Bleeding and wounds
Dr.Sawsan Mustafa Abdalla
Basic Trauma
First thing first
► Remember
ABC
► Airway
 If you stop moving air, nothing else matters.
► Breathing
 Stop breathing and it does not matter how
much you bleed. You still die very quickly.
► Circulation
 You need blood and a functioning heart for this.
Management of bleeding
► Stop
the bleeding and
protect the wound.
 If you remember this,
that’s pretty much all
you need to know.
► You
may be called
upon your skills for
yourself or anyone
else.
Stop, Think, then Do!
► Remember
to keep
your cool!
► Medical injuries can be
really ugly looking.
► Even the worst looking
injuries can be
survived.
► Don’t let the patient
see you lose your cool.
Bleeding and shock
► Shock
 Inadequate perfusion
(blood flow) leading to
inadequate oxygen
delivery to tissues
► Most
common cause
of shock in the
tactical environment
is BLEEDING!
Perfusion
► Basic
unit of life = cell
► Cells get energy needed to stay alive by
reacting oxygen with fuel (usually glucose)
► No oxygen, no energy
► No energy, no life
Perfusion
► Cardiovascular
System
 Transports oxygen, fuel to
cells
 Removes carbon dioxide,
waste products for
elimination from body
Cardiovascular system must be able to
maintain sufficient flow through
capillary beds to meet cell’s oxygen and
fuel needs
Flow = Perfusion
Adequate Flow =
Adequate Perfusion
Inadequate Flow =
Indequate Perfusion
(Hypoperfusion)
Hypoperfusion =
Shock
Basic Plumbing
► Pump
► Pipes
► Fluid
► Any
Heart
Blood Vessels
Blood
interruption leads
to low blood flow
(hypoperfusion) and
shock.
Bleeding
► Bleeding
(hemorrhage) is the escape of blood
from capillaries, veins, and arteries.
► Capillaries are very small blood vessels that carry
blood to all parts of the body.
► Veins are blood vessels that carry blood to the
heart.
► Arteries are large blood vessels that carry blood
away from the heart.
► Bleeding can occur inside the body (internal),
outside the body (external) or both.
Bleeding
► There
are three types of bleeding.
 Capillary bleeding is slow, the blood "oozes"
from the (wound) cut.
 Venous bleeding is dark red or maroon, the
blood flows in a steady stream.
 Arterial bleeding is bright red, the blood
"spurts" from the wound.
► Arterial
bleeding is life threatening and
difficult to control.
Small wounds
► In
small wounds, only the capillaries are
damaged.
► Deeper wounds result in damage to the
veins and arteries.
► Damage to the capillaries is usually not
serious and can easily be controlled with a
Band-Aid.
► Damage to the veins and arteries are more
serious and can be life threatening.
Larger Wounds
► The
adult body contains approximately 5 to 6
quarts of blood (10 to 12 pints).
► The body can normally lose 1 pint of blood (usual
amount given by donors) without harmful effects.
► A loss of 2 pints may cause shock, a loss of 5 to 6
pints usually results in death.
► During certain situations it will be difficult to
decide whether the bleeding is arterial or venous.
The distinction is not important.
► The most important thing to remember is that all
bleeding must be controlled as soon as possible.
External Wounds
► While
administering first aid to a casualty who is
bleeding, you must remain calm.
► The sight of blood is an emotional event for many,
and it often appears severe.
► However, most bleeding is less severe than it
appears.
► Most of the major arteries are deep and well
protected by tissue and bone.
► Although bleeding can be fatal, you will usually
have enough time to think and act calmly.
Take Control
► There




are four methods to control bleeding:
Direct pressure
Elevation
Indirect pressure
Use of a tourniquet.
Direct pressure
► Direct
pressure is the first and most
effective method to control bleeding.
► In many cases, bleeding can be controlled
by applying pressure directly to the wound.
► Direct pressure can be applied by the
casualty or a bystander.
► Under no circumstances is a dressing
removed once it has been applied.
Indirect pressure
► In
cases of severe bleeding when direct pressure
and elevation are not controlling the bleeding,
indirect pressure must be used.
► Bleeding from an artery can be controlled by
applying pressure to the appropriate pressure
point.
► Pressure points are areas of the body where the
blood flow can be controlled by pressing the artery
against an underlying bone.
► Pressure is applied with the fingers, thumb, or
heel of the hand.
Signs of internal bleeding
► 1.
Anxiety and restlessness.
► 2. Excessive thirst (polydipsia).
► 3. Nausea and vomiting.
► 4. Cool, moist, and pale skin (cold and clammy).
► 5. Rapid breathing (tachypnea).
► 6. Rapid, weak pulse (tachycardia).
