P.R.I.IN.

PEOPLE READINESS IN (FIRST AID)

INTERVENTION

MODULE 4 – Bleeding
After completion of this module, the participants shall be able to:

1. Understand basic anatomy of circulatory system;

2. Recognize signs of external bleeding;
3. Distinguish types of external bleeding;
4. Understand and apply basic principles to control external bleeding;
5. Understand principles of assistance in internal bleeding and crush
injury;
6. Understand and apply basic skills to manage wounds;
7. Understand and apply <C>ABC protocol for bleeding and wounds.

Objective
 HEART – “main pump” of body, 4
chambers push blood through
vessels.
 ARTERIES – deliver blood FROM
the heart to all organs.
 VEINS – collect blood FROM all
organs and deliver it to heart.
 CAPILLARIES – smallest vessels,
facilitate exchange of O2/CO2 in
organs.

Circulatory system is a closed

circuit, filled with BLOOD.

Anatomy of Circulatory System

 Minor (Pulmonary) Cycle – poor in O2
blood is collected from the entire body
and flown to right part of heart and then
to LUNGS. Gases exchange in lungs –
O2 into blood stream – CO2 into
ambient air.

 Major (Systemic) Cycle – rich in O2

blood delivered from lungs to LEFT
part of HEART and from left HEART –
to the entire body.

Anatomy of Circulatory System

 Blood is a liquid tissue of the body.
 It has ability to make clots to prevent or reduce blood leak from damaged
vessels.
 Clot formation is a complex reaction of body to injury and damaged walls
of vessels

Anatomy of Circulatory System

 BLEEDING is blood loss from damaged vessels.
 Sometimes you can see blood running from the wound – external
bleeding.
 Blood can leak into the body cavities (stomach), other tissues
(muscles, brain tissue) and cannot be seen right away – internal
bleeding. It can be difficult to recognize internal bleeding.
 Bleeding can often be dangerous and threatens life with deadly blood
loss.
 Damaged skin (wounds) enable germs to enter body – contamination
of wounds.

What is Bleeding?
 Capillary Bleeding  Venous Bleeding  Arterial Bleeding

Types of Bleeding
Capillary bleeding

 Occurs when small

vessels are
damaged – skin
abrasions.
 Rarely threatens
life.

Capillary Bleeding
Venous bleeding
 Looks like dark red
constantly oozing
river of blood.
 MIGHT THREATEN
LIFE!!!
 REQUIRES
IMMEDIATE
ASSISTANCE!

Venous Bleeding
Arterial bleeding
 Looks like fountain
of blood bright red
in colour, coming
in spurts with each
heart-beat.
 ALWAYS
THREATENS
LIFE!!!
 REQUIRES
IMMEDIATE
ASSISTANCE!

Arterial Bleeding
 Before you attempt to control bleeding –
always remember about BLOOD BORN
INFECTIONS!
 Protect yourself from blood – have PPE
on!
 Take care of your hands hygiene – wash
your hands before dealing with wounds.
 If patient responsive – have him seated
or lay him flat on his back.
 Remember, ABC principles are
applicable for severe bleeding!

First Aid in Bleeding

  Do not touch wounds with
unprotected hands!

 Wounds are gates for various

infections.

 Use gloves and protect yourself

and the patient.

 If gloves are not available – use

clean single use plastic packs

First Aid in Bleeding-Wound Management

 Sterile surface comes  Bandage is attached
into contact with to the back side of
wound – DO NOT
touch it! the sterile pad.

First Aid in Bleeding-Wound Management

  If there are NO embedded
foreign objects in wound
– APPLY DIRECT
PRESSURE through
sterile bandage. Use non-
fluffy material to cover
bleeding wound.
 You can ask patient to
assist you to apply
DIRECT PRESSURE.

First Aid in Bleeding-Direct Pressure

  Have patient seated or let him lay down.

 If there are NO embedded foreign objects

in wound – APPLY DIRECT PRESSURE
on wound.

First Aid in Bleeding-Direct Pressure

  If bleeding is from large vessels –
apply pressure with your BOTH
HANDS to control bleeding

First Aid in Bleeding-Direct Pressure

  If applying direct pressure does
not stop the bleeding, ELEVATE
the bleeding extremity.

First Aid in Bleeding-Elevation

 Handle limb gently if you  ELEVATE (raise) injured limb above the
suspect that there is a fracture level of casualty’s heart to reduce
blood flow → reduce blood loss.

