding up the heart to maintain blood Speeding up the heart to maintain blood pressure.pressure.

How much blood loss is criticalHow much blood loss is critical

Blood vessels can only close down so much Blood vessels can only close down so much andand

The heart can only go so fast so there is a The heart can only go so fast so there is a Limit to how much blood the body can lose.Limit to how much blood the body can lose.

The body can no longer compensate after 1/3The body can no longer compensate after 1/3of its blood has been lost.of its blood has been lost.

After this the blood pressure falls quickly After this the blood pressure falls quickly The blood supply to the brain falls and deathThe blood supply to the brain falls and deathwill resultwill result

BLEEDING CONT..BLEEDING CONT..EFFECTS OF BLOOD LOSS – HYPOVOLEAMIC SHOCKEFFECTS OF BLOOD LOSS – HYPOVOLEAMIC SHOCK

BLOOD LOSS 10% 20% 30% 40%+

CONSCIOUSNESS

NORMAL MAY FEEL DIZZY STOOD UP

LOWERED LOC RESTLESS, ANXIOUS

UNRESPONSIVE

SKIN NORMAL PALE CYANOSIS, COLD & CLAMMY

SEVERE CYANOSIS, COLD & CLAMMY

PULSE NORMAL (THIS IS AMOUNT DONATED)

SLIGHTLY RAISED

RAPID (OVER 100/MIN) HARD TO DETECT

UNDECTABLE

BREATHING NORMAL SLIGHTLY RAISED

RAPID DEEP SIGHING BREATHS (AIR HUNGER)

METHODS OF CONTROLLING METHODS OF CONTROLLING EXTERNAL BLEEDINGEXTERNAL BLEEDING

• Primary surveyPrimary survey• Correct casualty positioningCorrect casualty positioning• Examine / Expose wound…Examine / Expose wound…• Do not remove foreign objects…Do not remove foreign objects…• Elevation…Elevation…• Direct Pressure, apply dressings (2 max)Direct Pressure, apply dressings (2 max)

……• Think SHOCKThink SHOCK

PRESSURE POINTSPRESSURE POINTS

INTERNAL BLEEDINGINTERNAL BLEEDING

• Blood is not actually lost ‘externally’ from Blood is not actually lost ‘externally’ from the body, it is lost out of the arteries and the body, it is lost out of the arteries and veins so shock can quickly develop veins so shock can quickly develop

• Can be difficult to recognise in it’s early Can be difficult to recognise in it’s early stagesstages

• Can be of a result of direct trauma to Can be of a result of direct trauma to chest or abdomenchest or abdomen

• Can happen spontaneously i.e. bleeding Can happen spontaneously i.e. bleeding into the stomach from an ulcer or weak into the stomach from an ulcer or weak arteryartery

INTERNAL BLEEDINGINTERNAL BLEEDINGSIGNS & SYMPTOMSSIGNS & SYMPTOMS

• History…History…• Signs and Symptoms of Shock…Signs and Symptoms of Shock…• Pain…Pain…• Bruising and / or swelling…Bruising and / or swelling…• Other symptoms related to the site of Other symptoms related to the site of

bleeding (i.e. difficulty in breathing if bleeding (i.e. difficulty in breathing if the bleeding is in the lung).the bleeding is in the lung).

INTERNAL BLEEDING INTERNAL BLEEDING CONT…CONT…

Bleeding from the lower bowel/rectum. Possibly haemorrhoids or injury.Bleeding from the large intestines/bowel

Bright red fresh blood

Black ‘offensive smelling’ stools

Anus

Menstruation, miscarriage, injury or disease to the vagina or womb.

Fresh blood or clotsVagina

Bleeding in the kidneys or bladder.

Smoky red colourUrethra

Bleeding in the lungs.Bleeding in the stomach.

Bright red, frothyVomited, or brown ‘coffee grounds’ appearance

Mouth

Nose bleed.Fractured skull, leaking cerebrospinal fluid from around the brain.

Bright red / clotsBlood with a ‘watered down’ appearance

Nose

Perforated ear drum, fractured skull.Fractured skull, leaking cerebrospinal fluid from around the brain.

Bright red / clots

Blood with a ‘watered down’ appearance

Ear

Possible causesAppearanceBleeding from