Chapter 4 Bleeding

OSH 1252
FIRST AID AND EMERGENCY PLANNING
CHAPTER 4:
BLEEDING AND ITS
MANAGEMENT
LEARNING OUTCOMES
At the end of the topic, students should be able to:
• Differentiate between internal and external
bleeding
• Differentiate between arterial, venous and
capillary bleeding
• Describe and demonstrate how to control
external bleeding with direct pressure and
tourniquets.
HEMORRHAGE
• Bleeding (hemorrhage) is the escape of blood
from arteries, veins, or capillaries. The rate at
which blood is lost is significant.
• If larger amounts are lost or this amount is lost
more quickly, the patient may go into shock. If
massive bleeding is not controlled and medically
treated, the patient may die.
Bleeding may be external or internal.
 Internal: The skin is not broken and bleeding may

not be visible. Hidden bleeding into the thoracic
or abdominal cavities or into muscle surrounding
a fracture can account for a large amount of blood
loss.
 External: There is a break in the skin and blood
escapes to the outside.
• Arterial Bleeding: Blood from an artery spurts or
pulses out and is usually bright red.
• Venous Bleeding: Blood from a vein generally
comes in a steady flow and its colour is much
darker than arterial blood.
• Capillary Bleeding: Bleeding from capillaries is a
continuous, steady ooze.
BLEEDING SOURCES AND
CHARACTERISTICS
© 2012 Pearson Education, Inc.

MANAGEMENT OF
Direct Pressure EXTERNAL BLEEDING
• Pressure applied directly over the wound will control nearly all types of
bleeding.
• Pressure may first be applied with a gloved hand. If available, material such as a
dressing, shirt, or handkerchief may be used. In this situation, a sterile pressure
dressing or gauze pads are preferred.
• Once the sterile dressing is in place, pressure on the wound is maintained by a

loop tie or roller bandage that secures the dressing. The entire sterile dressing
should be covered above and below the wound by the bandage, tightly
secured.
• If the dressing becomes blood-soaked, apply additional dressings over the

initial one and apply direct pressure over it.
Pressure Points (Indirect Pressure)
• A pressure point is any location at which

pressure on the artery slows or stops bleeding
at a distal injury. This generally means that the
artery is close to the skin’s surface and lies over
a bone.
Pressure points are applied only when the patient is
hemorrhaging from a major artery and under the
following conditions:
• The bleeding is not stopping with direct pressure or

• The wound has a protruding bone or embedded
foreign body that interferes with direct pressure or
• There are other life-threatening priorities that
demand the First Aider’s attention
Tourniquet
A tourniquet can be used to control hemorrhage in the
following circumstances:
• If all other methods fail or
• If another life-threatening priority demands the First
Aider’s attention
• If direct pressure fails to control bleeding
The tourniquet is applied proximal to the wound and on the

upper arm or the thigh where the artery can be compressed
against a single long bone
Certain precautions must be observed when using
tourniquets:
• Do not use a tourniquet unless other means of
hemorrhage control are ineffective or another life-
threatening priority demands the First Aider’s
attention.
• If at all possible, avoid using material such as belts,
rope, or wire which can cut into tissue.
• Ensure that the tourniquet is applied with sufficient
pressure. A loose application will increase venous
blood flow from wounds beyond the tourniquet.
• If there is an extremity distal to the tourniquet,
the tourniquet must be released for 1 minute
every 45 minutes. This will provide some blood
flow to the distal limb and prevent tissue death.
• Tourniquets must never be covered by
bandages.
• The patient must be clearly marked as having a
tourniquet and the time it was applied. Fix a
large tag to the patient’s body, preferably not to
the clothes but to a limb.
Using a Tourniquet

CONTROL OF BLEEDING
• Steps to follow
– Stop the bleeding.
– Determine the cause and source of
bleeding, and general condition of victim.
– Place the victim in a position that minimizes
blood loss.
– Establish and maintain an open airway.

PROTECTION FROM INFECTIOUS DISEASE
• Precautions
– Place a barrier between yourself and the
victim’s blood, such as protective gear.
– Don’t touch your mouth, nose, or eyes, or
handle food.
– When treatment concludes, wash hands
thoroughly; brush under fingernails.
– Wash thoroughly all items that touched the
victim’s blood or body fluids.
INTERNAL BLEEDING
Signs of Internal Bleeding:
• bruised, swollen, tender or rigid abdomen

• blood in vomit
• wounds that have penetrated the chest or
abdomen
• bleeding from the rectum or vagina
• First aid for internal bleeding is limited as any
serious internal bleed will likely require surgical
intervention.
• If the internal bleed is minor, such as some
bruising, then cold packs can be applied to the
area to reduce the swelling and relieve pain.
• Be aware that the casualty may go into shock. If
they are unconscious and breathing then they
should be placed in the recovery position and kept
under close supervision until assistance arrives.
THANK YOU

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OSH 1252

FIRST AID AND EMERGENCY PLANNING

 Internal: The skin is not broken and bleeding may

© 2012 Pearson Education, Inc.

• Once the sterile dressing is in place, pressure on the wound is maintained by a

• If the dressing becomes blood-soaked, apply additional dressings over the

• A pressure point is any location at which

• The bleeding is not stopping with direct pressure or

The tourniquet is applied proximal to the wound and on the

© 2012 Pearson Education, Inc.

© 2012 Pearson Education, Inc.

Signs of Internal Bleeding:

• bruised, swollen, tender or rigid abdomen

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