Bleeding I
Lukáš Dadák
Learning goals
̶ Student will learn the types of bleeding.
̶ Student will learn about the use of pressure bandage and
tourniquet.
Blood
̶ The content of the cardiovascular system
̶ Blood volume 4.5 - 6 l of blood
(65 - 75 ml / kg body weight)
Blood loss:
̶ Up to 15% of volume does not cause more serious changes
(minimal tachycardia, normal blood pressure, thirst)
̶ 15-30% of volume (tachycardia, tachypnea, narrowing of systolic-diastolic difference)
̶ 30-40% of volume (tachycardia, tachypnea, hypotension, prolonged capillary refill time)
̶ > 40% of the volume danger to life
(shock image, attenuation of consciousness, cold skin, BP not measurable)
̶ > 50% of the volume risk of death
https://www.healthindustryhub.com.au/biotechnology-news-trends/bluebirdbio-claims-
first-approval-for-gene-therapy/
According to the vessel
Types of Bleeding
https://www.firstaidforfree.com/what-are-the-different-types-of-bleeding-in-first-aid/
According to the vessel
Types of Bleeding
manifestation
• Internal
• External
• Traumatic
• Non-traumatic
• Arterial:
BRIGHT RED PULSING blood
• Venous:
DARK RED blood
flows slowly but continuously
• Capillary:
blood slowly seeps from the
wound
The Most Important Division
̶ Capillary
̶ Venous
Use a patch or a simple gauze
bandage.
Minor Masive
Life threatening
Call for help!
Must be stoped as soon as
possible!
https://emcrit.org/emcrit/severe-trauma-karim-brohi/
https://www.ns-healthcare.com/news/haemophilia-treatment-gene-therapy/#
Stop the BLEED
̶ B – Barrier
̶ L – Locate and Examine
̶ E - External Direct pressure
̶ E – Elevation
̶ D – Dressing
B – Barrier
̶ Your safety comes first!
̶ Avoid direct contact with foreign blood !!
̶ Protect yourself, use gloves!
̶ Improvised barrier aids:
̶ a plastic bag,
̶ a waterproof jacket.
https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=zm6160
L – Locate and Examine
̶ Try to calm the injured
̶ If necessary, remove clothing
̶ Find a source !!
̶ If there is a foreign object in the wound,
do not pull it out.
https://sielearning.tafensw.edu.au/MCS/FirstAid_Ultimo/firstaid/lo/5262/5262_02.htm
E - External Direct Pressure
̶ Squeeze the bleeding wound directly
(preferably through the dressing material,
but do not waste time looking for it).
̶ If there is a foreign object in the wound, apply direct pressure
around that object.
̶ If possible, you can ask the injured person to compress the wound
with his free limb (this will give you time to provide additional aids
for the final treatment)
https://www.spokanevalleyfire.com/learn-to-stop-the-bleed/
E – Elevation
̶ Elevation itself has a small effect.
̶ Lay down or sit the injured person - prevention of fainting.
̶ Raise the limb above the level of the heart after the final
bandage.
̶ Do not move fractured limbs.
D – Dressing
Applying a pressure bandage
Pressure bandage layers:
̶ cover layer (gauze, dressing material)
̶ pressure layer (undeveloped dressing
package applied directly to the bleeding site)
̶ fastening layer (bandage wrapped under
tension)
https://mladyzdravotnik.cz/prvni-pomoc/obvazy/
Pressure Bandage
̶ Do not apply to a foreign body in the wound or to an open
fracture with arterial bleeding !!
̶ in this case it is necessary to use a tourniquet and a sterile wound dressing
̶ NEVER take off pressure bandage when bleeding !!!!
̶ attach another package and wrap and pull with another bandage
Tourniquet
̶ In case of life-threatening bleeding:
̶ amputation
̶ crushing of limbs
̶ open fracture with massive bleeding
̶ repeatedly massively soaked pressure
bandage 3 or more times
Tourniquet
T. is attached :
• Through the clothes
• Above the site of injury
• On the limb:
• Arm
• Thigh
• Tighten until the injured area
stops bleeding.
Record attachment time !
Do not attach:
• through the joints
• through foreign bodies in the
wound
• through open fractures
• on the neck or torso
Tourniquet
scarf, strip of fabric
̶ width at least 5cm
(never thin laces, strings)
̶ apply approx. 5cm above
the wound (close to the heart)
Solid object
̶ attach under the knot,
̶ tighten by turning firmly
̶ fix
Record attachment time !
https://medical-dictionary.thefreedictionary.com/tourniquet
Pressure Points
Nowadays, a very controversial method of
stopping bleeding.
• It is very difficult for a layman to find
points at all.
• Pressure bandages or tourniquets work
better.
https://www.survivalkit.com/blog/stop-bleeding-by-pinching-these-universal-pressure-points/
Massive Bleeding from the Neck
̶ the artery bleeds from both ends
̶ the vein without flaps → risk of air intake
into the heart → air embolism → SCA
FA:
̶ compression
̶ lying position, call EMS
̶ compression until EMS arrives https://radiologykey.com/normal-cerebrovascular-anatomy-and-collateral-pathways/
Conclusion
External bleeding is stopped:
̶ Direct compression of vessels in a wound
̶ Applying a pressure bandage
̶ Loading a tourniquet
EMS is used for safe transport to the hospital.
Learning outcomes
̶ Student knows the types of external bleeding (according to blood
vessels and severity).
̶ Student is able to describe the use of pressure bandage and
tourniquet.
̶ Student justifies the positioning during massive bleeding from the
neck.
Literature
̶ AUSTIN, Margaret, Rudy CRAWFORD and Barry KLAASSEN.
First aid manual: the Authorised Manual of St John Ambulance, St
Andrew's First Aid and the British Red Cross. Revised 10th
edition. London: DK, 2016. 288 pp. ISBN 9780241241233.
Simulation Centre, Faculty of Medicine, Masaryk University
2020