Chapter 24
Bleeding
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List the structure and function of the circulatory system.
Differentiate between arterial, venous, and capillary bleeding.
State methods of emergency medical care of external bleeding.
Establish the relationship between BSI and the trauma patient.
• Establish the relationship between airway management and the
trauma patient.
• Establish relationship between MOI and internal bleeding.
• List signs of internal bleeding.
• List the steps in the care of the patient with signs and symptoms
of internal bleeding.
Cardiovascular System
The Heart
Blood Vessels 1 of 2
• Arteries
– Carry oxygenated blood away from the heart
• Arterioles
– Smaller arteries that connect to capillaries
• Capillaries
– Small blood vessels where actual gas exchange takes place
Blood Vessels
2 of 2
• Venules
– Smaller veins that connect capillaries to veins
• Veins
– Carry deoxygenated blood to the heart
Perfusion
• Circulation within tissues in adequate amounts to meet the cells’
needs for oxygen, nutrients, and waste removal
• Failure of the body to provide adequate circulation to all body is
known as hypoperfusion or shock.
Priority Demand for Oxygen
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The heart (circulatory system)
The brain (nervous system)
The lungs (respiratory system)
The kidneys
External Bleeding
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Hemorrhage = bleeding
Body cannot tolerate greater than 20% blood loss.
The average adult male has about 6 L of blood.
Blood loss of 1 L can be dangerous in adults; in pediatrics, loss
of 100-200 ml is serious.
Conditions with Possible
Serious Bleeding
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Significant mechanism of injury
Poor general appearance of patient
Assessment reveals signs of shock
Significant amount of blood loss noted
You cannot control external bleeding.
Characteristics of Bleeding
• Arterial
– Blood is bright red and spurts.
• Venous
– Blood is dark red and does not spurt.
• Capillary
– Blood oozes out and is controlled easily.
Controlling External Bleeding
Direct Pressure and Elevation
• Direct pressure is the most common and effective way to control
bleeding.
• Elevation controls bleeding.
• Wrap a pressure dressing around the wound once bleeding is
controlled.
• If bleeding continues, apply additional dressings on top.
Controlling External Bleeding
Pressure Points
• If bleeding continues, apply pressure on pressure point.
• Pressure at proximal pulse point greatly slows down circulation
to extremity.
• The brachial artery and femoral artery are the two most common
pressure points used.
Controlling External Bleeding
Pressure Points
Controlling External Bleeding
Splints
• Splints can help control bleeding associated with a fracture.
• Air splints can be used to control bleeding of soft tissue injuries.
• If a fracture is suspected, be careful not to aggravate the injury.
Controlling External Bleeding
Pneumatic Antishock Garment (PASG)
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Stabilizes fractures of the pelvis and femurs
Controls blood loss associated with pelvis and femur fractures
Controls massive bleeding of the lower extremities
Controls shock due to internal bleeding
Controlling External Bleeding
PASG Contraindications
• Pregnancy (do not inflate abdomen)
• COPD & CHF patients (fluid in the lungs)
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Penetrating chest injuries
Groin injuries
Major head injuries
Less than 30 minute transport time
Controlling External Bleeding
Application of PSAG
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Apply the garment so the top is below the last rib.
Enclose both legs and the abdomen.
Open the stopcocks.
Inflate with the foot pump.
Check patient’s vital signs.
Controlling External Bleeding
Applying a Tourniquet
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Fold a triangular bandage into 4” cravat.
Wrap the bandage.
Use a stick as a handle to twist and secure.
Write “TK” and time and place on patient.
Controlling a Nosebleed
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Follow BSI techniques.
Help the patient sit and lean forward.
Apply direct pressure by pinching the patient’s nostrils.
Place a piece of gauze bandage under the patient’s upper lip and
press.
• Apply ice over the nose.
• Provide transport.
Internal Bleeding
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Hematemesis: Blood in vomit
Melena: Black, tarry stool
Hemoptysis: Coughing up blood
Pain, tenderness, bruising, or swelling
Broken ribs, bruises over the chest, distended abdomen
Signs of Hypoperfusion
• Tachycardia
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Weakness
Thirst
Nausea and vomiting
Cold, moist skin
Shallow, rapid breathing
Dull eyes
Dilated pupils
Decreased blood pressure
Altered level of consciousness
Emergency Medical Care
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Follow BSI techniques.
Maintain airway and administer oxygen.
Control external bleeding and care for any internal bleeding.
Monitor and record vital signs.
Elevate legs and keep patient warm.
Transport immediately to hospital.