Loss of blood
Blood is the medium in which oxygen is carried to all the living tissues of the body. Therefore, the loss of any great quantity of blood represents a threat to life itself and should always be treated as a medical emergency. The body has a very sophisticated clotting mechanism that can seal up small lesions quickly and efficiently. Furthermore, a healthy adult may suffer no ill effects even after a loss of 850 ml or 1"12pints.
The difficulty in an emergency situation is that it is often impossible to assess accurately the volume of blood that has been lost. It is therefore advisable for the first arider to take prompt action to stop bleeding wherever possible.
The type of bleeding suffered by a casualty will be dependent on the type of wound sustained. An open wound is one in which there is a visible break in the skin, whereas a closed wound causes the escape of blood from the circulation into the body tissues. The first kind of bleeding is known as external bleeding, and the second is known as internal bleeding.
Emergency Action for bleeding
Wherever possible, try to be aware of your own safety. If you have any open wounds, try to ensure that there is a barrier between yourself and the casualty's wound before dealing
1. Locate and examine the wound for foreign bodies such as glass. Remove any clothing obstructing your access to the wound. If the wound appears to be free of glass, etc, apply pressure directly onto the wound, preferably using sterile or clean padding. If the wound is long, or there is a foreign body protruding from it, press down firmly on eitherside of the wound whilst trying to keep the edges as close together as possible. Apply pressure with a clean pad of material or sterile dressing, but this is not essential and it is important not to waste time searching for one.
2. Elevate the affected part above the level of the casualty's heart - you may find it easier to lie the casualty down. Do not handle a limb you suspect may be fractured other than attempting to stop bleeding.
3 Lay the casualty down and continue to apply pressure for at least 10 minutes. If your original pad or dressing has become saturated, do not remove it. If possible wrap more
bandages round it firmly, but not so tightly as to obstruct circulation. Scarves, clean sheets and handkerchiefs, etc, make suitable substitutes for bandages.
If the wound contains a foreign body:
1. Make no attempt to pull out the foreign body as this could exacerbate bleeding and shock - it may be acting as a partial 'plug'. However, if it appears loose, it may be possible to flush it out under running water, but do not waste too much time attempting this.
2. Elevate the limb and then apply pressure on the edges of the wound. If you have access to sterile gauze pads or any other suitable material, try to build up padding on either side of the protruding object until this is higher than the object itself. (Leave the object exposed until this is achieved.)
3. Bandage finely on either side of the wound but avoid pressure on the wound and embedded object.
4. Cover the wound loosely with sterile dressings or clean material, elevate the limb and seek medical help immediately.
Remember: Your priorities are
- To control bleeding and prevent shock.
- To prevent or minimize infection.
- To secure medical help for your casualty as quickly as possible.
If despite your best efforts the casualty begins to display symptoms of shock then treat as follows:
1. Identify and treat the cause of shock, if possible.
2. Lay the casualty flat on the floor as comfortably as possible.
3. Elevate his or her legs above head height (unless you suspect a fracture).
4. Loosen any restrictive articles of clothing.
5. Keep the casualty warm by covering with blankets, rugs or coats, but do not apply a direct heat source such as a hot-water bottle.
6. Keep a check on the casualty's vital signs - breathing and circulation - and level of consciousness. Be ready to resuscitate if necessary (see ABC of resuscitation on p.442).
Internal bleeding may result from injury such as bone fracture or severe bruising, but it can also occur spontaneously as the result of a stomach ulcer or bleeding or seaearl other medical emergencies. In the absence of any visible blood, the diagnosis is often a hard one to make, but signs and symptoms of shock will emerge if internal bleeding is significant. Sometimes there will be blood present at body orifices, and there may be bruising. Always treat for shock and summon medical help immediately.