Bleeding you can and cannot see and open and closed...

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Bleeding you can and cannot

see and open and closed wounds

Shelley Westwood, RN, BSN

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITION

Copyright © 2006 by The American National Red Cross

All rights reserved.

2 AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITION



Introduction

Bleeding is the escape of blood from the arteries, capillaries or veins.

Bleeding occurs internally or externally.

Uncontrolled bleeding, whether internal or external, is life threatening.

Blood is made up of liquid (plasma) and solid components (white and red blood cells and platelets). Blood—

Transports oxygen, nutrients and wastes.

Protects against disease.

Maintains constant body temperature.




Introduction (continued)

The three major types of blood vessels are—

Arteries.

Capillaries.

Veins.

Blood in the arteries travels faster and under greater pressure.

Blood in the arteries pulses with each contraction of the heart.

Bleeding that is severe enough to critically reduce blood volume is life threatening because tissues will die from lack of oxygen.




External Bleeding

Each type of blood vessel bleeds differently.

Arterial bleeding is rapid and, if severe, is life threatening. The blood is bright red in color.

Venous blood is under less pressure and flows from the wound at a steady rate. The blood is dark red in color.

Capillary bleeding is usually slow because the vessels are small. Blood oozes from the wound.




External Bleeding (continued)

External bleeding occurs when a blood vessel is opened externally, such as a tear in the skin.

Signals of severe external bleeding include—

Blood spurting from the wound.

Bleeding that fails to stop after all measures have been taken to control it.




Care for External Bleeding

Apply direct pressure.

Apply a pressure bandage.

Call 9-1-1 or the local emergency number.

Continue to monitor the airway and breathing.




Closing

Check for severe bleeding while checking life-threatening conditions.

Care for external bleeding includes—

Direct pressure.

Applying a pressure bandage.

Questions?

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Bleeding you cannot see—

Internal Bleeding







Introduction

Internal bleeding is the escape of blood from arteries, veins or capillaries into spaces within the body.

Severe internal bleeding can occur from injuries caused by blunt force or a chronic medical condition.

Internal bleeding can also occur when an object penetrates the skin and damages internal structures.

You should suspect internal bleeding in any serious injury.




Signals of Internal Bleeding

Signals include—

Soft tissues, such as those in the abdomen, that are tender, swollen or hard.

Anxiety or restlessness.

Rapid, weak pulse.

Rapid breathing, shortness of breath.

Skin that feels cool or moist and looks pale, ashen or bluish.

Bruising in the injured area.

Nausea and vomiting or coughing up blood.

Abdominal pain.

Excessive thirst.

A decreasing level of consciousness.

Severe headache.




Care for Internal Bleeding

For minor internal bleeding, such as bruising, apply ice.

If you suspect internal bleeding, call 9-1-1 or the local emergency number immediately.

Follow these general care steps:

Do no further harm.

Monitor signs of life and consciousness.

Help the victim rest comfortably.

Keep the victim from getting chilled or overheated.

Reassure the victim.

Give any specific care needed.




Shock

Shock is a progressive condition in which the circulatory system fails to circulate oxygen-rich blood to all parts of the body.

When the body is unable to meet its demand for oxygen because blood fails to circulate adequately, shock occurs.

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Causes of Shock

Trauma causes shock.

Types of trauma that can cause shock include:

▫ Hemorrhage

▫ Severe pain

▫ Infection

▫ Heart attack

▫ Stroke

▫ Poison

▫ Lack of oxygen

▫ Dehydration

▫ Psychological trauma

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Types of Shock

Anaphylactic Shock

Cardiogenic Shock

Hemorrhagic Shock

Metabolic Shock

Neurogenic Shock

Psychogenic Shock

Respiratory Shock

Septic Shock




Signals of Shock

Without intervention, the body’s failed attempt to compensate for blood loss eventually will result in death.

Signals of shock include—

Restlessness or irritability.

Altered consciousness.

Pale or ashen, bluish, cool or moist skin.

Rapid breathing.

Rapid and weak pulse.

Excessive thirst.

Nausea and vomiting.

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Treating shock

Because shock is such a serious condition, the caregiver should begin treatment immediately.

