1 Bleeding Pakistan ICITAP

2 Learning Objectives Identify different types of bleeding Identify different types of wounds Learn First Aid steps to control external bleeding Learn how to apply dressings and bandages Learn the proper use of a tourniquet

3 Introduction As Police Officers, you will be exposed to bleeding injuries resulting from accidents, combat and blast injuries The victim of bleeding must be treated at a medical facility as soon as possible A knowledge of first aid can often mean the difference between life and death

4 Introduction Blood is essential to life. Without enough blood circulating you will quickly die. Many people die as a result of bleeding and shock These deaths ARE preventable with proper treatment First Aid techniques can help either stop or reduce the flow of blood

5 Bleeding

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7 Blood Each adult has about 6.6 liters of blood Rapid loss of 2.2 liters of blood can cause death Arteries carry blood AWAY from the heart  Veins return the blood TO the heart  Capillaries are smaller blood vessels that carry the blood directly to the body’s cells

8 Types of Bleeding Bleeding can be External or Internal External Internal

9 Types of Bleeding External:  Blood coming from an open wound Internal:  Bruises  Blood in vomit, in the stool, or in urine

10 Bleeding is often classified by the blood vessel that is bleeding: Arterial bleeding (Artery) Venous bleeding (Vein) Capillary bleeding Types of Bleeding

11 Arteries and Veins Capillaries

12 Inside of a Blood Vessel Blood is made up of 90% liquid and 10% cells

13 How does bleeding stop? Blood Clots

14 Types of Bleeding Bleeding from the ARTERY (arterial)  Bright red blood, spurting from the wound  Blood loss is rapid and extensive  Arterial bleeding is the most difficult to control  Life-threatening and must be controlled IMMEDIATELY!

15 Arterial Bleeding Injury to right side of carotid artery Notice the size of the blood vessel

16 Types of Bleeding Bleeding from the VEIN (Venous) Bleeding from the VEIN (Venous)  Dark red blood, often so dark it appears to be maroon  Bleeds in a steady flow without the spurts, but it can still be severe  Venous bleeding is easier to control than arterial bleeding

17 Venous Bleeding

18 Capillary Bleeding Blood oozes from the bed of capillaries The color of the blood is red, usually less bright than arterial bleeding The blood flow is generally slow, as seen in minor cuts and scrapes to the skin

19 Capillary Bleeding

20 WOUNDS

21 Types of Wounds There are two classifications of wounds: Open Closed

22 Open Wounds Gunshots – penetration of the skin by a bullet, that may have both an entrance and exit wound. It may cause massive bleeding and internal damage. Lacerations – a cutting of the skin. It has jagged edges and tends to bleed. Incision – caused by a sharp objects. The wound has clean, even edges. Puncture/Penetration – has little bleeding on the surface. It is nearly impossible to determine the extent of bleeding under the skin. This poses greater danger for infection. Avulsion – This skin is torn loose and sometimes torn completely from the body

23 Entry wound Exit wound Gunshot Wounds

24 Lacerations

25 Incision Wounds

26 Puncture Wounds Puncture wounds to the body may result in unseen internal injuries

27 X-Ray of Puncture Wound

28 Penetrating Wounds If a knife or other penetrating object is still present in the wound, DO NOT attempt to remove it

29 Puncture/Penetrating Wounds Penetrating Trauma on the left side of the chest

30 Penetrating Wounds The act of removing the object will often cause further damage and complications Immobilize object to prevent further injury Apply pressure around the object in an effort to stop the flow of blood The removal of the object must be left to qualified medical staff

31 Avulsions Degloving injury: skin came off Degloved portion

32 Direct Pressure Warnings  may be from a skull fracture  An ear or nose bleed may be from a skull fracture  DO NOT attempt to stop the flow  Catch the blood/drainage with a loose dressing

33 Direct Pressure Warnings Eye injury – DO NOT use direct pressure on eye because this may cause permanent damage Neck area - Special attention should be given when dressing and bandaging this area. Errors may result in possible airway problems.

34 DO NOT BE FOOLED!  The amount of blood that is present may not a good indicator of how serious the injury really is  Serious injuries may not always bleed heavily  Some minor injuries may bleed heavily, for example: head and face area.

