Bleeding, Shock, and Wounds

Abdulfattah Alhazmi
[email protected]
 Bleeding
• When a blood vessel or vessels are damaged, bleeding occurs.
• Bleeding can be external, from a cut or wound, or it can be internal,
when the skin isn’t broken but blood vessels inside the body are
damaged.
• There are three different types of external bleeding, depending on
what kind of vessel is damaged.
1. Arterial bleeding
2. Venous bleeding
3. Capillary bleeding
EXTERNAL BLEEDING
• Arterial bleeding- It occurs when
arteries are damaged. Bright red
blood that gushes in a jet with
each heartbeat.
• Venous bleeding- It occurs when
veins are damaged. Dark red
blood loss that may not be as
severe but may bleed steadily.
• Capillary bleeding- It comes
from tiny blood vessels found
throughout the body and
normally causes only slight blood
loss.
 EXTERNAL BLEEDING
• The seriousness of any injury depends on
o Depth of cut,
o Degree of bleeding,
o Duration of bleeding, and
o Type of blood vessels that are damaged.
• The average-sized adult has a little less than ten pints of blood and
can safely lose a pint.
• Any rapid loss of blood in excess of a pint will lead to a dangerous fall
in blood pressure, general weakness, confusion, and sweating, also
known as shock.
EXTERNAL BLEEDING
First Aid for Bleeding
• Try to keep the person as calm as possible, even if it
calls for ordinary conversation.
• Have him lie down and manage for shock if necessary.
• START BLEED

