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Bleeding

Bleeding occurs when one or more blood vessels is damaged. Bleeding can be external from a wound or from the nose for instance, or it can be internal, when blood vessels insidethe body are damaged but the skin remains unbroken: this type of bleeding is harder to detect than external bleeding. There are three different types of bleeding:

There are three different types of bleeding:

• Arterial bleeding – bright red blood which spurts with each beat of the heart from damaged arteries (blood vessels which carry blood from the heart to the rest of the body).
• Venous bleeding – dark red blood which comes from veins (blood vessels that carry blood back to the heart). Blood loss may be severe but it occurs at a steady rate.
• Capillary bleeding – oozing blood from capillaries (tiny blood vessels found throughout the body). Only slight blood loss normally occurs.

The seriousness of the injury depends on the depth of the cut, the amount of bleeding, the time it takes to control the bleeding and the type of blood vessels damaged.

What are the possible complications of bleeding?

An average- sized adult has about 5 litres of blood and can safely lose half a litre. However, rapid loss of larger volumes of blood leads to a dramatic fall in blood pressure, general weakness, confusion and sweating, known as shock. In addition, there is a risk of infection with any bleeding injury, especially if a foreign object is present in the wound.

What should I do if someone is bleeding?

Be aware that coming into contact with blood and body fluids may expose you to infections such as hepatitis B and C, and HIV, so whenever possible, put on a pair of disposable, preferably sterile gloves before touching the person who is bleeding. If gloves are not available, use a thickly folded, smooth- textured cloth, such as a dish towel and wash your hands thoroughly before and after touching the person.

The aim of first- aid treatment of a bleeding wound is to stop or reduce blood loss and help the person cope with the effects of the blood already lost. Before giving any first aid, you should assess the degree of seriousness of the bleeding.

Major wound bleeding

• Phone 999 for an ambulance
• Check the injured person's ABC (see box bellow)
• If necessary, and you are trained to do so, perform cardiopulmonary resuscitation
• Check to see if an object, such as glass, is in the wound. Do not put direct pressure on a wound with an embedded object or a protruding bone. Instead, press down firmly on either side. If there are no embedded objects or broken bones, apply firm, direct pressure over a clean covering, if possible.
• Raise the injured body part above the level of the heart, while continuing to apply pressure
• Place a sterile dressing or clean piece of cloth over the wound and bandage or wrap it firmly, but not too tight so that it stops circulation. If the dressing becomes soaked with blood, do not remove it – this may remove any blood clot that has begun to form. Instead, add another dressing or piece of clean cloth on top.

ABC of first aid

Airway

Is the airway clear? If it is blocked: Place 2 fingers under the chin, put your other hand on the forehead, lift the jaw and tilt the head back slightly

Breathing

Is the person breathing? Look for chest movement, listen for breathing from the person's mouth, feel for the person's breath against your cheek

Circulation

Is the heart pumping blood around the body? Check the person's pulse in the neck, using finger tips (not thumbs).

Internal bleeding

Internal bleeding is always serious and requires immediate medical assistance. Causes of internal bleeding include bone fractures, ulcers, certain drugs, or a forceful external impact such as a road traffic accident. It can be difficult to know if internal bleeding is occurring, but signs to look out for include a fast weak pulse, marks or fresh bruises on the chest or abdomen, bleeding from mouth or blood in urine, confusion or restlessness, or pale appearance with cold, clammy skin.

If you suspect internal bleeding:

• Have the person lie down and raise and support their legs
• Phone 999 for an ambulance and check the person's ABC every 10 minutes
• If necessary and you are trained to do so, perform cardiopulmonary resuscitation

Minor external bleeding

Minor bleeding can usually be stopped by applying pressure to the wound:

• First, rinse the wound under running water to clean it
• Pat the wound dry with a sterile gauze swab or any clean, non-textured cloth
• Put a sterile dressing or a clean, non-textured cloth on the wound and apply firm pressure to control bleeding
• Cover the wound with an adhesive dressing or a piece of cloth that you can tie securely in place. If you can't stop the bleeding in a few minutes, seek medical help

Nosebleeds

Nosebleeds can occur spontaneously or when a person has banged their nose or been hit on the nose by someone else.

• Have the person sit down and loosen any tight clothing around the neck.
• While the person is leaning forward, pinch their nostrils just below the bony part of the nose. The person should be breathing through the mouth. Keep pinching for at least 10 minutes.
• If the bleeding hasn't stopped, continue pressure for another 10 minutes.
• If the nose is still bleeding after 30 minutes, seek medical help.

Bleeding from the mouth

Bleeding from the mouth can happen when a tooth is knocked out or a person bites their lip, tongue or cheek.

• Have the person sit down and lean their head forward, towards the injured side to let the blood drain out of their mouth. The person should be encouraged not to swallow the blood because it induces vomiting.
• Apply a sterile gauze pad or any clean non- textured cloth over the wound and have the person squeeze it to stop the bleeding.
• If the wound is large or the bleeding doesn't stop, seek medical help

What else can I do?

Bleeding injuries can happen anywhere, anytime. Proper first aid can significantly improve a person's chances of a full recovery. Consider taking a first aid course, where you can learn about providing first aid in a wide range of accidents and emergencies. Several organisations offer first aid courses, including vital instruction on cardiopulmonary resuscitation. You can contact St John Ambulance by calling 020 7278 7888 or the British Red Cross on 020 7235 5454.

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