Bleeding

Bleeding (Hemorrhage)

Definition: Blood loss outside blood vessels.

Types according to site:
a) External bleeding: bleeding through skin wound. b) Internal bleeding: is either visible or concealed.
Visible: in that the bleeding can be seen. eg. Bleeding in the Lungs, Bleeding from the Ears
Concealed: where no direct evidence of bleeding is obvious. eg. Intracranial haemorrhage.

Causes:

1- External: Skin wounds or surgical incisions.
2- Internal: Haemorrhagic blood disorder: Purpera, Haemophilia. Hypertension.

Complications:

Pain.
Blood loss that may lead to shock.
Contamination of wounds.

Care and management of external bleeding

DR ABC see before
Expose the wound and check for visible foreign bodies.
Apply a dressing with direct pressure over the wound.
Raise and support the injured part above the level of the heart if possible.
Treat shock if required.
Check circulation regularly to ensure bandage is not too tight.

Care and management of internal bleeding

Symptoms and signs:

Pale, cool, clammy skin.
Thirst.
Rapid, weak pulse.
Rapid, shallow breathing.
Pain or discomfort.
Nausea and/or vomiting.
Gradually lapsing into shock.
Internal bleeding is always to be considered as a very serious matter, and urgent medical aid is necessary.
Call for an ambulance.
Position the casualty supine, with legs elevated and bent at the knees.
If unconscious, side position with support under the legs to elevate them.
reassurance
treat any injuries
give nothing by mouth

Nosebleed (Epistaxis)

Care and management:

Have the casualty pinch the fleshy part of the nose just below the bone.
Have the casualty lean slightly forward.
Maintain this posture for at least 10 minutes.
Apply cool compress to over the nose, neck and forehead.
If bleeding persists, put cotton soaked in a vasoconstrictor through the nose.
Obtain medical aid.

Advise the casualty not to blow or pick nose for several hours or to swallow blood.

Circulation

Circulation:

In order to determine if the victim's heart is beating, place two fingertips on his carotid artery, If there is no pulse then the victim's heart is not beating, and you will have to perform chest compressions.

Chest compressions:

When performing chest compressions, proper hand placement is very important. Place two fingers on the victim's sternum at the site shown in the pic.

And then put the heel of your other hand next to your fingers . Now you need to place your hand on top of that hand and interlace the fingers.

Lock your elbows and using your body's weight, compress the victim’s chest. The depth of compressions should be approximately 1½ to 2 inches - remember: 2 hands, 2 inches.

If you feel or hear slight cracking sound, you may be pressing too hard. Do not become alarmed and do not stop your rescue efforts! Damaged cartilage or cracked ribs are far less serious then a lost life. Simply apply less pressure as you continue compressions.

Count as you compress 15 times ( or 30 times stated by some authors ) at the rate of about 3 compressions for every 2 seconds. Finish the cycle by giving the victim 2 breaths. This process should be performed four times - 15 compressions and 2 breaths - after which remember to check the victim's carotid artery for pulse and any signs of consciousness.

What to do next:

If there is no pulse, continue performing 15 compressions/2 breaths, checking for pulse after every 4 cycles until help arrives. If you feel a pulse (i.e. the victim's heart is beating) but the victim is still not breathing, rescue breaths should be administered, one rescue breath every five seconds (remember to pinch the nose to prevent air from escaping). After the first rescue breath, count five seconds and if the victim does not take a breath on his own, give another rescue breath.

The emergency action plan

THE EMERGENCY ACTION PLAN

The emergency action plan consists of Danger, Response, Airway, Breathing and Circulation. These steps are also commonly called DR-ABC.

Danger (Hazards, risks, safety):

Be sure that there is no threat in or around the scene. If present, you can either remove the threat or move the causality to a safer place. If the risk can not be removed or the causality is severly injuried wait for the medical help.

Response:

Check the casualty for a response by touching the casualty on the shoulders and asking loudly ‘are you all right?’ This is known as the ‘Touch & Talk’ technique. There is no need to shake a casualty to gain a response. A casualty that does not react should be considered unconscious.

