1Department of Orthopaedics, St Helier Hospital, Carshalton, UK Show Find articles by Will BJ Rudge 2Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK Find articles by Ben CJ Rudge 3National Clinical Director for Transplantation, Department of Health, London, UK Find articles by Chris J Rudge Author information Copyright and License information Disclaimer Copyright © 2010 by the Annals of The Royal College of Surgeons of England The majority of arterial bleeding from the peripheral vasculature can be controlled with relative ease by direct pressure. The most effective way of applying pressure is by hand, but this is not practical for prolonged periods. A traditional pressure dressing of gauze and bandage is often ineffective in providing point pressure and may result in a tourniquet effect as bandages are repeatedly tightened. We describe a simple dressing technique for providing localised pressure, using equipment readily available in any ward or emergency department (Fig. 1).  Initially, a small non-adherent dressing is placed over the site of bleeding. Then the lid of a small specimen pot is very firmly packed with cotton wool and positioned directly over the site where pressure is required (Fig. 2). This is secured in place using a bandage around the limb. During the application of the bandage, as it crosses over the lid it is twisted through 180° in order to provide pressure specifically over the bleeding point (Fig. 3). This gives excellent point pressure exactly where required, and can control bleeding without compromising distal blood flow. We have not found this technique previously described in the literature. It was initially developed for use in dialysis units to control excessive bleeding from arteriovenous fistulae but the authors have also used it successfully in various trauma situations, including radial and brachial artery injuries. It is effective, quick, simple to apply and safe, and provides control of bleeding until definitive intervention. Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England
When you lose more than a fifth of your blood, your blood pressure crashes and your heart struggles to pump a sufficient amount to your internal organs. This leads to a condition called hypovolemic shock, and ultimately to death if left untreated. Serious blood loss is always a medical emergency. But there are three different types of bleeding, and they all signify different things. They include: Arterial bleedingThe arteries carry oxygenated blood away from the heart and toward the internal organs—while veins carry oxygen-depleted blood back to the heart. This type of bleeding happens when there is a wound to a major artery. Blood pressure inside the arteries tends to be higher than that in the veins—and when a major artery is injured, that’s demonstrated in dramatic fashion. Arterial bleeding is characterized by pulsing spurts, sometimes several meters high. The blood in this kind of bleeding event is sometimes said to be bright red, because it’s oxygenated. However, the color of the blood can sometimes be difficult to discern. Because of the fast spurts, arterial bleeding is often the most difficult to control. To treat it, apply direct pressure. If possible, ask the patient to hold a thick pad or dressing in place while you secure it with roller gauze. Don’t lift the dressing to see if the bleeding has stopped—instead, lift your hand to see if blood is seeping through. Venous bleedingVeins carry deoxygenated blood back to the heart. The blood pressure in your veins is lower than that in your arteries; because of this, if you injure a major vein, the wound may ooze rather than spurting. Sometimes this blood is also noted to be darker in color than that of an arterial bleed—but again, this can be difficult to judge. While venous bleeding is not as fast and dramatic as arterial bleeding, it is just as serious. As with arterial bleeding, the way to treat it is to apply direct pressure. Capillary bleedingThis is bleeding of the tiny capillaries that exist close to the surface of the skin, as well as inside organs such as your lungs. Capillary bleeding is usually superficial. You may see a fast flow of blood at first, but it usually slows to a trickle and is easily managed. Often, capillary bleeding will stop on its own. If needed, applying a Band-Aid or other bandage can help stop it—just be careful not to get the sticky part of the Band-Aid on the cut. Capillary bleeding may not be a big deal, but heavier bleeding is always a medical emergency—and you should always call emergency services as soon as the bleeding is controlled. Sources