There are several aims for treating shock, including:

▫ Eliminating or controlling the cause of shock

▫ Improving blood flow

▫ Providing oxygen

▫ Regulating body temperature




Care for Shock

Follow the emergency action steps, CHECK—CALL—CARE, including calling 9-1-1 or the local emergency number.

To care for shock—

Monitor the victim’s breathing and signs of life.

Control any external bleeding.

Elevate the legs about 12 inches to help blood circulate to the vital organs.

Do not elevate the legs—

If the victim is nauseated or having trouble breathing.

If you suspect head, neck or back injuries or possible broken bones.

If moving causes more pain.




Care for Shock (continued)

Do not give the victim anything to eat or drink, even though he or she is likely to be thirsty.

Help the victim maintain normal body temperature by keeping him or her from getting chilled or overheated.




Closing

Internal bleeding is less obvious than external bleeding.

Recognize when a serious injury has occurred, and suspect internal bleeding.

Activate the EMS system immediately, and give care until EMS personnel arrive and take over.

Do not wait for shock to develop before giving care to a victim of injury or sudden illness.

Follow the general care steps for any emergency to minimize the progression of shock.

Questions?

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Soft Tissue Injuries—Open and

Closed Wounds







Introduction

Millions of people suffer disabling injuries each year.

Thousands of lives are lost each year as a result of injuries.

The more common injuries involve the soft tissues of the body.

Two basic types of injuries are—

Soft tissue injury.

Musculoskeletal injury.




Soft Tissue Injuries

Soft tissues include the layers of skin, fat and muscle.

The skin is composed of two primary layers:

Outer (epidermis)

Deep (dermis)

The epidermis provides a barrier to bacteria and other organisms that can cause infection.

The dermis layer contains the—

Nerves.

Hair roots.

Sweat.

Oil glands.

Blood vessels.




Soft Tissue Injuries (continued)

The hypodermis, located beneath the epidermis and dermis, contains—

Fat.

Blood vessels.

Connective tissues.

The muscles lie beneath the fat layer and comprise the largest segment of the body’s soft tissues.

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Wounds

A wound is an injury that damages the body’s tissues.

The two greatest concerns in regards to wounds include excessive bleeding and infection.

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Signs of Infection

Redness

Swelling

Pain

Heat

Fever

Pus

Red streaks coming from the wound




Wounds

Wounds are typically classified as either closed or open.

Closed wound—the soft tissue damage occurs beneath the surface of the skin.

Open wound—has a break in the skin.




Closed Wounds

The simplest closed wound is a bruise, also called a contusion.

Bruises result when the body is subjected to force.




Care for Closed Wounds

To decrease bleeding and to help control pain and swelling—

Apply direct pressure.

Apply ice or a cold pack.




Open Wounds

In an open wound, the break in the skin can be as minor as a scrape of the surface layers or as severe as a deep penetration.

Four common types of open wounds:

Abrasion

Laceration

Avulsion

Puncture




Care for Open Wounds: Dressings and Bandages

All open wounds need some type of covering to help control bleeding and prevent infection.

These coverings are commonly referred to as dressings and bandages.




Dressings and Bandages

A dressing is a pad placed directly over a wound to absorb blood and other body fluids and to prevent infection.

A bandage is any material used to wrap or cover any part of the body.

A bandage applied snugly to create pressure on a wound or an injury is called a pressure bandage.

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Dressings

A dressing is a sterile covering for a wound or injury.

Dressings are used to:

▫stop bleeding

▫prevent infection

▫absorb secretions

▫treat pain

Gauze pads are the most common materials used for dressings. However, in an emergency situation, any clean cloth can be used.

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Bandages

A bandage is material used to secure dressings and splints.

Bandages should be tight enough to control bleeding and to hold a dressing in place. However, they should not interrupt blood circulation.

Three popular types of bandages are:

▫Roller gauze

▫Elastic

▫Triangular




Care for Minor Open Wounds

Follow these general guidelines:

Put on disposable gloves.

Wash the wound thoroughly with soap and water.

Place a sterile dressing over the wound.

Apply direct pressure for a few minutes, usually shallow wounds, producing very little blood.

