WOUND AND BLEEDING CONTROL

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 Objectives
• After completing this chapter students will be able to
effectively control wound and bleeding. To meet this
students should;
Define wound and bleeding
Identify the causes of bleeding and wound.
Know the types of wounds and bleeding
Practice the different techniques used to manage
wound and bleeding.

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 WOUNDS
What is wound?
• It is the break in the continuity of skin ,mucosa or
viscera by accident or surgery.
• Wound & Hemorrhage go hand in hand & is usually
accidental.
• It is a break in the continuity of the tissue of the body
either internal or externally and allows bacterias to
enter and cause infections.

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 What is bleeding?

• Bleeding / hemorrhage is the processes of

losing blood from the body / vessels usually
through disease, injury, or other physical
conditions..
• Escape of blood from capillaries, veins, and
arteries.
• Adult body:
– Contains approximately 5 to 6 liters of blood

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 Causes of Bleeding
 Rupture of veins (epistaxis, esophageal varices)
• Accidental injury
• Abnormal clotting
• Blunt trauma
• Internal organs damage
• Post partum hemorrhage (laxed uterus)
• Abortion
• Cerebrovascular accident (intracranial hemorrhage) etc

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 Bleeding

• Bleeding inside body cavity may follow an injury,

such as a fracture or a penetrating wounds, but can
also occur spontaneously for example, bleeding
from a stomach ulcer.
• The main risk from internal bleeding is shock. In
addition, blood can build up around organs such as
the lungs or brain and exert damaging pressure on
them.

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 Bleeding
• You should suspect internal bleeding if a
casualty develops signs of shock without
obvious blood loss. Check for any bleeding
from body openings (orifices) such as the ear,
mouth, urethra, or anus.

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 How to recognize internal bleeding
• Initially, pale, cold, clammy skin. If bleeding
continues, skin may turn blue- grey (cyanosis).
• Rapid, weak pulse, thirst
• Rapid , shallow breathing
• Confusion, restlessness, and irritability.
• Possible collapse and unconsciousness
• Bleeding from body openings (orifices)

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 Signs of bleeding

• Signs of bleeding vary depending on the site of

blood loss, but the
• most obvious feature is a discharge of blood
from a body opening (orifice). Blood lose from
any orifice is significant and can lead to shock.
• In addition, bleeding from some orifices can
indicate a serious underlying injury or illness.

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 Sources of Bleeding
 Capillary bleeding
• Bleeding of very small blood vessels
• Usually happen after superficial injuries
• Blood just oozes from the cut /tear
• Slow and oozing; often clots spontaneously.
• If the wound covers a large area, cover it with clean
piece of material in clean cold water.

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 Venous Bleeding

• is bleeding from veins

• it is under less pressure than arterial bleeding
(if major veins are damaged, blood may gush
profusely)
• Steady flow; dark red or maroon in color
• To stop the bleeding raise the bleeding part of
the body above the rest of the body.

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 Arterial Bleeding

• It is bleeding from an artery

• The blood is bright red
• Is usually profuse, Rapid and pulsating
• If a main artery is injured, it may jet blood several
feet high
• Apply direct hard pressure in the wound by using
a safe, clean piece of cloth

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 Complications of bleeding

• Contamination – infection
• Septicemia
• Shock
• Cardiac arrest
• Death

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 Equipment
• Bandage
• Gauze
• Tourniquet
• Glove
• Plaster
• Antiseptic solutions

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 TECHINIQUES IN MANAGING
BLEEDING WOUND

 Treatment by Direct Pressure

• First, expose the wound!!!
• Place a sterile dressing over the wound and
apply pressure protecting the hand from contact
to the blood .
• Apply the pressure bandage, maintain a steady pull
on the bandage, and then tie the bandage with the
knot directly over the pad.

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 Treatment by Elevation

• Raise injured extremity above the heart.

• Used together with direct pressure.
• Use an object to maintain elevation.
• Utilize bystanders.

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 …Elevation

• Unless there is evidence of a fracture, a severely

bleeding open wound of the hand, neck, arm or leg
should be elevated above the level of the victim’s
heart.
• Elevation uses the force of gravity to help reduce
blood pressure in the injured area and slows down
the loss , however, it should be aided by direct
pressure.

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 Treatment by Pressure Dressing

• Use a pressure dressing if bleeding is NOT controlled

with direct pressure
• Using a roller bandage, cover dressing completely,
using over lapping turns.
• Secure the bandage
• If blood soaks through the bandage, place additional
dressings and bandages over the wound.

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 Use a pressure point

• For bleeding not controlled by direct pressure and

elevation.
• Applying digital pressure to “pressure points” is
another method of controlling bleeding.
• This method uses pressure from the fingers, thumbs,
or the heel of the hand applied to an artery supplying
the wound.
• Apply pressure to appropriate pressure point.

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Temporal

Carotid

Brachial

Radial

Femoral

Posterior
/
Anterior
tibialas
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 Brachial Pressure Point

• Lower part of the upper arm.

• Above the elbow in the groove between
muscles.
• Using fingers or thumb.
• Apply pressure to the inside of the arm over
the bone.

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 Femoral Pressure Point

• Control severe bleeding of thigh and lower leg

• Front, center part of crease in the groin.

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 Tourniquet

What is tourniquet?
• A constricting band placed around an extremit
to stop arterial bleeding.
• Only used on an arm, forearm, thigh, or leg.
• Used when there is no time to control bleeding
• Used on an amputation of the arm, forearm,
thigh, or leg.

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• Direct pressure, elevation, pressure dressings
or pressure points may not stop some
bleeding.
• In these cases, a tourniquet may be
lifesaving.

