1. Bleeding

2. objectives At the end of this session, each student should be able to:
Determine type of bleeding.
Describe how to control bleeding.
Identify common signs of internal bleeding.
Describe how to control epistaxis.

3. Bleeding (hemorrhage) is the escape of blood from capillaries, veins, and arteries.
Bleeding can be external (i.e., outside the body), internal (i.e., inside the body), or external and internal.
Note:
Uncontrolled bleeding (massive bleedingنزيف شديد ), whether external or internal, is life threatening.

4. Bleeding also has three types: Arterial Bleeding نزيف شرياني:
The BRIGHT RED blood "spurts" from the wound.
Arterial bleeding is life-threatening and difficult to control.
Loss of blood is pulsating فقد الدم على شكل تدفقات كالنبض .
Venous Bleedingنزيف وريدي :
The DARK RED (reddish purple) blood flows in a steady streamبشكل منساب ومستمر .
Capillary Bleedingنزيف للشعيرات الدموية :
A slow medium red blood "oozes" from the wound site.

5. Notes:
Capillary bleeding is usually not serious and can easily be controlled.
Arterial and Venus bleedings are more serious and can be life-threatening.

6. Methods to Control Bleeding
There are four methods to control bleeding:
Direct Pressure,
Elevation,
Indirect Pressure, and
The Use of a Tourniquet.

7. 1. Direct Pressure
Direct pressure is the first and most effective method to control bleeding.
In many cases, bleeding can be controlled by applying pressure directly to the wound.
Place a sterile dressing or clean cloth on the wound, tie a knot اعمل عقدة (ربطة)or adhere tape directly over the wound, only tight enough to control bleeding.
If bleeding is not controlled, apply another dressing over the first or apply direct pressure with your gloved hand or fingers over the wound.

8. 2. Elevation
Elevation of an injured arm or leg (extremity) above the level of the heart will help control bleeding.
Elevation should be used together with direct pressure.
Do NOT elevate an extremity if you suspect a broken bone (fracture) until it has been properly splinted.

9. 3. Indirect Pressure
(ONLY) In cases of severe bleeding when direct pressure and elevation are not controlling the bleeding, indirect pressure must be used.
Bleeding from an artery can be controlled by applying pressure to the appropriate pressure point.
Pressure is applied with the fingers, thumb, or heel of the hand.
Pressure Points are areas of the body where the blood flow can be controlled by pressing the artery against an underlying bone.

10. Indirect
Pressure Points

11. Indirect
Pressure Points

12. Notes:
Indirect pressure is used in addition to direct pressure and elevation.
Indirect pressure can cause damage to the extremity due to inadequate blood flow.
Pressure points should be used with caution.
Do NOT apply pressure to the two neck (carotid) pressure points at one time, it can cause cardiac arrest.
The brachial artery is used to control severe bleeding of the lower part of the arm.
The femoral artery is used to control severe bleeding of the thigh and lower leg.

13. 4. The Use of Tourniquet
A tourniquet should be used only as a last resortآخر حل to control severe bleeding
After all other methods have failed.
It is used ONLY on the extremities.
Tourniquets cause tissue damage and loss of extremities when used by untrained individuals.
Tourniquets are rarely required and should only be used when an arm or leg has been partially or completely severed and when bleeding is uncontrollable.
A tourniquet can be a strap, belt, towel, or other similar item. NEVER use wire, cord, or any material that will cut the skin.

14. Application of Tourniquet
Leave at least 2 inches (5 cm) of uninjured skin between the tourniquet and wound.
Place a pad (roll) over the artery.
Wrap the tourniquet around the extremity twice.
Never cover a tourniquet.
Identify the time in which tourniquet was applied.

15. Internal Bleeding

16. Internal Bleeding
Internal bleeding, although not usually visible, can result in serious blood loss.
Victims with internal bleeding can develop shock before you realize the extent of their injuries.
Bleeding from the mouth, ears, nose, rectum, or other body opening (orifice) is considered serious and normally indicates internal bleeding.

17. Common Causes of Internal Bleeding
Deep chest or abdominal wound.
Any cut into muscle or fracturing of bone.
Bleeding ulcersنزيف التقرحات (الداخلية في المعدة والأمعاء مثلا) .

18. Signs of Internal Bleeding
Anxiety and restlessness قلق وعدم راحة.
Excessive thirst (polydipsia) عطش شديد .
Nausea and vomiting.
Coolبارد , moistرطب , and pale skin جلد شاحب اللون
Rapid breathing (tachypnea).
Rapid, weak pulse (tachycardia).
Bruising ازرقاقor discoloration at site of injury (contusionرضات ).

19. If you suspect internal bleeding, do the following:
Apply ice or cold pack [inside a cloth to prevent damage to the skin], to reduce pain and (edema) swelling.
Call local emergency or medical personnel.
Monitor circulation, airway, and breathing (CAB).
Treat for shock.
Place the victim in most comfortable position.
Maintain normal body temperature.
Reassure the victim.

20. Epistaxis (nose bleeding) رعاف الأنف
It is hemorrhage from the nose, due to mainly rupture of minute vessels.
هي نزيف من الأنف، ينتج عادة بسبب تفجر لأوعية دقيقة (صغيرة)

21. Common Causes
Trauma due to:
(1) blow on the nose ضربة على الأنف, and
(2) foreign bodyجسم غريب .
Violent sneezingعطس شديد وقوي .
Blood diseasesأمراض دموية .
Hypertensionارتفاع ضغط الدم الشرياني .

22. First Aid Treatment
Apply pressure by pinching the nostrils for 5-10 minutes.
Keep the patient in a sitting, leaning forward position.
Apply ice over the nose.
Keep the patient quite.

23. Hospital Emergency Care
Simple packing of the nose.
Use of adrenaline nasal pack.
In hypertension cases: sedation and decreasing blood pressure.
Check for blood coagulative disorders.
استفسر عن أمراض متعلقة بتجلط الدم