CHAPTER THREE

WOUNDS AND BLEEDING

By :- Manalebsh .A (BSc)

By: Manalebsh. A
 Learning Objectives 2
After completion of this chapter, the student will be able to:-
1. Define wound and bleeding

2. Classify different types of wound

3. Identify common causes of wound
4. Give first aid measures for different types of wounds.

5. Apply first aid measures to stop severe bleeding.

6. Explain the preventive measures of contamination and
infection of wounds.

By: Manalebsh. A
 Definition 3

 A wound is a break in the continuity of the tissue of the body

either internal or external.

 The main aims when dealing with wound are:- ƒ

 To control/stop bleeding ƒ
 To treat and prevent shock
ƒ To protect the wound from contamination and infection
 ƒTo prevent complication secondary to wound and
bleeding ƒ
 Obtain medical attention
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 Causes of Wounds 4

 Wounds usually result from external physical forces.

 The most common accidents resulting in open wounds are:-

 Accidental falls and

 Mishandling of sharp objects, tools, machinery and
weapons.
 Motor vehicle accidents

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Effect of wound 5

 Immediate loss of all or part of organ function

 Hemorrhage and blood clotting

 Bacterial contamination (infection)

 Cell death

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 Classification of Wounds
6

Based on causes wounds can be divided in to two broad categories.

Such as:

1. Surgical wound/intentional wound – is wound secondary to

planned therapy such as surgical incisions, needle introduction.
2. Accidental wound- it is unintentional injury. Such as, wounds
usually result from external physical forces.

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 Classification of Wounds Con’t…………….
7

A. Open wound: an open wound is a break in the skin or the

mucus membrane.
B. Closed wound: a closed wound involves injury to underlying

tissues with out a break in the skin or mucous membrane.

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 Types of Open Wounds:-8
 Abrasions
 Incisions
 Lacerations
 Punctures
 Avulsions
 Amputation

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 1. Abrased Wound 9

 The outer layers of the protective

skin are damaged.

 It usually results when the skin is

scraped against a hard surface.

 Bleeding is limited.

 Danger of contamination and\

infection is high.

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 2. Incised Wounds 10

 It frequently occurs when body

tissue is cut on knives, rough edges

of metal, broken glass or other

sharp objects.
 Bleeding may be rapid and heavy.

 Deep cuts may damage muscles,

tendons and nerves.

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 3. Lacerations 11

 It is jagged, irregular or blunt

breaking or tearing of the soft tissues .

 Usually caused when great force is

exerted against the body.

 Bleeding may be rapid and extensive.

 Destruction of tissue is greater in

a lacerated wound than in a cut.

 Deep contamination of the wound

increases the chance for later infection.

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4. Puncture 12

 It is produced by an object piercing skin

layers, creating a small hole in the tissue.

 It is produced by objects such as pointed

Objects like pins, needle, nails and splinters.

 External bleeding is usually quite limited.

 Internal damage may have resulted to

the organs causing internal bleeding.

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 Puncture wound
13 con’t……………
 The hazard of infection is increased because of the limited

flushing action of external bleeding.

 The opening in the skin may appear small but the wound can be

very deep and pose a serious infection problem.

 Tetanus may develop

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5. Avulsions 14

 It results when tissue is forcibly separated

or torn off from the victim’s body.

 An incised wound, a lacerated wound,

or both will usually occur when a body

part is avulsed.
 There will be heavy and rapid bleeding.

 An avulsed body part may be reattached

to a victim’s body by a surgeon.

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6. Amputation
15

 Cutting or tearing off of a body part

Fingers, hand, toes, foot e.t.c

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 First aid Measure for Open Wounds
16

A. Stop bleeding
 Wear gloves

 Expose wound

 Control bleeding with direct pressure and if possible elevate the

wound.
B. Cleaning the wound
- Helps to prevent infection
 Wash with soap and water

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 First aid for open wound
17
con’t………..
 Irrigate with water

C. Cover wound
 Cover wound with sterile dressing to prevent contamination or

infection.
 Keep clean and dry

 Obtain medical attention.