First Aid in Bleeding-Elevation

 Once the bleeding stops, the
wound shall be covered and
dressed.

 Cover wound with sterile

dressing. Dressing pad
should be larger than the
wound.

 Apply bandage with enough

pressure, but not too tight
not to impair circulation.

First Aid in Bleeding-Wound Dressing

  If the first dressing becomes
soaked with blood – DO NOT
remove it – apply another
dressing over the soaked
one.

 Attempts to remove the first

dressing might worsen
bleeding

First Aid in Bleeding-Wound Dressing

  If there is FOREIGN BODY
inside the wound – DO NOT
ATTEMPT TO REMOVE IT!
 Build up PADDING on
either side of the object.
 Carefully bandage around
the object – DO NOT
PRESS on it.

First Aid in Bleeding-Embedded Object

  DO NOT APPLY DIRECT
PRESSURE on wound with
embedded object –
pressure must be applied
around object – on the
edge of wound.

 Do not press over the

object in the wound –
secure it with pads

First Aid in Bleeding-Embedded Object

  If bleeding control is not effective –
apply TOURNIQUET.

 You can use commercial or

improvised tourniquet.

 Improvised tourniquet might be

done of triangular bandage, sleeve
of coverall, waist belt, etc.

First Aid in Bleeding-Tourniquet

 Tourniquet is used as a last resort if direct pressure and elevation
control measures are not effective to control bleeding.
 Should be applied 2 fingers (~4-5 cm) above the wound edge.
 Tighten it until bleeding stops and secure it on the limb.
 WRITE date and time when it was applied.
 DO NOT COVER tourniquet with dressing – it MUST BE VISIBLE
always!
 Reassess ABC every 1-2 minutes.
 Quick transportation to hospital. Inform receiving personnel when
the tourniquet was applied.
 Report tourniquet to medical personnel

First Aid in Bleeding-Tourniquet

  Triangular bandage might be used
Base as improvised tourniquet to control
bleeding

Point End

First Aid in Bleeding-Triangular Bandage

  Fold triangular bandage to make a
stripe of 4 – 5 cm width

First Aid in Bleeding-Triangular Bandage

Apply it 2 – 3 fingers above the edge of the
wound and tighten the bandage.

 Tighten the first knot

First Aid in Bleeding-Triangular Bandage

 Use pen / pencil / wooden stick as a valve. Tighten second knot to fix the pen.

First Aid in Bleeding-Triangular Bandage

 Rotate “valve” to tighten it  Fix it on extremity. Do not cover it with dress.
until bleeding stops. Write date and time when bandage was applied.

First Aid in Bleeding-Triangular Bandage

 If there is a penetrating wound to chest or stomach – DO NOT
REMOVE object from the wound!!!
 DO NOT APPLY PRESSURE on object!!!
 SECURE it inside the wound with pads and apply dressing AROUND
object.
 RAPID TRANSPORTATION of casualty to hospital – you CANNOT
control internal bleeding.
 Always remember ABC!!!
 DO NOT give anything by mouth.

First Aid in Bleeding-Penetrating Wound

 Follows major injuries.

 It is difficult to recognize it.

 You CANNOT control it.

 Always remember ABC!

 Quick transportation of patient to hospital!

First Aid in Bleeding-Internal Bleeding

  Crush injury
– common
reason for
internal
bleeding.

First Aid in Bleeding-Crush Injury

 IF CRUSHED FOR < THAN IF CRUSHED FOR > than 15
15 MINUTES MINUTES

 Activate emergency  Activate emergency protocol

protocol IMMEDIATELY!!!
IMMEDIATELY!!!
 Release casualty quickly.
 DO NOT RELEASE CASUALTY
 Control and apply
<C>ABC. who has been crushed for more
than 15 minutes – you will not be
 Cover wounds with sterile
dressing. able to control this condition. If
released, death can be immediate.
 Quick transportation to
hospital!!!  Reassure and comfort casualty.
 Time is always critical!!! Control and apply <C>ABC.
 Time is always critical!!!

First Aid in Bleeding-Crush Injury

  Could be serious.
 Might be a sign of head injury.
 If responsive – have patient seated
and leaned FORWARD.
 Have patient pinched nostrils.
 Instruct patient not to sneeze, blow
his nose, or snivel.
 Take patient to health practitioner.
 If head or major injury is suspected
– IMMEDIATELY activate
emergency protocol.

First Aid in Bleeding-Nasal Bleeding

QUESTIONS?

End of Module 4