Types of External Bleeding

1 BleedingThe average-size adult has 5 to 6 quarts (10 12 pints) of blood and can safely do-nate a pint during a blood donation. However, rapid blood loss of 1 quart or morecan lead to shock and death. A child who loses 1 pint of blood is in extreme of External BleedingExternal Bleeding refers to blood coming from an open wound. The termhemorrhagerefers to a large amount of Bleeding in a short time. External bleed-ing can be classified into three Types according to the type of blood vessel that isdamaged: an artery, vein, or capillary . In arterial Bleeding , blood spurts(up to several feet) from the wound. Arterial bleedingis the most serious type ofbleeding because a large amount of blood can be lost in a very short period of Bleeding also is less likely to clot because blood can clot only when it isflowing slowly or not at all.

2 However, unless a very large artery has been cut, it isunlikely that a person will bleed to death before the flow can be , arterial Bleeding is dangerous and must be venous Bleeding ,blood from a vein flows steadily or gushes. Venous bleed-ing is easier to control than arterial Bleeding . Most veins collapse when cut. Bleedingfrom deep veins, however, can be as massive and as hard to control as arterialbleeding. In capillary Bleeding ,the most common type of Bleeding , blood oozesfrom capillaries. It usually is not serious and can be controlled easily. Quite often,Figure 8-1 BleedingTypes of 3/31/06 12:13 PM Page 90 Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION this type of Bleeding will clot and stop by itself.

3 Each typeof blood vessel artery, vein, or capillary contains bloodof a different shade of red. An inexperienced person mayhave difficulty detecting the difference but identifying thetype of Bleeding by its color is not important. The bodynaturally responds to Bleeding in the following way:Blood vessel contain small amountsof muscle tissue in their walls. If a blood vessel iscompletely severed, it draws back into the tissue,constricts its diameter, and slows the Bleeding dra-matically. If an artery is only partially cut across itsdiameter, however, constriction is incomplete. Thevessel may not contract and the loss of blood maynot slow as elements (platelets)in blood forma clot.

4 Clotting serves as a protective covering fora wound until the tissues underneath can repairthemselves. In a healthy person, initial clot forma-tion normally takes about 10 minutes. Clottingtime is longer in people who have lost a great dealof blood over a prolonged period of time, are tak-ing aspirin or anticoagulants, are anemic, or havehemophilia or severe liver for External BleedingRegardless of the type of Bleeding or the type of wound,the first aid is the same. First, and most important, youmust control the Bleeding () yourself against disease by wearing med-ical exam gloves. If they are not available, use sev-eral layers of gauze pads, clean cloths, plastic wrap,a plastic bag, or waterproof material.

5 If those areunavailable, you can have the victim apply pres-sure on the wound with his or her the wound by removing or cutting the vic-tim s clothing to find the source of the a sterile gauze pad or a clean cloth such asa handkerchief, washcloth, or towel over the en-tire wound and apply direct pressure with your fin-gers or the palm of your hand (Skill Drill Step).Hold steady, firm, and uninterrupted pressure onthe wound for at least 5 minutes. The gauze orcloth allows you to apply even pressure. Directpressure stops most Bleeding . Applying direct pres-sure to the wound compresses the sides of the tornvessel and helps the body s natural clotting mech-anisms to work.

6 Be sure the pressure remains con-stant, is not too light, and is applied to the bleedingsource. Do not remove blood-soaked dressings;simply add new dressings over the old the Bleeding is from an arm or leg, elevate theinjured area above the level of the heart to reduceblood flow as you continue to apply pressure (SkillDrill Step ).Elevation allows gravity to make itmore difficult for the body to pump blood to theaffected extremity. Elevation alone, however, willnot stop Bleeding and must be used in combina-tion with direct pressure over the free you to attend to other injuries or victims,use a pressure bandage to hold the dressing on thewound. Wrap a roller gauze bandage tightly overthe dressing and above and below the wound site(Skill Drill Step ).

7 The Bleeding continues, apply pressure at a pres-sure point to slow the flow of blood as you con-tinue putting direct pressure over the wound (SkillDrill Step ). pressure pointis where an artery near the skin ssurface passes close to a bone, against which it canbe compressed. The most accessible pressurepoints on both sides of the body are the brachialpoint on the inside of the upper arm and thefemoral point in the groin. Using pressure pointsrequires skill, because unless the exact locationof the pulse point is used, the pressure-pointSkill Drill 8-1 Chapter 8 Bleeding91 Capillary, venous, and arterial 8-1Do notcome in contact with blood with your barehands.

8 Protect yourself with medical exam gloves,extra gauze pads, or clean cloths, or have the victimapply the direct pressure. If you must use your barehands, do so only as a last resort. After the bleedinghas stopped and the wound has been cared for,vigorously wash your hands with soap and notuse direct pressure on an eye injury, a woundwith an embedded object, or a skull notremove a blood-soaked dressing. Apply anotherdressing on top and continue putting pressure over 3/31/06 12:13 PM Page 91 Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION1 Put on medical exam gloves and expose direct an injured extremity above heartlevel while keeping pressure on the for External Bleeding92 First Aid, CPR, and AEDA pply a pressure bandage over the dressingand above and below the Bleeding cannot be controlled, use abrachial femoral pressure 3/31/06 12:13 PM Page 92 Jones and Bartlett Publishers.

9 NOT FOR SALE OR DISTRIBUTION technique is useless. Many first aiders have diffi-culty finding the precise pressure-point , however, that direct pressure stopsmost direct pressure cannot be applied, such asin the case of a protruding bone, skull fracture, orembedded object, use a doughnut-shaped (ring)pad to control Bleeding . To make a ring pad, wrapone end of a narrow bandage (roller or cravat) sev-eral times around your four fingers to form a the other end of the bandage through the loopand wrap it around and around until the entirebandage is used and a ring has been Bleeding stops, use procedures found inChapter 9 for wound people panic when they see even the small-est amount of blood.

10 The sight of more than a cou-ple of tablespoonfuls of blood generally is enoughto frighten victims and bystanders. Take time toreassure the victim that everything possible is be-ing done. Do not belittle the victim s Internal BleedingThe signs of internal Bleeding may be seen in either in-jured or suddenly ill victims:Bright red blood from the mouth or rectum or bloodin the urineNonmenstrual vaginal bleedingVomited blood; may be bright red, dark red, or looklike coffee groundsBlack, foul-smelling, tarry stoolsPain, tenderness, bruising, or swellingBroken ribs, bruises over the lower chest, or a rigidabdomenCare for Internal BleedingFor severe internal Bleeding , follow these vomiting.