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 Con’t……………
18

 Do not clean large or life- threatening wounds

 Do not Scrub a wound

 Do not Irrigate with full strength alcohol

 Do not use hydrogen peroxide

 Hydrogen peroxide can effect blood flow and wound healing

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 First aid for amputation
19

 Control bleeding

 Treat for shock

 Recover amputated part

 Rinse to remove debris.

 Do not scrub

 Wrap in clean dry dressing

 Do not cut off partially attached body part

 Obtain for medical attention

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First aid for Impaled Object
20
 Do not try to remove the impaled object/ penetrating object.

 Control bleeding with direct pressure on skin around object

 Stabilize object

 Shorten only if necessary

 Obtain for medical attention

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 Closed Wounds
21

 Happens when a blunt object strikes the body

 Skin or mucous membrane is not broken

 Tissue and blood vessels beneath skin is

crushed or injured
 This may cause internal bleeding

 Closed wound includes:-

 Contusion and
 Hematoma
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 Contusion
22

 Another name for a bruise.

 Is injuries of tissue without laceration

 Caused when blood vessels are damaged

or broken from a blow to the skin

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 Contusion treatment
23

Initial treatment for contusion should include 

 Rest,
 Icing the affected area for 20 minutes, and
 Applying a compression wrap to help minimize swelling.

If there is an accompanying open wound, keep the area

clean and bandaged.

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 Hematoma
24

 Is a collection of blood outside the

blood vessels
 Caused by internal bleeding

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 First aid for closed wounds
25

 Control bleeding with an ice pack

 Elastic bandage as needed

 Check for fracture

 Elevate to decrease pain, swelling

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 Bleeding 26

Bleeding:- is defusing or oozing of blood from blood vessels

(Hemorrhage) usually through disease, injury, or other physical
conditions.

Types of bleeding
 Arterial bleeding- bright red in color, flow from the wound inside
ƒ
 Venous bleeding – dark red in color, flow is steady ƒ
 Capillary bleeding –oozing from bed of capillaries, red in color,
usually less bright than arterial blood with slow flow.
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 Internal bleeding: Bleeding inside body cavity may follow
27
an injury, such as a fracture or a penetrating wounds, but can also
occur spontaneously for example, bleeding from a stomach ulcer.

To recognize internal bleeding :-

 Initially, pale, cold, clammy skin.
 If bleeding continues, skin may turn blue- grey
(cyanosis).
 Rapid, weak pulse
 Thirst
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 Con’t……
28

 Rapid , shallow breathing

 Confusion, restlessness, and irritability.
 Possible collapse and unconsciousness
 Bleeding from body openings (orifices) such as the ear,
mouth, urethra, or anus.

By: Manalebsh. A
Methods of controlling bleeding externally
29
1. Direct pressure- using compresses

 Pressure stops the flow of blood and permits normal coagulation to occur.

 Apply pressure with your gloved fingertip or hand over the top of a sterile

dressing.

 Hold uninterrupted pressure for at least 5 minutes

 It is the preferred method for the control of severe bleeding since it

prevents blood loss from the body with out interference with normal
blood circulation.

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 Direct pressure……………..
30

 In case of very severe bleeding, manual pressure over the main

artery, nearest to the bleeding point, should be applied as well as

direct pressure over the wound itself.
 Apply the pressure bandage, maintain a steady pull on the

bandage, and then tie the bandage with the knot directly over the
pad.

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 Direct pressure……………..
31

Direct Pressure:
 Is applying direct pressure to
the wound.
 Is best way to control bleeding
 Did not interference with
normal blood circulation

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 2. Elevation
32
 Unless there is evidence of a fracture, a severely bleeding open
wound of the hand, neck, arm or leg should be elevated above the
level of the victim’s heart.
 Elevation of the injured part help :-
 To reduce blood pressure in the injured

area and
 To slows down the loss of blood through

the wound, however, it should be aided by

direct pressure.
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 33

NB:
 Never apply pressure if there is an object in the wound or a
protruding bone.
 Avoid if there is evidence of a fracture

By: Manalebsh. A
3. Applying pressure on the supplying artery(Pressure

point) 34

 Use the pressure point technique by temporarily compressing the

main artery (which supplies blood to the affected limb) against the
underling bone and nearby tissues.
 The technique also stops circulation within the limb.

