Bleeding

Bleeding is the flow of blood from a blood vessel. Bleeding is distressing and if severe, it could lead to shock. Loss of around 30 % of the adult patient's blood (around 1.5 liters) could prove fatal. Hence it is important to halt bleeding immediately.

The bleeding may be external as from a wound or open fracture. This is obvious loss of blood. It may be internal as in spleen rupture, intracranial collection. This is not seen externally, but suspicion of such a bleed is very important. In fact, if a person with injury has weak peripheral pulses, an internal bleed should be immediately thought of.

The site of bleeding is also important. If it is arterial, it is bright red in color and spurts. It also reveals the pulsating flow. Venous flow is slow flowing and dark red in color. The capillary bleeds are just oozes and the flow is slow and even.

It is important for the rescuer to know that attempts to halt the bleeding immediately are of utmost importance. At the same time, wound, if present, should be handled with clean hands to minimize the infection. When blood loss continues, medical help is required.

General measures to be adopted are :
• Place the patient in a comfortable position. Elevate the leg end in order to increase the venous drainage to the heart. This will help decrease the shock.
• Wash hands and wear disposable sterile gloves. Place sterile gauze, clean cloth or pad over the wound and press firmly for at least 10 minutes. Apply firm dressing over the area.
• If bleeding continues, apply pressure on a main artery above site of bleeding with your fingertips.
• Watch out for shock.
• Covering him/her with blankets should decrease the patient's body heat loss.
• Maintain the airway patency.
• Some doctors advocate application of ice over the bleeding wound. It causes vasoconstriction and hence less bleeding. But it also decreases the formation of the clot.

Specific treatment:
• If the bleeding is minor and external, rinse it under free flowing water. Apply pressure over the wound with sterile gauze or pad. Put an adhesive antiseptic dressing.
• If there is a major external bleeding, apply direct pressure with sterile pads. If it is gaping, bring the two ends together before application of pressure over the wound. Remember to remove any foreign body. Immobilize the part. Reassure the patient. Loosen the clothes. Allow fresh air. Elevate the lower limbs and let the head be on the lower side. Cover the patient with warm blankets. If the bleeding continues, give pressure at the pressure points. These points are places where the artery comes in contact with the underlying bone and hence the artery can be compressed against it. A tourniquet may be used to control severe bleeds from major arteries in the limbs.
• If the bleeding is internal, keep the victim in a head low position. Reassure. Loosen the clothing. Warm blankets to cover the victim. Immobilize the part and elevate the limbs. Give cardio-respiratory resuscitation if required. Transport to the hospital immediately. DO NOT FEED THE PATIENT LEST ANESTHESIA IS NEEDED.