► 7. Bruising or discoloration at site of injury
(contusion).
Basic wound care
► In
evaluating the casualty for location, type, and
size of the wound or injury, cut or tear his clothing
and carefully expose the entire area of the wound.
 This procedure is necessary to avoid further
contamination.
 Clothing stuck to the wound should be left in place to
avoid further injury.
 DO NOT touch the wound; keep it as clean as possible.
► DO
NOT REMOVE protective clothing in a chemical
environment.
 Apply dressings over the protective clothing.
Basic Penetrating Trauma
► Before
applying the
dressing, carefully
examine the casualty
to determine if there is
more than one wound.
► A missile may have
entered at one point
and exited at another
point.
► The EXIT wound is
usually LARGER than
the entrance wound.
Basic Penetrating Trauma
► Casualty
should be continually monitored for
development of conditions which may
require the performance of necessary basic
lifesaving measures, such as clearing the
airway and mouth-to-mouth resuscitation.
► All open (or penetrating) wounds should be
checked for a point of entry and exit and
treated accordingly.
Basic Penetrating Trauma
Basic Penetrating Trauma
►
►
►
►
►
If the missile lodges in the body
(fails to exit), DO NOT attempt to
remove it or probe
the wound.
Apply a dressing.
If there is an object extending from
(impaled in) the wound, DO NOT
remove the object.
Apply a dressing around the object
and use additional improvised bulky
materials/dressings (use the
cleanest material available) to
build up the area around the object.
Apply a supporting bandage over
the bulky materials to hold them in
place.
Battlefield dressing
► DO
NOT touch the
white (sterile) side of
the dressing, and DO
NOT allow the white
(sterile) side of the
dressing to come in
contact with any
surface other than the
wound.
Battlefield dressing
► Hold
the dressing
directly over the
wound with the white
side down.
► Pull the dressing open
and place it directly
over the wound
Battlefield dressing
►
►
►
►
Hold the dressing in place
with one hand.
Use the other hand to
wrap one of the tails
around the injured part,
covering about one-half of
the dressing.
Leave enough of the tail
for a knot.
If the casualty is able, he
may assist by holding the
dressing in place.
Battlefield dressing
►
►
►
If bleeding continues after
applying the sterile field
dressing, direct manual
pressure may be used to
help control bleeding.
Apply such pressure by
placing a hand on the
dressing and exerting firm
pressure for 5 to 10
minutes.
The casualty may be asked
to do this himself if he is
conscious and can follow
instructions.
Battlefield dressing
►
►
►
►
Elevate an injured limb
slightly above the level of
the heart to reduce the
bleeding.
DO NOT elevate a
suspected fractured limb
unless it has been properly
splinted.
If the bleeding stops,
check and treat for shock.
If the bleeding continues,
apply a pressure dressing.
Your Battlefield dressing
► The
Israeli dressing
► One dressing does it
all
 Simple dressing
 Pressure dressing
 Tourniquet
Your Dressing
►
►
►
The sterile, non-adherent pad is placed on the wound.
The application of direct pressure to the wound site is
achieved by wrapping the elasticized woven leader over
the topside of the bandage pad where the specially
designed pressure bar is situated. The pressure bar is
designed to readily accept the wrapping leader.
After engagement of the pressure bar, wrapping the
leader in any direction around the limb or body part and
onto the pressure bar forces the pressure bar down
onto the pad creating the direct pressure needed to bring
about homeostasis.
Your Dressing
► The
pressure bar, in addition to its primary
function, facilitates bandaging. The elastic
bandage uses the rigid shape of the pressure bar
to change direction while bandaging, thus
affording the caregiver more options for effective
dressing of the wound.
► Subsequent wrappings of the leader secures and
maintains the pad in place over the wound, and
by covering all the edges of the pad acts as a
sterile secondary dressing. The bandage leader
is woven wide and will not bunch up or twist itself
into a rope.
Your Dressing
► The
closure system of the bandage is multifunctional yet simple, quick, and
familiar. Situated at the end of the leader
is a closure bar (dowel with hooking clips)
at each end to secure the wrapping leader
the same way that a pen is secured in a
shirt pocket. The closure bar holds the
bandage securely in place over the wound
site.
Your Dressing
► If
additional pressure is required the
closure bar is easily removed from its
normal closure position and inserted
between previous layers of the leader
directly above the protruding pressure bar
and rotated. This rotation acts to screw
down the pressure bar onto the wound to
exert blood-staunching pressure. The
closure bar is used as before to secure the
dressing
Your Dressing
►
Immediate and effective
direct pressure to the
wound may reduce the
need for a tourniquet
application. This is an
important benefit as
tourniquet applications
are to be avoided and
used only as a last
resort.
Thanks for your attention.