Bleeding

The heart needs a rich and well-distributed blood supply. Blood leaves each chamber through a one-way valve. Smaller blood vessels that connect the arteries and capillaries are arterioles. Capillaries are small tubes, with the diameter of a single red blood cell, that pass among all the cells in the body, linking the arterioles and the venules. Platelets are the key to the formation of blood clots. Blood clots are important to the formation of blood clots. The autonomic nervous system monitors the body’s needs and adjusts the blood flow by constricting or dilating blood vessels. If blood volume is significantly diminished and the system fails to provide sufficient circulation for every body part to perform its function, then hypoperfusion, or shock, results. Perfusion is the circulation of blood within an organ or tissue to allow it to meet the cells’ current needs for oxygen. The volume of blood for organs typically varies, but some organs do not tolerate interruption. These are some body systems that require blood and the length of time they can go without it. The heart can go 4 to 6 minutes, as well as the brain, which can go the same amount of time. The lungs can go for about 15 to 20 minutes without blood flow, while the kidneys can go up to 45 minutes. Skeletal muscles can last as long as 2 to 3 hours without blood.

Another word for bleeding is hemorrhage, and there are two types: internal and external. When treating external bleeding, it is important to determine how much blood loss there is. A typical adult man weighing 175 pounds (79 kg) has a total blood volume of about 10 to 12 pints (6 L). The body cannot tolerate an acute blood loss greater than 20% of this total blood volume, or more than 2 pints (1 liter) in the average adult. The word acute is important here because the body is resilient and can create blood rapidly when it is lost, which is why you can get a liter of blood drawn at a blood drive over 30 minutes but cannot do the same over a couple-minute period. When dealing with an infant, they show significant blood loss after only 3 to 6 oz (100 to 200 ml) because the typical one-year-old only has 27 oz of total blood. When a hemorrhage is occurring, the patient generally has poor appearance and no response to stimuli. Typical arterial bleeding is bright red because it is oxygen-rich and spurts in time with the pulse. Venous bleeding from an open vein is darker than arterial blood and can flow slowly or rapidly depending on the size of the vein and does not spurt. Bleeding from capillaries is dark red and oozes from a wound steadily but slowly. You need to be concerned about broken bones causing internal hemorrhage. If you suspect internal bleeding, treat for shock and promptly transport.

In most cases, external bleeding can be controlled simply by applying direct, local pressure to the bleeding site. If there is an object protruding from the wound, never remove it unless it is in the cheek and blocking the patient’s airway. Apply bulky dressings to stabilize the impaled object in place and apply pressure as best you can for at least 5 minutes. Once you have applied a dressing to control bleeding, create a pressure dressing to maintain the pressure by firmly wrapping a sterile, self-adhering roller bandage around the entire wound. Use 4 × 4 inch sterile gauze pads for small wounds and sterile universal dressings for larger wounds. Cover the entire dressing with the bandage above and below the wound and stretch the bandage tight enough to control bleeding. If bleeding oozes slowly through the dressing, then reinforce it by applying more dressings on top of it. Do not remove a dressing until a physician has evaluated the patient. Position the patient supine and keep the patient warm.

If direct pressure fails to immediately stop hemorrhage, then apply a tourniquet above the level of bleeding. Then consider a junctional tourniquet or wound packing with a hemostatic dressing if available. A hemostatic dressing is a dressing impregnated with a chemical compound that slows or stops bleeding by promoting clot formation. A tourniquet is often useful if a patient has substantial bleeding from an extremity injury. Do not apply over any joint; if one doesn’t help, try a second one. Never cover with a bandage, don’t loosen it, and mark the exact time. A junctional tourniquet should be applied to the groin or the axilla but can also be used as a pelvic binder.

When bleeding from the nose, ears, and mouth, there is a risk for airway obstruction or aspiration. Position the patient correctly and suction when indicated. Sometimes a nosebleed can cause blood loss great enough to send a person into shock. You can apply pressure with a rolled gauze bandage between the upper lip and gum while calming the patient. Bleeding from the nose or ears following a head injury may indicate a skull fracture. In these cases, do not attempt to stop the blood flow. Applying pressure could force the blood leaking through the ear or nose to collect within the head. This could increase the pressure on the brain and possibly cause permanent damage. If there is cerebrospinal fluid, you will see a yellowish halo. Also, a thing to keep in mind is that splinting will help with internal bleeding if there is any.