Bleeding (also known as hemorrhaging) often occurs after an injury. Additionally, it can be the result of a disease. Bleeding occurs when blood vessels become damaged. Bleeding injuries can happen on the outside of the body (external bleeding) or inside the body (internal bleeding). Minor bleeding injuries can heal on their own, when the body produces clots to stop the bleeding. However, when the bleeding is more severe and wont stop on its own, first aid becomes necessary. Treatment will depend on the type, severity, and cause of the injury. 3 Types of Bleeding.In general, there are 3 types of bleeding: arterial, venous, and capillary. As you might expect, they are named after the three different types of blood vessels: the arteries, veins, and capillaries. The 3 types of bleeding injuries have different characteristics. Arterial bleeding is usually the most severe. Blood may ‘spurt’ from a damaged artery in rhythm with the victim’s heartbeat. This is because the blood is under direct pressure from the heart’s pumping action. Arterial bleeding is an emergency and typically results in the most blood volume lost out of the 3 types of bleeding. Healthy arterial blood is often a bright red color, due to its high oxygen content. Venous bleeding can also be serious, as the veins also carry a high volume of blood. Unlike arterial bleeding, blood will not usually ‘spurt’ from a damaged vein. Instead, blood will flow out consistently. This is because the veins are not under direct pressure from the heart’s action. Despite this, venous injuries can still result in rapid blood loss. Since venous blood doesn’t have as much oxygen, it has a dark red appearance. Capillary bleeding occurs in all wounds. It is the least serious of the 3 types of bleeding, since it is the easiest to control and results in the least blood loss. Blood ‘trickles’ out of capillaries for a short while before the bleeding stops. External Bleeding vs Internal BleedingExternal bleeding and internal bleeding are similar in principle: a blood vessel becomes damaged and leaks blood out. However, they will present differently. A common example of external bleeding is a cut or puncture on the skin that blood will leak out of. The wounded area is clearly visible in this type of external injury. On the other hand, a common example of internal bleeding would be a bruise. Small blood vessels inside the body are leaking into the tissue. The normally dark red blood presents as a dark blue color through the translucent skin. However, internal bleeding is not always as easy to identify as a bump or bruise. Internal bleeding can be very serious. Depending on the type of internal injury, there may different signs to look for. Be aware of the signs of shock. Internal bleeding can show:
If the injured person has sustained a brain injury then the symptoms can be similar to a stroke. These include:
How to Treat BleedingAll wounds should be treated carefully. Different wounds will require different treatments, but you can follow these general guidelines. External bleeding First AidBefore you attempt to treat someone who is bleeding, be sure to take the necessary safety precautions:
Minor bleeding First AidTreating minor external bleeding is straightforward: clean the affected area with soap and water if possible. If soap and water are not available and the victim is still bleeding, clean the wound with a sterile gauze or similar item. Do not use a fabric that will leave lint or debris in the wound. Keep direct pressure on the wound, and dress it carefully. In most cases, minor bleeding can usually be stopped by keeping direct pressure on the wound. Since high-volume blood loss isn’t a risk, the top priority in this situation is to clean the wound to prevent infection, then stop the bleeding. Severe bleeding First AidWhen dealing with a severe bleeding injury the top priority is to bring the bleeding under control. As always, call 911, get your first aid kit, and wear your PPE. If the bleeding victim is conscious, have them keep pressure on their wound. Apply the dressing to the site firmly. Keep pressure on the area with the flat part of your fingers, or your palm. If the bleeding does not stop after dressing the wound, apply a second dressing over the first and add more pressure. Do not attempt to remove the first dressing, since that can result in more bleeding. In very severe cases, a tourniquet may be needed to stop bleeding. A tourniquet is a device that is placed on a bleeding limb, applying pressure to stop blood flow. Commercial tourniquets can be purchased, but you can make your own in an emergency if you don’t have one. To apply a tourniquet:
Keep in mind, a tourniquet is only a temporary solution for severe bleeding. A tourniquet should only be removed by a professional. Internal bleeding First AidInternal bleeding is a medical emergency. The best thing you can do to help someone with internal bleeding is to make sure the scene is safe, and that they are not at risk of further injury while waiting for an ambulance to arrive. Be prepared to help the victim if they go into shock. Keep the victim lying down on their back. Cover them to keep them warm, and be prepared to perform CPR if it is needed. |
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