Control of Bleeding
Bleeding can be a life-threatening injury, depending one where the wound is, which blood vessel has been cut as well as the size of the casualty. It is important that a first aider assesses and manages the casualty’s bleed as soon as is possible.
How much blood have we got?
The quantity of blood in the human body is always a contentious question on our courses, as our learners all have various ideas as to what the level of blood in the body is. In this month’s article we want to dispel any myths and misconceptions on the blood in the human body.
The simple answer to ‘how many pints of blood are in the human body?’ is that blood volume varies with our size. It is therefore to remember that a child has less blood than an adult. The rule of thumb to remember is that there is 1 pint of blood for every stone in the body up to a maximum of 10 pints. This therefore does not work for people who are overweight.
Is blood loss critical?
As we alluded to earlier, blood loss can be a life-threatening condition. When the body loses blood, it will instinctively compensate for the loss of blood. The first thing the body will do is close the supply of blood to the non-emergency systems of the body for example the digestive system. The second thing that the body will do is to speed up the heart in order to maintain blood pressure.
The problem is that there is only so far that the body can go. And therefore, once you have lost one third of the blood that you started off with the body can no longer compensate. This means that the beyond this point the blood pressure will fall quickly and the brain will be starved of oxygen.
How do we lose blood?
There are 3 types of bleeding, depending on whether it is an:
- Vein, or
- Capillary bleed.
The correct term for a bleed that is coming form the artery is an ‘arterial’ bleed. This type of bleed is under direct pressure from the heart pumping and will spurt out of the body in time with the heartbeat. This is a rapid blood loss wound, and it can become life-threatening in as little as 2 to 3 minutes. One of the additional issues with an arterial bleed is that the blood in an artery is full of oxygen, meaning that the body is losing oxygen as well as blood. It may be difficult to assess the colour of the blood that is bleeding out, but if you are able to it will be bright red. It is easier for a First Aider to assess how the blood is exiting the body rather than the colour!
In contrast to the Artery, a vein is not under pressure from the heart, they do however carry the same volume of blood as an artery does. A bleed from a vein is called a Venous bleed. This type of bleed will flow profusely and can be life-threatening. The fact that a venous bleed is a life-threatening bleed comes as a surprise to some people as they believe it is not as risky as an arterial bleed, the reasoning being that it isn’t under the same pressure as the artery.
The capillaries are the small blood vessels in the human body, they generally go to places that bigger arteries and veins cannot get to. It is fair to say that bleeding from the capillary occurs in all wounds, however the flow may look fast at first the blood lost is usually slight and easily controlled. The bleed from a capillary is described as a trickle of blood.
What types of wounds are there?
On our First Aid courses we introduce our learners to the Mnemonic ‘CLIPAG AD.’ This is an easy Mnemonic to remember the types of wounds that you may face as a first aider. So, what does this Mnemonic mean?
- C – Contusion,
- L – Laceration,
- I – Incision,
- P – Puncture,
- A – Abrasion,
- G – Gunshot,
- A – Amputation,
- D – De-Glove.
A contusion is a region of injured tissue or skin in which blood vessels have been ruptured, it is more commonly known as a bruise.
The main aim when treating this type of wound is to reduce swelling. The best way to do this is to wrap an ice pack in a tea towel and place on the affected area for 10 minutes, whilst applying pressure. Not got an ice pack? Cold running water will also help!
A laceration is a deep cut or tear in the skin or flesh.
When treating a laceration, dampen the pad of the wound dressing before applying to the skin, to avoid the flap of skin caused by the laceration sticking to the pad. Then it is important to wrap the bandage as you would for other injuries.
An incision is described as a surgical cut made in skin of flesh, it is a straight cut and therefore caused by a straight object.
The puncture wound is described as a small hole in something such as the skin, caused by a sharp object.
Providing the object that has caused the wound is no longer in the body it is safe to wrap and bandage the injury. However, if the offending object has been embedded in the wound then it should not be removed. This object may be stemming bleeding, or the removal may cause more damage.
The correct treatment would be to use sterile dressings and bandages to ‘build up’ around the embedded object. This will provide pressure around the wound and support the object, you should then send your casualty to hospital for removal of the object.
The abrasion wound is an area damaged by scraping or wearing away.
It is Important that you thoroughly irrigate the abrasion with copious quantities of drinkable water until there is no foreign matter in the wound. If the casualty is bleeding from the wound this is ok and could wash out germs. You will need to pat the area dry and then cover with a sterile plaster or bandage.
A gunshot is a wound that has been caused by the bullet of a gun OR any high velocity object going through the body.
You will need to be aware of a small entry wound as well as the possibility of a larger exit wound. These wounds will need to be dressed to control any external bleeding. You will need to be aware of the possibility of internal injuries, however you will not be able to treat these, but will be useful to pass on the information to the paramedics.
The dictionary definition of the word amputation is the action of surgically cutting off a limb. In a first aid situation the limb would not be amputated in a surgical way.
The correct treatment for an amputated wound is to use a ‘tourniquet’ The tourniquet is a band that is tightened around a limb to stop blood flow. Complications can occur if tourniquets are not applied correctly, therefore training is essential to ensure safe and effective application.
A De-glove or De-gloving wound, also called avulsion, is a type of severe injury that happens when the top layers of your skin and tissue are ripped from the underlying muscle, connective tissue, or bone.
If you are able to you should pull the skin back in place and arrange urgent transport to hospital.
What is the treatment for bleeding?
For all types of bleeding there are 4 simple steps that should be taken in order to treat your casualty who is losing blood.
These steps are:
Sit or lay
Depending on the location of the wound and the extent of the bleeding, sit or lay your casualty down.
It is important that you quickly identify the type of bleeding that you are seeing, as well as identifying if there is anything inside the wound, and the exact point of bleeding so that you sure you are applying pressure to the right spot.
You should apply pressure to the casualty’s wound continuously for 10 minutes. It is possible that you may need to press into the wound to help stop the bleeding. A deep wound may need packing, (We can train you on how to do this!). Remember to only apply pressure around an embedded object and not over the object, which could end up injuring you as well as the casualty further.
Any dressing that you use should be sterile and just large enough to cover the wound. The bandage selected should be absorbent and have a surface ideally that wont stick to clotting blood. Once applied the dressing should not restrict blood flow to rest of the limb, the best way to check this is to do a capillary refill check.
We hope that this month’s exploration of blood and wounds have been useful,
Remember that there is no substitute for actual training,
The majority of our courses include the Control of Bleeding module as standard.
Why not get in touch today and book a course?