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• It is best to avoid a tourniquet and use it only
as a last resort to save life
• There is always a risk that the tourniquet may
compromise the distal circulation of blood
leading to gangrene (tissue death) of the limb.
• However, if a tourniquet has to be used then
the following must be kept in mind:

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• The tourniquet should be at least 2(two) inches wide.
• If a proper tourniquet is not available, one can easily
use a towel , cravat, a BP cuff or any other material
available. as a substitute.
• The time of application of the tourniquet should be
noted on a prominent place over the victim’s limb or
body.

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 Tourniquet
• In combat, a tourniquet can be applied quickly
to control serious bleeding.
• Precaution: release the tourniquet every 15
minutes, and notify others as tourniquet is
applied not to forget in its applied site.
• Do not attempt to remove an object impeded
in the wound

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 Causes of Epistaxis :

• Trauma to the nose from nose picking, foreign

bodies, forceful nose blowing or any other external
injury
• Frequent upper respiratory tract infections.
• Vitamin C & K deficiency
• Use of blood thinning medications.
• High blood pressure.
• Blood clotting disorders

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• Leukemia
• Pregnancy
• Nose piercing
• Infection: AFI, typhus, influenza

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 Treatment of Epistaxis
• Do not panic Calm the patient; calm yourself .
• Remove any object if present inside the nose.
• Sit down and lean forward so the blood will drain out
of your nose instead of swallowing the blood back
into your throat.
• Pinch the nostrils together until bleeding stops
• Avoid strenuous activities after a nose bleed.
• Cold application –

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 Nasal Packing:
 Lower BP, d/c anticoagulant
 IV fluid, blood transfusion

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 Wound

What is wound?
• It is a break in the continuity of the tissue of
the body either internal or externally
• Allows bacterias to enter and cause infections.

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 Causes of wound
• Accidental falls
• Mis Handling of sharp objects
• Gunshot
• Burn
• Vehicle accident
• Animal bite ------------ etc

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 General Classification of wounds

• Open wound – Is a break in the skin or the

mucus membrane.
• Closed wound – Is injury to underlying tissue
with out a break in the skin or mucus
membrane.

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 Types of open wound

 Abrasion
 Involves outer layers of skin.
– Results when the skin is scraped against a
hard surface.
– Bleeding is small.
– High risk of contamination.

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 Incised wound

• Occurs when body tissue is cut on knives,

edges of metal, broken glass.
• Bleeding may be rapid and heavy.
• Deep cuts may damage muscles, tendons
and nerves.
• Smooth edges of wound.

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 Lacerations

 Usually caused when great force is exerted against

the body.
• It is irregular tearing of the soft tissues.
• Bleeding may be rapid and extensive.
• High risk of deep contamination and later infection.
• High chance of tissue destruction.
• by an object that tears tissues producing irregular
edges. e.g. glass,

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 Puncture wound

• Is produced by an object piercing the skin layers.

• Produced by objects such as bullet,
• Limited external bleeding.
• High chance of internal organs injury and internal
bleeding.
• Hazard of infection is increased.
• Tetanus may develop.

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 Avulsions

• It results when tissue is forcibly separated or torn

of the victim’s body.
• Heavy and rapid bleeding.
• It occurs in accidents such as motor vehicle,
gunshots, explosions, animal bites-----
• An avulsed body part may be reattached to a
victim’s body by a surgeon.

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 Dressing of wounds

• Clean wound-
 is a wound which is not infected with microorganisms
and doesn’t have pus.
 Eg -closed surgical wounds
• Purpose
 To keep the wound clean.
 To prevent further injury.
 To keep drugs in position.
 To keep edges of the wound together.
 To apply pressure.

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 Dressing of wounds

• Equipments
 sterile cotton, gauze.
 sterile forceps.
 sterile kidney dish, bowel (small)
 solutions.
 plaster & scissors.
 Bandage.

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 Dressing of wounds
• Procedure
Take a sterile forceps, clean the wound with cotton balls
soaked in antiseptic solution, starting from inside to the
outside.
Repeat cleaning at least 3 times & dry it by using gauze.
Apply medications if any, and dress the wound with the
gauze.
Make sure that the wound is properly covered
Fix dressing in place by using adhesive tape or bandage.

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 Dressing of wounds
Infected wound :- Bacterial organism is
present in the wound which presents sign of
infection, in flammation, purlent drainage, or
skin separation
• Purpose
To absorb discharge
To apply pressure to the area
To apply local medication
To prevent pain, swelling and injury

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 Dressing of wounds
• Procedure
First remove the outer layer of the old dressing.
Wear glove, remove the entire dressing by using a
forceps then discard the forceps.
Start cleaning the wound from the cleanest outer
part to the most contaminated (inner) by using
(H2O2).
Repeat the cleaning as necessary and dry it with
the same technique as above.
Dress the wound-cover it completely.
fix dressing in place with adhesive tape or
bandage.
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 Precautions in making wound dressing

• Wash hands thoroughly before & after

dressing.
• Wear gloves when touching blood and body
fluids mucous members or non-intact skin of
all clients when handling items or surfaces
soiled with blood or body fluids.

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 Precautions in making wound dressing

• Wear mask and protective eye wear as appropriate if

procedures commonly cause droplets or splasing of blood or
body fluids
• All articles, touching the wound, should be sterile
• If soakage is present dressing should be changed frequently.
• Cleansing of the wound should be done from the cleanest area
to the less clean area {center to periphery.}
• Separate instruments should be used for each dressing.
• Keep The forceps lower than the handles at all times this
prevents contamination by fluid traveling up to the hands and
nurses wrist and back to tip
• Saline should be used to remove adherent dressings

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