FIRST AID and EMERGENCY NURSING University of Tabuk Faculty of Applied Medical Sciences Department of Nursing FIRST AID and EMERGENCY NURSING

HEMORRHAGE Loss of blood escaping from the circulatory system. Bleeding can occur internally, where blood leaks from blood vessels inside the body, or externally, either through a natural opening such as the mouth, nose, ear, urethra, vagina or anus, or through a break in the skin.  Hypovolemia is a massive decrease in blood volume, and the complete loss of blood, causing death, is referred to as exsanguination. Typically, a healthy person can endure a loss of 10–15% of the total blood volume without serious medical difficulties, and blood donation typically takes 8–10% of the donor's blood volume Department of Nursing Department of Nursing

Four Classes of Hemorrhage (according to: American College of Surgeons' advanced trauma life support (ATLS). Class I Hemorrhage Involves up to 15% of blood volume. No change in vital signs Fluid resuscitation is not usually necessary. Class II Hemorrhage  Involves 15-30% of total blood volume. Tachycardia is present Skin is pale, cold to touch. May exhibit slight changes in behavior. Fluid resuscitation with crystalloids (NSS or LR) solution is required. Blood transfusion is not typically required. Department of Nursing Department of Nursing

Involves loss of 30-40% of circulating blood volume. Class III Hemorrhage  Involves loss of 30-40% of circulating blood volume. Blood pressure drops Heart rate increases Peripheral hypoperfusion (shock), such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion are usually necessary. Class IV Hemorrhage Involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death. Department of Nursing Department of Nursing

The World Health Organization made a standardized grading scale to measure the severity of bleeding. Grade 0 no bleeding Grade 1 petechial bleeding; Grade 2 mild blood loss (clinically significant); Grade 3 gross blood loss, requires transfusion (severe); Grade 4 debilitating blood loss, retinal or cerebral associated with fatality Department of Nursing Department of Nursing

Causes Accidents/Falls Blow to the head Injuries, like scalp wounds Tooth Extraction  Certain medications  Illnesses like: Hemophilia- a medical condition in which the ability of the blood to clot. Scurvy- a disease caused by a deficiency of vitamin C, characterized by swollen bleeding gums and the opening of previously healed wounds. Scurvy- Department of Nursing Department of Nursing

Leukemia Peptic Ulcer Cancer Platelet disorder Thrombocytopenia- deficiency of platelets in the blood. This causes bleeding into the tissues, bruising, and slow blood clotting after injury. Aplastic Anemia- deficiency of all types of blood cell caused by failure of bone marrow development. Septicemia- Liver Disease Department of Nursing

Treatment Wash hands well before administering to patient Wear synthetic gloves  Make the victim lie down  Slightly elevate the legs  If possible keep the affected area elevated Remove any obvious debris/particle  Apply direct pressure using clean cloth/bandage Department of Nursing Department of Nursing

Apply pressure continuously for at least 20 minutes Do not remove the cloth to check the bleeding  Hold the bandage in place using an adhesive tape  If bleeding seeps through bandage, do not remove it  Add extra bandage on top of the first one  Apply direct pressure on the artery if necessary  The pressure points for arm--below arm- pit/above elbow  For leg--behind knee/near groin  Squeeze the artery keeping finger flat  Continue applying pressure on the wound  Once bleeding stops immobilize the affected part  Department of Nursing Department of Nursing

Epistaxis – Nosebleed Blood may come from the anterior or posterior portion of the nose. Most anterior nosebleeds respond to pressure. Intervention Instruct the patient to sit down and lean the head forward. Pinch the nostrils shut for at least 10 minutes Advise the patient not to blow or pick at the nose for several hours. Department of Nursing Department of Nursing

References: Severe Bleeding - First Aid and Emergency Treatment Guide Medindia http://www.medindia.net/patients/firstaid_ severebleeding Department of Nursing Department of Nursing