35 Minor or serious injury?

36 Closed (Internal) Wounds Bruises and Concussions are types of closed wounds:  Bruise is the result of bleeding under the skin  Concussion is a type of bleeding or bruising that occurs on the brain With these types of wounds, it is difficult to detect the amount of bleeding

37 Internal Bleeding BruiseConcussion

38 Internal Bleeding Remember: closed wounds can be the cause of serious internal injury A patient can internally lose large amounts of blood in one area A patient can internally lose large amounts of blood in one area This blood may travel to other areas, such as the lungs or abdominal area, causing further problems This blood may travel to other areas, such as the lungs or abdominal area, causing further problems

39 Bandages and Dressings

40  Conduct a rapid head to toe examination to determine if the victim has a severe life threatening bleed

41 REMEMBER: BE SAFE!! When giving aid to someone with an open wound, precautions should be taken to prevent the transmission of disease Wear sterile gloves, or put layers of sterile gauze, or plastic wrap on the wound to prevent contact Always wash your hands immediately after administering First Aid with someone with an open wound

42 Dressings and Bandages  Dressings: Material that is placed directly on the wound with pressure from the hand or bandaging  Bandages: Holds dressings in place

43 The purpose of dressings and bandages Control bleeding Prevent infection and contamination Absorb blood and fluids coming out of the body Protect the wound from further injury Always use a dressing large enough to extend over the wound’s edges

44 Control the Bleeding Place a clean dressing on the wound and apply direct pressure Bandage the dressing Elevate the wound above the level of the heart If bleeding still continues, apply pressure to nearest Pressure Point Apply Tourniquet only as a last resort

45 Direct pressure  If patient bleeds profusely immediately apply direct pressure to the wound

46 How to apply dressing  Open dressing

47 How to apply dressing  Do not touch white sterile side of dressing

48 How to apply dressing  Place white side of dressing on wound

49 How to apply bandaging  Hold dressing in place  Wrap one tail around the injury and the other tail in opposite direction

50 How to apply bandaging  Wrap tails of dressing to cover all edges  This will also help keep wound clean

51 How to apply bandaging  Tie knot on the outside of wound  You should be able to slip 1-2 fingers under knot  This will ensure proper circulation

52 How to apply bandaging  Tuck any remaining tails inside to avoid catching them

53 Elevation of affected area  Elevate extremity above level of the heart to help stop bleeding

54 Apply pressure to pressure point If the bleeding does not stop after 5-10 minutes, you will need to apply pressure on an artery or pressure point between the wound and the heart Pressure points should ALWAYS be used with caution! Release pressure every 5 minutes for a few seconds

55 Pressure Points ش ر يا ن Do not apply pressure to the neck (carotid) pressure point. It can cause a heart attack.

56 Apply pressure to pressure point  Apply pressure to nearest pressure point between the wound and the heart  Hold for 3-5 minutes

57 Reinforce the dressing  If bleeding continues, DO NOT remove original dressing  Reinforce wound with additional dressings and bandages  Apply additional dressings as needed

58 Reinforce the dressing  Tie knot on top of dressing

59 Reinforce the dressing  Tuck any remaining tails under to avoid catching them

60 Reinforce the dressing  You should be able to slip 1-2 fingers under knot

61 Signs of improper bandaging Bandage is too tight if: Fingernails and toenails turning blue A feeling of numbness or cold in the affected area Bandage is too loose if: Bleeding is not controlled due to inadequate pressure

62 Applying a Tourniquet

63 Applying a tourniquet If all methods to control bleeding have failed, the LAST resort is to apply a a tourniquet Why?

64 Using a tourniquet A tourniquet applies pressure against the blood vessels, stopping the flow of blood

65 Applying a tourniquet Apply a tourniquet only if the victim is in immediate danger of dying from blood loss Never use wire, or other material that will cut the skin Once a tourniquet is applied, it should be removed only in a medical facility

66 Applying a tourniquet  Material used for tourniquet should be between 5 and 10 centimeters wide

67 Applying a tourniquet Tourniquet should be placed 2 – 3 finger widths above the wound site

68 Applying a tourniquet  Do not place tourniquet over a joint or over the wound

69 Applying a tourniquet Use rigid object to twist the cloth tight around the injured extremity This will assist in controlling the blood flow

70 Applying a tourniquet TOURNIQUET SHOULD BE TIGHTENED ONLY UNTIL BLEEDING HAS STOPPED Wound may still be bleeding slightly

71 Applying a tourniquet Twist the rigid object and secure it so it does not unwind

72 Applying a tourniquet Do not cover tourniquet

73 Applying a tourniquet  Mark on patient’s forehead: T, and the time tourniquet was applied  This is done to inform medical personnel when the tourniquet was applied

74 Applying a tourniquet After tourniquet is in place, bandage the end of the amputation

75 Remember, the person you are most likely to be saving is a colleague

76 Review What type of bleeding is hardest to control? Practice using dressings and bandages to stop external bleeding What is a common sign of internal bleeding? If initial bandaging does not control the bleeding, what is the next step? When do you apply a tourniquet? Demonstrate proper use of tourniquet

77 Questions?

78 Class Practical Exercise Practice some of the skills shared in this presentation