• Notice:
• Apply direct pressure to most bleeding wounds, except
those that are caused by an object such as glass or
those that have protruding bone.
• For wounds with object, press down firmly on either
side of the object, keeping the injured body part above
the level of the heart.
 Controlling Severe External Bleeding
• Arterial bleeding may be life threatening and is often difficult to control.
• The first and most effective method to control bleeding is by applying
direct pressure. To do this, we should:
1. Place a sterile dressing or clean cloth over the injury and secure it with
tape, or tie something around the wound just tight enough to control
the bleeding.
2. If bleeding doesn’t stop, place another dressing over the first or apply
direct pressure over the wound as outlined below.
3. Never remove a dressing once it has been applied to a severe wound.
 Controlling Severe External Bleeding
4. Elevate an injured arm, leg, or head above the level of the heart
to help control the bleeding.
5. Don’t elevate or move an area of the body if broken bone
(fracture) is suspected until splint is applied and it is sure that
movement will cause no further injury.
• When the use of direct pressure and elevation are not controlling the
bleeding, use indirect pressure by applying pressure to the
appropriate pressure point.
• Pressure points are areas where we can control blood flow by
pressing the artery against an underlying bone with our fingers,
thumb, or heel of the hand.
 Controlling Severe External Bleeding
• Use pressure points with caution because extremity may be damaged
due to inadequate blood flow from the nearby pressure.
• Never apply pressure to the neck (carotid) pressure points because it
may reduce or stop circulation to the brain, and can also cause
cardiac arrest.
• The two main pressure points most commonly used are
• Groin, and
• Upper arm
 Controlling Severe External Bleeding
Femoral artery
o Starts in the lower abdomen and goes down into the thigh
o Pressure point is the front, center part of the crease in the groin that supplies
the majority of blood to each leg.
o This artery can be found by locating the pulse on the inner part of the thigh
and pressing it up against the pelvic bone.
The brachial artery
o Found on the upper, inside arm just below the bicep, about halfway between
the shoulder and elbow.
o Apply pressure to the inside of the arm over the bone using your fingers or
thumb.
Controlling Severe External
Bleeding
Tourniquets
• Tourniquets may cause tissue damage and loss
of extremities and are only to be used when
bleeding is uncontrollable by other methods.
• We can use a strap, belt, necktie, towel, or any
piece of cloth folded to about three or more
inches wide and six to seven layers thick.
• Never use anything that may cut into the skin
such as wire or cord.
 Controlling Severe External Bleeding
The steps to apply a Tourniquet are:
1. Position the tourniquet between the heart and the wound while still
maintaining the proper pressure point and allowing two or more
inches of unharmed skin between the tourniquet and wound.
2. Put a pad or roll of gauze over the artery.
3. Wrap the tourniquet twice around the extremity and tie a half-knot
(the first step in tying a shoe lace) on the upper surface.
4. Put an object like a small stick on the half-knot and complete the
knot (square knot).
 Controlling Severe External Bleeding
5. Twist the stick gently to tighten until bleeding has stopped, then secure
the stick.
6. Leave the tourniquet uncovered.
7. Use marker (such as lipstick) to write a “T” on the person’s forehead
indicating that a tourniquet was applied, and the time the tourniquet
was applied.
Caution
• Use a tourniquet to control severe bleeding only as a last resort, and only
use on the extremities.
• Don’t loosen or remove a tourniquet after it has been applied because it
may dislodge clots, resulting in continued blood loss, shock, and death.
 Video to First Aid for Bleeding
• https://youtu.be/NxO5LvgqZe0
 Internal Bleeding/Blunt Trauma
• Internal bleeding is more difficult to detect and to treat.
• Losing blood inside the body may lead to insufficient blood flow to
the tissues and organs, and dangerously low or loss of blood pressure
due to insufficient volume of blood or plasma, called hypovolemic
shock, which will result in death if untreated.
Caution
• “Call medical provider immediately for bleeding from any body
opening such as the mouth, ears, nose, or rectum because it is a sign
of internal bleeding that is a serious condition requiring urgent
medical care”.
 Internal Bleeding/Blunt Trauma
• Internal bleeding can be the result of
o Motor-vehicle accidents and domestic violence, causing internal trauma and
fractures;
o Bleeding duodenal or gastric ulcers;
o Brain hemorrhage; and
o Ectopic pregnancy (pregnancy occurring outside the uterus that is life threatening
and requires immediate medical attention).
• Severe internal bleeding is usually caused by
o Blunt trauma,
o Violent force such as in motor-vehicle accidents, or
o Puncture wounds such as knife or gunshot wounds
• Whenever signs of shock are present, you must suspect internal bleeding.
 Internal Bleeding/Blunt Trauma
Common signs of internal bleeding
Bruises (contusions), may indicate deeper damage Any bruising or discoloration at the area of injury
Anxiety and restlessness Blood in the stool, or stool that appears black & tarlike
Excessive thirst Blood in the urine
Nausea and vomiting Swelling, distended (bloated) abdomen
Rapid breathing (tachypnea) Vomiting dark red (resembling coffee grounds)
Cold and clammy skin Decreased level of consciousness
Pale ashen or bluish skin Severe headache
A rapid, weak pulse (tachycardia)
 First Aid for Internal Bleeding
Use the following steps to treat internal bleeding:
1. Apply a cold pack or ice pack covered with a cloth to bruises in order to reduce pain and
swelling.
2. Call for help and place the injured person with legs elevated if there is no chest injury.
3. In a case of chest injury, elevate the head and torso and keep the person warm until
help arrives.
4. Manage shock as discussed.
5. Don’t allow the person to eat or drink or take any medication unless you are advised to
do so by a doctor.
Caution
• “Examine the injured person for bruises, grazes, or discoloration in the chest area,
markings from a seat belt, chest pain, and difficulty breathing; these may be signs of
internal bleeding, so you need to be alert, as you may need to manage for shock”.
• The Golden Hour refers to the first sixty
minutes after severe trauma, when it’s
thought that the injured person’s chances
of survival are greatest if he or she
receives emergency care and necessary
surgery.