There are three levels of consciousness:

• fully conscious - the casualty is responsive and alert and aware of time and place.
• semi-conscious - the casualty is drowsy or confused.
• unconscious - the casualty is unresponsive.

If the casualty does not respond:

• shout for help.
• check the airway.

Airway:

Ensuring a clear airway is essential to allow the casualty to breathe. Check the airway is ‘open & clear’.

To Open Airway:
Place your hand on the forehead place your fingertips under the point of the casualty’s chin.
- Gently tilt the head back and lift the chin to open the airway.
- Remove any visible foreign bodies.

If Airway Is Obstructed:
• roll casualty onto side ( recovery position ).
• remove any visible obstruction from the victim’s mouth

• remove dislodged or loose dentures
• leave well fitting dentures in place

If Airway Is Clear: check breathing.

Breathing:

Keep the airway open and check for normal breathing.

• look, listen and feel for no more than 10 seconds for normal breathing
• look to see if the chest rises
• listen for the sound of normal breathing
• feel for air against your cheek

If Breathing Present:

• roll into recovery position .
• check the casualty’s condition and get help if needed.
• observe and reassess the casualty for continued breathing regularly.

If Breathing Absent:

• send or go for help.
• open the airway with head tilt and chin lift
• close the casualty’s nose
• give 2 breaths: blow into the casualty’s mouth for about 1 second
• watch for chest rise with each breath
• give second breath (use a shield barrier if one is available)

If the victim remains unresponsive (no breathing, coughing or moving), check his circulation.

Principles of first aid

PRINCIPLES OF FIRST AID

1- Immediate action:

Quick action is necessary to preserve life. If quick effective first aid is provided, then the casualty has a much better chance of a good recovery. It is important that quick action does not lead to panic. Try to remain calm and think your actions through. A calm and controlled first aider will give everyone confidence that the event is being handled efficiently and effectively.

2- Getting help:

Remember, as an aidee, you are not a doctor, so you need to get help. To get expert medical assistance, call an ambulance as early as possible. If you are attending to a casualty, get a bystander to telephone for help. If you are on your own you may have to leave the casualty momentarily to make a call. There are 3 important things to remember when calling for help:

1. State which emergency service you want; Ambulance, Fire, or Police.
2. Stay on the line until connected with the emergency service operator as they will need to talk to you before sending assistance.
3. Give as much information as you can about the emergency, including:

• exact address or location
• landmarks
• caller’s name
• phone number from where the call is being made
• what happened - eg. car accident
• number and condition of the casualties

3- Reassurance:

The psychological value of reassurance is as important as the treatment that you give. A calm approach by the first aidee, and keeping the casualty informed of what is happening will also assist in the reassurance process.

Introduction to first aid

First aid has been as much a part of the culture as tea. And now both non medical and medical personalities should have an idea about it as it is LIFE SAVING; in this series we are going to discuss as much as we can about first aid. We will start with an intro. then go into details.

What is first aid?

First aid is the initial care of a suddenly sick or injured person. It is this prompt care and attention prior to the arrival of the ambulance. First aid saves lives.
First aid has limitations, as not everybody is doctor, so never do something you're not qualified to do.

The main aims of first aid are:

To preserve life.
To protect the casualty from further harm.
To relieve pain.

What is a first aider?

A first aider is someone who has undergone a training course in administering first aid and holds a current first aid certificate granted by an organization recognized by the Commission.

What is first aid kit?

First aid kit is consisting of a portable box divided into compartments to store first aid articles required and on which are affixed the words «first aid» in conspicuous characters.

List of contents:

• Cotton.
• Gauze swabs.
• Sterile dressing ( different sizes ).
• Non Sterile dressing ( different sizes ).
• Adhesive sterile dressing ( different sizes ).
• Paper Handkerchief.
• Sterilized and non sterilized gloves.
• Antiseptic solution eg. Betadine.
• Pressure bandages - small, medium & large.
• Triangular cloth bandage. Scissors (stainless steel).
• Forceps (stainless steel).
• Torch. 5ml syringe.
• Thermometer.
• Eye patch.
• Hot water bottle & Ice bag.
• First aid book