This week on DD First Aid, Aiden Thompson from Donegal Safety Training Solutions talks about one of the most common reasons we administer first aid in the home, bleeding.
We have all given ourselves a small cut or nip that has caused us to bleed at some point and it is always a good idea to have a first aid kit in the home with plasters, paper stitches, and some antiseptic cream to treat these wounds.
When we treat our own injuries, we generally do not need to wear gloves, but when we treat anyone else other than ourselves, we really should use gloves as they prevent the risk of cross-infection.
Remember, all body fluids have the potential to cause infection. Not only am I at risk of catching something from a casualty’s blood by treating them without wearing my gloves, but I am also at risk of spreading something that I may have onto an unsuspecting casualty because of small cuts or germs that may be on my hands.
Our blood is Fifty-Five percent liquid and Forty-Five percent solids. The liquid is Plasma, a light- yellow liquid that transports nutrients, water, salt, hormones, and proteins to all parts of the body.
The solids are our blood cells, which are made in our bone marrow. Our Red blood cells carry oxygen around our body to feed our tissue and organs. Our White blood cells are our immunity cells and they fight off infection from viruses and bacteria that enter the bloodstream and our Platelets bind together to form clots when we bleed.
The human body has approximately ten pints of blood in total, so we mustn’t allow a casualty to bleed profusely. Arteries carry oxygen-rich blood away from the heart and the blood is pumped by the heart muscle. Therefore, an arterial bleed is often described as being bright red and pumping from a wound. A venous bleed, described as dark red, because the Oxygen has been used up, flows from a wound because the blood is not under the same pressure from the heart.
Any major loss of blood will cause shock to develop, therefore, we must stop the bleed immediately regardless of whether it is an arterial or venous bleed.
First aid for bleeding
When we have a casualty who has a bad wound, we need to encourage that person to sit down or lay down and apply pressure onto their wound while we get our first aid kit and gloves on. We also ask them to elevate the injury to reduce the flow of blood to the wound.
Once we have our gloves on, we need to inspect the wound. We always cut away any clothing that might be covering the
wound, never roll a sleeve or trouser leg up over a wound because there may be something impaled in the wound and we will dislodge it if we roll the sleeve up.
If anything is sticking into or out of the wound such as a large splinter of metal, we must leave it in place and bandage around the impaled object. We do not remove this object because we do not know how deep it is in the body or what structures it may have damaged or is laying close to as it entered the body. If we remove this object, we may cut through a blood vessel or nerve that has not yet been damaged and encourage further bleeding or injury.
If it is a dangerous bleed, our priority is to stop the bleed first. When we have inspected the wound, we must now dress it. Use a clean sterile dressing or bandage that is larger than the wound and apply it evenly over the injury. With very large open wounds, perhaps as a result of a chainsaw accident, for example, we may also need to pack the wound.
Dressings must be tight to apply direct pressure on the wound and restrict the loss of blood. If your first dressing becomes saturated in blood, simply put a second dressing over the first and either call the emergency services or transport the casualty to the hospital for stitches. If we remove a blood-soaked dressing to apply a clean one the Platelets that have begun binding together to form a clot will be removed and the casualty will bleed as heavily again.
Remember, our priority is to stop the bleed, the doctors and nurses can always clean a wound in the local A+E and treat it with antibiotics once the bleeding is controlled.
Some people will be prescribed certain medications that are designed to thin their blood or prevent clots from forming. If someone is on these medications and is bleeding badly, we need to get help fast because we may struggle to control this situation. If this scenario does arise inform the emergency operator immediately when you make a call and follow their guidance. Lay people should not attempt to cut off the blood supply completely by using a tourniquet. These devices are only used by trained medical professionals or if you are encouraged to do so by the operator in very limited scenarios.
Types of wounds
Some wounds are worse than others and being able to recognise the type of injury can help us
decide what to do next. We use the CLIPS acronym to determine the type of wound.
C. Contusion: This is the medical term for a bruise. Most people assume a bruise is nothing to worry about, after all, most kids are covered in bruises from their ankles to their knees. However, a bruise is a sign of underlying injury below the surface of the skin. A bruise on the shin will not harm, but a bruise to the chest wall or abdomen may indicate that there is organ damage and must be investigated.
L. Laceration: A rough jagged cut that bleeds heavily and is difficult to treat. There will be rough edges to the wound and significant scarring will occur. With bad lacerations, a casualty will often receive a Tetanus to counteract any infection.
I. Incision: A nice clean slice that tends not to bleed too badly, is often easily treated, and leaves a slight scar that often fades with time.
P. Puncture: These wounds are dangerous because we cannot see how deep the wound is or what internal structures are involved. Remember, never push anything back into a wound, such as a bone, or never pull something out that is impaled. Call for help.
S. Special wounds: Some wounds can be particularly difficult to treat because they can be hidden. Electricity will often have an entry and exit wound but the exit wound may be concealed. A bite is a series of puncture wounds and a human mouth is full of germs so these wounds need to be assessed professionally. Abrasions, like a road rash injury after falling off a bike at speed, will often not cause a bad bleed but again they need to be treated with care.
Simply sit the casualty down, lean them forward and pinch their nose below the nasal bone and hold it for ten minutes. Do not encourage the casualty to tilt their head back, this makes them feel ill. If after ten minutes the bleeding hasn’t stopped, try it again and if it hasn’t stopped after twenty minutes you need to visit A+E to have the blood vessel cauterised.
Do not place tissue into the nose as it can tear and leave a piece being inside the nasal cavity which can become infected and form an abscess. Small children will be tempted to sniff, pick or blow their noses but this will only remove any clot that has formed to stop the bleed.
If the nose bleed is the result of a bad bang to the face consider the chance of a broken nose or eye sockets and potential head and neck injury. Keep the casualty calm and do not move them until the emergency services arrive and treat the casualty as a spinal injury.
Internal bleeding often occurs as a result of blunt force trauma to the body. A child could be knocked down and have no outward signs of bleeding but can be bleeding very heavily internally. Our organs can be easily damaged so always consider how the injury has occurred, or what was the mechanism of injury?
If we do suspect major trauma or the risk of internal injuries, we need to call for help immediately and keep the casualty still. Do not move the casualty unless it is necessary. Keep the casualty warm, this will delay the onset of shock. If we can, try to elevate the casualty’s legs to encourage the blood flow into the central core where the major organs are. Try to remain calm, and keep our casualty calm. This reduces their heart rate and thereby reduces blood loss.
If we cough up blood or pass blood in our stool always seek medical advice.
Thanks for reading this article, next week we will discuss Halloween safety and how we can keep our little gremlins safe and sound over the holidays.
Aiden Thompson is a PHECC registered paramedic and former Search And Rescue winchman with the Irish Coastguard helicopter, R118, based in Sligo. As a PHECC registered first aid instructor and an Irish Heart Foundation training site coordinator Aiden delivers the highest standard of training to members of the public.
If you would like any further information on courses available in your area, please contact Aiden on 0863111661 or visit his website www.dsts.ie for further details.