“Golden Hour” for Severe Trauma

 Shock
• Preventing and managing shock is a matter of life and death in
emergencies.
• When the circulatory system stops working to deliver blood to the body,
shock occurs.
• If the heart beats irregularly, if blood vessels become too dilated, or if a
person is losing too much blood, shock may occur.
• The symptoms of shock are a weak and rapid pulse; disorientation;
dizziness or confusion; cold, clammy skin and hands and pale skin; extreme
thirst; nausea and vomiting; high level of anxiety; and fingernails that do
not blanch with applied pressure (turn white when pressed and color does
not return within two seconds).
 Call for help immediately,
because shock cannot be
managed alone for long, Begin CPR if needed
and the person is likely to
go into cardiac arrest.

If the head, neck, back,

hips, or legs are not Use a towel, a sanitary
injured, lay the person on napkin, or a piece of
Shock the ground facing up and
elevate the legs to keep
critical blood flow to vital
clothing to apply
pressure to open wounds
to slow bleeding.
organs.

Keep the person calm,

comfortable, and warm,
Monitor the person until
but never give the person
help arrives.
water, even if they claim
to be very thirsty.
Shock
 Wounds
• A wound is a type of injury in which skin is torn, cut, or punctured (an
open wound), or where blunt force trauma causes a contusion (a
closed wound).
 Classification
According to level of contamination, a wound can be classified as:
• Clean wound – made under sterile conditions where there are no organisms
present, and the skin is likely to heal without complications.
• Contaminated wound – usually resulting from accidental injury; there are
pathogenic organisms and foreign bodies in the wound.
• Infected wound – the wound has pathogenic organisms present and multiplying,
exhibiting clinical signs of infection (yellow appearance, soreness, redness, oozing
pus).
• Colonized wound – a chronic situation, containing pathogenic organisms, difficult to
heal (i.e. bedsore).
 Classification
Based on breakage of first anatomical barrier (Skin), a wound can be
classified into following two types
• Open wound
• Close wound
 Incision Wound

Open Wound

Open wounds can be classified according to

the object that caused the wound:

1. Incisions or incised wounds– Caused by a

clean, sharp-edged object such as a knife,
razor, or glass splinter.
Laceration
2. Lacerations– Irregular tear-like wounds
caused by some blunt trauma. Severe
lacerations may extend through the full
thickness of the skin and into
subcutaneous tissues, including underlying
muscle, internal organs, or bone.
 Open Wound
3. Abrasions (grazes) – Superficial wounds
in which the topmost layer of the skin
(the epidermis) is scraped off. Abrasions
are often caused by a sliding fall onto a
rough surface.
4. Avulsions – Injuries in which a body Abrasion Puncture
structure is forcibly detached from its
normal point of insertion. A type of
amputation where the extremity is
pulled off rather than cut off.
5. Puncture wounds – Caused by an object
puncturing the skin, such as a splinter,
nail or needle. Usually don’t bleed a lot,
but can cause internal injury.
Avulsion
 Open Wound

6. Penetration wounds– caused by an

object such as a knife entering and
coming out from the skin.

7. Gunshot wounds– caused by a

bullet or similar projectile driving
into or through the body. There
may be two wounds, one at the
site of entry and one at the site of Penetrating wound Gun shot wound
exit, generally referred to as a
"through-and-through."
 First Aid for abrasions
Keep the area around the wound clean and change any dirty
Keep
dressings promptly.

Remove any debris such as dirt, fiber, and rocks from an

Remove
abrasion before cleaning it.

Use tweezers to remove small objects, and a nonalcoholic

Use
wipe to gently clean off the wound, wiping in one direction.

Wash the wound with soap and water, apply an antibiotic

Wash
cream, and cover with a clean dressing.

