BLEEDING

 DEFINITION :
 Any rapture of blood vessel which leads to loss of
blood, known as bleeding.
 TYPES OF BLEEDING :-
 1. External :-
 When it is from surface of body
2. INTERNAL :
 If bleeding is within skull, chest or abdomen
etc. blood can not be seen but it may ooze out
from nose, ear, or in stool , cough or
vomiting.
 FUNCTIONS OF BLOOD
1. Exchange of oxygen & Co2.
2. Supply of oxygen to all parts
of body
3. Transportation of nutrients &
minerals & vitamins.
4. Protect against infections –
Antibodies.
TYPES OF INTERNAL BLEEDING
a) ARTERIAL :
Comes out in jet. Bright Red in colour.
Cause death very quickly.
b) VEINES :
Flow out in continuous stream. Dark
red in colour.
c) CAPILLARY:
Ooze out slowly. On the surface of
body. Not serious.
 SIGNS & SYMPTOMS
 1. Casualty feels faintness. May even
collapse.
 2. Skin become cold, pale & Clammy.
 3. Pulse get rapid but very weak.
 4. Breathing becomes shallow,
casualty gasps for breath.
 5. Profuse sweating.
 6. Casualty feels thirsty.
 MANAGEMENT
1.MINOR BLEEDING :
Will stop by itself or by firm pressure
& bandage.
2.MAJOR BLEEDING :
1. Bring slides of wound together &
press firmly.
Cond…
Contd..

2. Place casualty in comfortable

position.
3. Raise the injured part, clean the
surrounding area with sterile water.
4. Press on the pressure point for 10
to 15 minutes.
5. Apply clean pad larges than the
wound & press it firmly until
bleeding is stopped or become
less.
6. If bleeding continues, add
more pads without removing
the first.
7. Treat for shock
8. Any outside object may be
removed, don’t press against
broken bone or foreign object,
press along side
9. Get the casualty to hospital if
required
 INTERNAL BLEEDING
1. Lay the casualty down with head
low.
2. Raise the legs by using pillows
etc.
3. Keep him calm & relaxed
4. Reassure him.
5. Do not allow him to move.
6. Keep the body heat with thin
blankets etc.
7. Do not give any thing to eat or
drink.
8. Do not apply hot water or ice
bags to chest or abdomen
9. Take him to hospital as
quickly as possible.
10.Transport gently.
5. Excretion of wastes through
skin & kidneys.
6. Regulate the temperature of
the body.
7. Distribution of chemicals,
hormones etc.
 SOFT TISSUE INJURIES
 Soft tissue injury commonly referred as
wounds, are injuries to skin, muscle, nerves
and blood vessels.
 CLOSED WOUNDS : Injury to the soft tissues
beneath unbroken skin ( skin is impact)
 Recognitions of closed wounds :
- swelling
- tenderness ( Pain to touch)
- Discoloration
- Possible deformity
Pre hospital treatment for closed
wounds
 Apply RICE method. i.e., Rest, Ice,
Compress, Elevate.
 Monitor the patient for any rapid
changes in vital signs. That might
indicate internal bleeding which
should be treated by a physician.
 Treat for shock
 OPEN WOUNDS
Open wounds :
A soft tissue injury resulting
in breaking of the skin (In this
case blood may come out )
TYPE OF OPEN WOUNDS :
 Scratches and abrasions
 Lacerations ( cuts)
 Penetration and puncture wounds
( through nails, knife, bullet)
 Avulsions ( skin flap )
 Amputations ( Separation of body part)
 Crushing injury ( May be open or close)
 Gun shot wounds ( Firing bullets )
 Impaled object ( knife stabbing and
remains in body )
 PULSE
 INFANT - 120 – 150 P.P.M.
 CHILD - 80 - 150 P.P.M.
 ADULT - 60 – 80 P.P.M.

SKIN TEMPERATURE
98.6°F or 37°C
Free –hospital treatment for
open wounds
 P.P.E. on
 Expose the wound.
 Control bleeding.
 Prevent contamination
 Dressing and bandage
 Cover the patient
 Treat for shock.
 FRACTURES
 Definition :- Any break in the continuity of a
bone.
 Types :
1) Closed injury : One in which the over
lying skin is intact.
2) Open injury : One in which the skin
has been broken or
torn either from the
inside or out side.
 Dislocation
Injury in which a bone is moved out of its
normal position in a joint and remains that
way.
Sprain :
Injury in which ligaments are stretched or
partially torn, commonly associated with joint
injuries.
Strain :
Injury in which muscle or a muscle and
tendon are over – extended.
Dislocation, fracture and sprain may all be
present in an injury.
 BURNS
DEFINITION : Injuries caused by exposure
to excessive heat from thermal, chemical,
Electrical or Radiating sources.
CAUSES :
 Thermal
 Chemical
 Electrical
 Radiant
CLASSIFICATION BY DEPTH :
 Superficial ( 1st degree ) burns :
These involve only the top layer of the
skin.
 Partial thickness (2nd degree) burns :
The superficial layer of the skin is burned
through and the second layer is damaged.
 Full thickness (3rd degree) burns :
All layers of the skin are burnt, including
the fatty layer.
 RULE OF NINES FOR ADULTS AND
CHILDREN
Extent of burns :
Adult Child
 Head 9% 18 %
 Upper extremities 9 % each 9 % each
 Anterior Trunk 18 % 18 %
 Posterior Trunk 18 % 18 %
 Genital 1 % Incl. in anterior trunk
 Lower extremities 18%each 14 % each

BSA (Body surface area) 100 % 100 %

MINOR BURNS:
 Full thickness burns of less than 2% BSA,
excluding face, hands, feet, genitalia or
respiratory tract.
 Partial thickness burns of less than 15%
BSA.
 Superficial burns of 50% BSA or less.
MODERATE BURNS :
 Full thickness burns of 2 % to 10 % BSA,
excluding face, hands, feet, genitalia or
respiratory tract.
 Partial thickness burns of 15 % to 30% BSA
 Superficial burns over 50 % BSA.
CRITICAL BURNS :
 All burns complicated by injuries of the
respiratory tract, other soft tissue injuries
and injuries of the bones.
 Partial or full thickness burns involving the
face, hands, feet, genitalia and respiratory
tract.
 Full thickness burns of more than 10% BSA
 Partial thickness burns of more than
30%BSA
 Burns complicated by musculoskeletal
injuries.
PRE-HOSPITAL TREATMENT FOR BURNS
1) Stop the burning process. Run cold water over
the scald burns. Flush away chemicals with
water for 20 min. or more.
2) Remove any smoldering clothing and jewellery.
3) Perform initial assessment (check ABC)
4) Administer oxygen per local protocol.
5) Determine the severity of burns, using the rule
of nine.
6) Cover the burns. Use dry sterile dressing. Do
not use grease, ointment, lotion, antiseptic or
Ice on the burns. Do not break any blisters.
 PRE-HOSPITAL TREATMENT FOR
CHEMICAL BURNS
 Brush off dry chemical, such as lime
powder, before flushing with water .
 Rinse the area with water for at least
20 min. or more.
 Apply sterile dressing to the affected
area.
 Treat for shock.
 PRE-HOSPITAL TREATMENT FOR
ELECTRICAL BURNS
NOTE : Prolonged C.P.R. should be
performed on electrical injury victims as
they can remain viable for a longer period
than with other types of injuries.
 Perform initial assessment. (check ABC)
 Evaluate burns and look for at least two
burn area.
 Apply dry sterile dressing to the burns.
 Treat for shock.