Remove the dressing, and apply an antibiotic ointment once the bleeding is controlled.

Apply a new sterile dressing.

Wash your hands immediately after giving care.

Can usually be treated at home but if not treated, can become infected.

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Elastic and Roller

Gauze Bandages

Elastic and roller gauze bandages are used to secure dressings and to support injured areas. They can be used on just about any part of the body.

Elastic bandages have the advantage of stretching and

molding to the body part.

Elastic bandages can also pose a disadvantage because their elasticity makes it easy to wrap an injury too tightly.




Dressings and Bandages (continued)

To apply an elastic or

roller gauze bandage—

Check feeling, warmth and color.

Secure the end of the bandage.

Do not cover fingers or toes.

If blood soaks through the dressings, do not remove them. Apply additional dressings and another bandage.




Dressings and Bandages (continued)

Elastic roller bandages are designed to keep continuous pressure on a body part.

If properly applied, an elastic bandage can control swelling or support an injured limb.

If improperly applied, an elastic bandage can restrict blood flow and cause tissue damage if not corrected.

Always check the area above and below the injury site for feeling, warmth and color.

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Triangular

Bandages

The triangular bandage is a triangular shape of cloth. It is often used for:

▫Head and scalp injuries

▫To create slings for shoulder, arm, wrist, and hand injuries

Triangular bandages can also be folded into cravats, which is a long strip of bandage folded to the proper width according to

the injury.

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Slings

A sling is a device used to keep an injured hand, forearm, arm, or shoulder immobilized.

Slings can be used in combination with a cast or used in place of a cast or splint until one can be applied.

Commercial slings are available. However, a sling can be created using a triangular bandage.




Care for Major Open Wounds

To care for a major open wound:

Call 9-1-1 or the local emergency number.


To control external bleeding, use the general steps below:

Cover the wound with a dressing and press firmly against the wound with a gloved hand.

Apply a pressure bandage. If blood soaks through the bandage, do not remove it; add more pads and bandages to help absorb the blood.

Monitor vital signs and watch for signs of shock..




Care for Major Open Wounds (continued)

If the victim has an avulsion in which a body part has been completely severed:


Wrap the severed part in sterile gauze or any clean material.

Place the wrapped part in a plastic bag. Keep the body part cool by placing the bag on ice.

Make sure the severed part is transported with the victim to the medical facility.




Care for Major Open Wounds (continued)

If the victim has an embedded object in the wound—


Do not remove the object.

Use bulky dressings to stabilize the object.

Control bleeding by bandaging the dressing in place around the object.

Wash your hands immediately after giving care.




Closing (continued)

Caring for wounds involves a few simple steps:

Control bleeding.

Minimize the risk of infection.

Always wear disposable gloves or use a barrier, such as plastic wrap, dressings or a clean folded cloth, to avoid contact with blood.

Dressings and bandages, when correctly applied, help control bleeding and minimize the danger of infection.

Questions?

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Procedure for a Circular Bandage

http://www.bing.com/videos/search?q=video+of+applying+a+circular+bandage&FORM=VIRE1#view=detail&mid=69F246C8A9A8EEEF309369F246C8A9A8EEEF3093




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Procedure for a Spiral Wrap Bandage

http://www.bing.com/videos/search?q=video+of+applying+a+circular+bandage&FORM=VIRE1#view=detail&mid=F0A905F1282FBFAC1AFEF0A905F1282FBFAC1AFE





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Procedure for a Figure-Eight Ankle Wrap Bandage

http://www.bing.com/videos/search?q=video+of+applying+a+figure+eight+bandage&FORM=VIRE1#view=detail&mid=E834A43C3099BB6F77AEE834A43C3099BB6F77AE




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Head bandages and slings You may use a triangular bandage as a cravat for a head wound, to elevate

a bleeding wound above the heart or to create a sling for an injured arm, wrist or shoulder.

http://www.bing.com/videos/search?q=video+of+applying+a+triangular+bandage&qs=n&form=QBVR&pq=video+of+applying+a+triangular+bandage&sc=0-19&sp=-1&sk=#view=detail&mid=CC417E52332183CD636FCC417E52332183CD636F







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