Dress the wound with a sterile gauze, preferably nonstick,

Dress
bandage to protect the wound from infection
 First Aid for simple cuts and abrasions
• Change most dressings daily and replace dressings when any fluids
soak through, to decrease any chance that the wound will dry and
stick to the dressing.
• Cleaning open wounds can sometimes cause bleeding, which can be
easily stopped with direct pressure using a sterile gauze pad.
Caution
Never dress a wound with obvious
contamination. If you aren’t able to get it
clean, then cover it lightly with a sterile
bandage and seek medical attention.
First Aid for Deeper Cuts (lacerations)
In the case of lacerations that are deep enough to see
fatty tissue:
• Pull the edges of the wound together and use butterfly
closures to secure them.
• Apply antiseptic or antibiotic ointment over butterfly
closures, cover with a bandage, and seek medical
attention.
Caution

Never wash deep cuts, because it may increase the rate of

bleeding. Don’t remove blood-stained dressings from deep
cuts, as this may restart bleeding. Instead, reinforce the old
dressings by putting additional dressings on top until the
bleeding stops.
 First Aid for Puncture Wounds

Always Wash hands with soap and water and wear gloves.
assume
that a
Clean the wound under a stream of running water, using
puncture soap followed by povidone-iodine.
wound is
dirty. Bandage loosely and monitor the wound daily for signs of
infection such as increased swelling, redness, or
discharge.
 First Aid for Puncture Wounds

Caution
• Never seal the puncture wound and do not use antibiotic ointments because
sealing the wound may actually increase the chance of infection.
• Don’t attempt to clean a major puncture wound as this may cause more
serious bleeding.
• Never try to remove an imbedded object from a puncture wound.
Depending on where the wound is located, this can cause further damage,
bleeding, and even immediate death.
• Never remove debris from a wound, attempt to push body parts back in, or
breathe on a wound or dressing because doing so may cause serious
infection later.
 First Aid for Accidental Tooth Loss

A knocked-out or partially Handle the tooth with a

Adults should hold the tooth
dislodged tooth can usually be sterile gauze or pad and rinse
in place with clean gauze, do
reinserted in the socket it with water if it has become
not to touch the root of the
within thirty minutes of an very dirty, but it is best not to
tooth.
injury. clean a dislodged tooth.

If not able to hold the tooth in

place for any reason or cannot
reach a dentist or emergency For an empty bleeding socket,
Maintain this pressure for
room within thirty minutes, place a fold of sterile gauze or
twenty minutes or until
the tooth may be placed in a pad over the socket and bite
bleeding stops.
container with fresh whole down on it.
milk or the person’s own
saliva for transport.
 First Aid for Accidental Tooth Loss
Caution
• If a child loses a tooth due to
accident or injury, do not try to
reinsert the tooth.

• A child may not hold the tooth in

properly or may accidentally
swallow it.

• Instead, place the tooth in whole

(not powdered or skim) milk to
keep the tooth alive until a dentist
can reinsert it.
 First Aid for Ear Injury

Ear injuries are typically accompanied by pain, dizziness,

hearing loss, and bleeding from inside the ear canal. Take
the following steps to treat an ear injury:
• Cover the outside of the ear loosely with a bandage or dressing to soak
up blood and drainage, but do not attempt to plug the ear or try to stop
any flow.
• Place the person on the injured side with the injured ear facing down to
drain the blood, and call for help or go to an emergency department
immediately.
 Closed Wounds
Closed wounds have fewer categories, but are just as dangerous as
open wounds:
• Hematomas (or blood tumor) – caused by damage to a blood vessel
that in turn causes blood to collect under the skin.
• Hematomas that originate from internal blood vessel pathology are
petechiae, purpura, and ecchymosis. The different classifications are based on
size.
• Hematomas that originate from an external source of trauma are contusions,
also commonly called bruises.
• Crush injury – caused by a great or extreme amount of force applied
over a long period of time.
 First Aid for Closed Wounds
Goal of treatment is to control the pain, and keep the bleeding and inflammation to a
minimum. Following steps are followed:
Elevation of affected Immobilization of the
Apply ice packs Compression
limb affected limb or area

Note: Topical antibiotic ointment may be applied locally to wounds in cases of associated
skin lacerations and abrasions
Thanks