Emergency Care for External Bleeding

The most effective way to control bleeding is by applying direct pressure to the bleeding site. The pressure functions by either slowing down or stopping the flow of blood. The amount of pressure required depends on the type of bleeding. A small amount of pressure is usually sufficient to control capillary bleeding, whereas significant pressure is often required to control arterial bleeding.

If bleeding cannot be controlled with direct pressure, a pressure point can be used. A pressure point is a site on the body where an artery lies close to the surface of the skin and can be compressed against an underlying bone. See Figure 2 for an illustration of pressure points. Using a pressure point helps slow or stop the flow of blood from the wound. The pressure points used most often are on the brachial and femoral arteries. The brachial artery is located on the inside of the upper arm midway between the elbow and shoulder. Squeezing the brachial artery * helps control severe bleeding in the arm. The femoral artery is located in the groin and helps control severe bleeding in the leg.

The specific steps for controlling bleeding are:

1. Apply direct pressure to the wound with a clean covering such as a large, thick gauze dressing (Figure 3, A). If gauze is not available, a clean material such as a sanitary napkin, washcloth, handkerchief, or sock can be used. If the wound is located on an extremity, elevate the limb while continuing to apply direct pressure.

2. Apply additional dressings if needed. If the dressing soaks through, apply another dressing over the first one and continue to apply pressure (Figure Ç, B). (Never remove a dressing once it has been applied because this could result in more bleeding.) If the bleeding cannot be controlled with direct pressure, apply pressure to the appropriate pressure point while continuing to apply direct local pressure.

3. Apply a pressure bandage. When bleeding has been controlled, apply a bandage snugly over the dressing to maintain pressure on the wound (Figure З, C).

4. Transport the patient to an emergency care facility, or, if the case is serious enough, activate the local emergency medical services.

Nosebleeds

A nosebleed, or epistaxis, is a common form of external bleeding and is usually not serious but is more of a nuisance. Nosebleeds are usually caused by an upper respiratory infection but can also result from a direct blow from a blunt object, hypertension, strenuous activity, and exposure to high altitudes.

Wounds

Awound is a break in the continuity of an external or internal surface, caused by physical means. Wounds are either open or closed.

Open Wounds, An open wound is a break in the skin surface or mucous membrane that exposes the underlying tissues. Because the skin is broken, hemorrhaging and wound contamination are primary concerns with open wounds. Open wounds include incisions, lacerations, punctures, and abrasions. An individual with an open wound should receive prompt medical attention by a physician if any of the following occur: spurting blood; bleeding that cannot be controlled; a break in the skin that is deeper than just the outer skin layers; embedded debris or an embedded object in the wound; involvement of nerves, muscles, or tendons; and occurrence on the mouth, tongue, face, genitals, or other area where scarring would be apparent.

Incisions and Lacerations. An incision is a clean, smooth cut caused by a sharp cutting instrument such as a knife, razor, or a piece of glass. Deep incisions are accompanied by profuse bleeding; in addition, damage to muscles, tendons, and nerves may occur. Because the edges of the wound are smooth and straight, incisions usually heal better than lacerations.

A laceration is a wound in which the tissues are torn apart, rather than cut, leaving ragged and irregular edges. Lacerations are caused by dull knives, large objects that have been driven into the skin, and heavy machinery. Deep lacerations result in profuse bleeding, and a scar often results from the jagged tearing of the tissues.