 Use it for short duration of time.

E.g 1. Use the brachial artery for the control of severe bleeding
from an open arm wound

2. Use femoral artery for the control of severe bleeding from an

open leg wound
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 Pressure point……………….
35

 Is used temporarily for short duration of time

 Is in case of very severe bleeding that not controlled with direct
pressure
 Is manual pressure by compressing the main artery that
supplies blood to the affected limb against the underlying bone
and nearby tissues

By: Manalebsh. A
 4. Apply tourniquet in sever bleeding
36
 The use of a tourniquet is dangerous and the tourniquet should

be used only for a severe life threatening hemorrhage that can

not be controlled by other means.
Precaution: check the tourniquet every 10-15 minutes
 If the bleeding becomes controllable, (manageable by applying

direct pressure), release the tourniquet.

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 Internal Bleeding: First Aid
37

 Activate EMS first.

 Establish & maintain open airway, and monitor ABCDs.

 Assess for fractures; apply a splint if needed.

 Keep the victim quiet.

 Position & treat the victim for shock; keep warm.

 If the victim vomits, place in recovery position.

 Monitor victims every 5 minutes until EMS arrive.

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 Prevention of contamination
38
and infection
 Open wounds are subject to contamination and infection.

 This danger can be prevented or minimized by appropriate first

aid measures, depending up on the severity of bleeding.

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 Positioning
39

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 Nasal bleeding / Epistaxis
40

Epistaxis
 Is a very common health problem. About 60% of people have
at least one episode in their life time.
 Resulted from injury, disease, activity, temperature extremes,
or other causes
 Most are self limited and treated conservatively
 But it is dangerous if uncontrolled, it can lead to shock

By: Manalebsh. A
 First aid measure for nose Bleeds
41

 Priority is to control the bleeding and keep airway open

 Keep the victim quiet.

 Position victim in a sitting position

 Keep head tilted slightly forward

 Never lie down,

 Nor backwards

By: Manalebsh. A
 First aid measure con’t…………
42

 Pinch both nostrils

 Apply direct pressure by pinching nostril against the septum

for 10 minute
 Apply cold compress to nasal root and face

 Apply ice to bridge of nose

 Cautions - if a skull fracture

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 Infection prevention………………
43

 Do not remove or disturb the cloth pad initially placed on the

wound.
 Do not try to cleanse the wound, since the victim requires medical

care.
 Watch for signs of shock before and during transportation.

 Immobilize the injured area.

 Adjust the victim in a lying position, so that the affected limb can be

elevated if no evidence of fracture.

By: Manalebsh. A
 Measure to be taken to prevent contamination and
infection for open wound
44 with severe bleeding

 Wash your hands thoroughly with soap and water and wear

glove.
 Wash in and around the wound to remove bacteria and other

foreign materials (wash the wound from inside to outer side).

 Rinse the wound thoroughly by flushing with clean water.

 Dry with a sterile gauze pad or clean cloth.

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 Con’t…
45

 Apply a dry bandage or clean dressing and secure it firmly in

place.

 Inform the victim to see a physician immediately if evidence

of infection appears

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 Infection
46

 Bacteria can get inside tissues of the body through breaks in the

skin or mucous membranes.

 May develop serious infection within hours or days following an

injury.

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 Signs and Symptoms of Infection
47
include the following
o Swelling of the affected part

o Redness of the affected part.

o A sensation of heat

o Throbbing pain

o Fever

o Pus formation

o Swelling of lymph nodes depending on the affected sites.

o Red streaks leading from the wound (sign of

spreading of infection through the lymphatic circulation).

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 Emergency Care for Infection
48

 Keep the victim lying down and quiet, and immobilize the entire

infected area.
 Elevate the affected body part if possible.

 Apply heat to the area with hot water bottle or placing warm,
moist towels or clothes over the wound.
 Do not delay efforts to get medical care for the victim

By: Manalebsh. A
 49

THANK YOU

By: Manalebsh. A