BLEEDING

ACTC
OBJECTIVES
At the end of the lesson, students should be able
to :
• Interpret the related concepts.
• Discuss types of bleeding.
• Discuss clinical manifestations of bleeding.
• Identify causes of bleeding.
• Demonstrate skills in the management of
bleeding.
DEFINITION

• Bleeding/Haemorrhage: Escape of blood from

an injured vessel, or just loss of blood.
CAUSES OF BLEEDING

• Cutting objects.
• During surgery.
• Internal bleeding from an abdominal ulcer or any
internal injury.
• Ear bleeding could be fracture of the skull (mixed
with cerebral spinal fluid).
• Nose bleeding (epistaxis).
Cont…

• Bleeding from the mouth

• Gum bleeding

• Scalp and head wounds

• Vaginal bleeding
TYPES OF BLEEDING

• Bleeding is classified by the type of blood vessel that is

damaged: Artery, vein or capillary.
Arterial bleeding
• Is characterized by brighter red blood (richly oxygenated
blood)
• It pulsate or spurts from the wound with each heartbeat
• Rapid blood loss
Venous bleeding
Dark red blood, flows at a slower pressure than
arterial blood and will not spurt, it may gush
profusely if a major vein is ruptured.
Capillary bleeding
• Contain both arterial and venous blood
• Blood oozes over the surface.
• It is present in any wound
• It may be the only type in minor wounds and
blood oozes from the wound.
CLINICAL MANIFESTATIONS OF
BLEEDING
Major external bleeding
• There is evidence of major external blood loss.
• Symptoms and signs of shock are present.
• Casualty complains of thirst.
• Vision may be blurred and casualty feels faint and
giddy.
• Face and lips become pale.
• Skin become cold and clammy.
• Pulse becomes faster but weaker.
• Casualty becomes restless and talkative.
• Breathing becomes shallower, times
accompanied by yawning and sighing (air
hunger).
• Possible unconsciousness.
SKILLS IN THE MANAGEMENT OF
BLEEDING
Major external bleeding

Aims:
• To control the bleeding

• To prevent and minimize the effects of shock

• To arrange urgent removal of casualty to hospital

• Use disposable gloves,
• Wash hands well with soap before and after
treatment.
• Expose the wound and check for foreign bodies.
• Apply direct pressure to control bleeding by
pressing with fingers or palm of hand.
• If the wound is large, squeeze the edges
together.
• Lay the casualty down if the wound is on a limb
and if you do not suspect a fracture, raise and
support it.
• If the injury is on a limb and direct pressure is
ineffective, apply indirect pressure to the main
artery which supplies the limb but not for more
than 15 minutes.
• Place a sterile dressing over the wound, making
sure that it extends well beyond the edges of the
wound.
• Press it down firmly and secure enough to
control bleeding but not so tight to immobilize
the circulation.
• An improvised dressing can be made from any
suitable material.
• If bleeding continues, apply further dressings or
pads on top of the original ones and bandage
firmly.
• Minimize shock.
• Transfer to the hospital immediately.
 MANAGEMENT OF EAR BLEEDING
• Aim
To allow blood to drain away
• To minimize the risk of infection

• Arrange transfer to hospital.

• If skull fracture is suspected pay particular attention
to the levels of responsiveness
• Help the casualty into a half-sitting position, with the
head inclined to the injured side to allow drainage
• Cover the ear with a sterile dressing or clean pad,
lightly held in place
• NB: Do not plug the ear
• Check breathing rate, pulse and levels of
responsiveness at 10 minutes intervals.
• Minimize shock
• If the casualty becomes unconscious but is
breathing normally place in the recovery
position.
• The head should lie on the side to allow fluid to
drain from the ear.
• If breathing and heartbeat stop, begin
resuscitation immediately.
• Transfer to hospital; transport as a stretcher case
maintaining the treatment position.
MANAGEMENT OF NOSE
BLEEDING/EPISTAXIS

Aim
• To control blood loss.

• To maintain an open airway.

• To safeguard the breathing by preventing

inhalation of blood.
• Sit the casualty down with the head held well
forward.
• Advise the casualty to breathe through the
mouth and to pinch part of the nose near the
nose bridge.
• Tell the casualty to spit out any blood in the
mouth; swallowed blood may cause nausea and
vomiting.
• Once the bleeding is under control, keep the
casualty still, learning forward.

• While the head is still leaning forward, gently

clean around the nose and mouth using a swab
or clean dressing soaked in cold water.
• Tell the patient to try not speak, swallow cough,
spit, or sniff, as this may disturb blood clotting.
• After 10 minutes, tell the casualty to release the
pressure, if nose is still bleeding, reapply the
pressure for further periods of 10 minutes.
•Do not plug the nose.

•When the bleeding stops tell the casualty to avoid

blowing the nose for at least 4 hours so as not to
disturb the clot.

•If after 30 minutes the bleeding persists or recurs

seek medical aid or transfer casualty.
MANAGEMENT OF GUM BLEEDING

• Bleeding from a tooth socket and possible

lacerations around the socket.

Aim of management
• To safeguard the breathing by preventing inhalation
of blood and control bleeding.
• If tooth has been dislodged seek dental aid.
• Ask the casualty to sit down with the head
inclined toward the injured side to allow blood
to drain.
• Place a thick pad of gauze or a clean clot on but
not into the bleeding socket.
• This pad must be thick enough to prevent teeth
meeting when casualty bites on it.
• Ask the casualty to hold the cloth in position
with finger and then to bite on it for 10-20
minutes, supporting the chin on the hand.
• Tell the casualty to spit out any blood in the
mouth while keeping the pad in position;
swallowed blood can cause vomiting.
• After 10-20 minutes carefully remove the pad,
disturbing the cloth as little as possible, and
inspect the socket.
• If it is still bleeding, change the pad and ask the
casualty to continue the pressure for further 10
minutes.
• Do not wash out the mouth as this may disturb
the clot.
• Advise the casualty to avoid all hot drinks for the
next 12 hours.
• If the bleeding persists or recurs, seek dental or
medical aid.
• If the casualty has lost a tooth and it can be
found place it in a clean container and seek
dental aid as soon as possible.
• Send the tooth with the casualty.
MANAGEMENT OF BLEEDING SCALP AND
HEAD WOUNDS

• Replace displace flaps of skin

• Cover wound with sterile dressing/pad
• Apply firm direct pressure to minimise blood loss
• Help casualty to lie down with head and
shoulders slightly raised.
• Monitor signs of shock.
• If you suspect head injury monitor level of
response closely.
MANAGEMENT OF VAGINAL
BLEEDING
Aim
• To make the woman comfortable, and Reassure
her.
• To observe her and arrange to hospital.
• Remove her, if possible to a place with some
privacy.
• Give her a sanitary pad or clean towel.
• Make casualty as comfortable as possible, in
whichever position she prefers.
• If she choose to sit up ,prop her up with rolled-
up clothing or cushions, or lay down with head
and shoulders slightly raised and the knees bent,
supported on a blanket.
• If the pains are sever, and are due to
menstruation, the casualty may take pain-killer
tablets that prescribed for relief.
• Always be sensitive to the woman’s feelings, she
may be embarrassed by male presence.
Reference

• (St. John’s Ambulance Association (2009) The South

African First Aid Manual, Emergency procedures for
everyone at home, at work, or at leisure, Cape Town:
Struik 10th Edition PP 107-129 )
THE END