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

2. 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

3. 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

4. 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

5. 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

6. 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-
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Department of Nursing

7. 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

8. 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

9. 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

10. 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

11. References:
Severe Bleeding - First Aid and Emergency Treatment Guide Medindia 
severebleeding
Department of Nursing
Department of Nursing