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BBLLEEEEDDIINNGG
LLeeaarrnniinngg oouuttccoommeess 
• Identify three types of bleeding. 
• Describe the types and severity of 
bleeding. 
• Explain the effect of severe blood loss 
on an infant and a child. 
• To identify the signs of internal 
bleeding. 
• Demonstrate how to control external 
bleeding.
TTYYPPEESS OOFF WWOOUUNNDDSS 
• WWhhaatt ttyyppeess ooff wwoouunnddss ccaann yyoouu tthhiinnkk ooff?? 
• BBRRUUIISSEESS OORR CCOONNTTUUSSIIOONNSS 
• LLAACCEERRAATTIIOONNSS 
• IINNCCIISSIIOONNSS 
• GGRRAAZZEESS 
• PPUUNNCCTTUURREE 
• GGUUNN SSHHOOTT
TTYYPPEESS OOFF BBLLEEEEDDIINNGG 
AArrtteerriiaall 
 ffrroomm aann aarrtteerryy uunnddeerr ddiirreecctt pprreessssuurree ffrroomm tthhee 
hheeaarrtt.. RRiicchh iinn ooxxyyggeenn ssaaiidd ttoo bbee bbrriigghhtt rreedd,, 
ssppuurrttss ffrroomm aa wwoouunndd…… 
VVeennoouuss 
 nnoott uunnddeerr ddiirreecctt pprreessssuurree ffoorrmm tthhee hheeaarrtt bbuutt mmaayy 
ccaarrrryy ssaammee vvoolluummee ooff bblloooodd aass aarrtteerriieess.. DDeepplleetteedd ooff 
ooxxyyggeenn ssoo iiss ssaaiidd ttoo bbee ddaarrkk rreedd,, mmaayy ‘‘oooozzee’’ 
pprrooffuusseellyy.. 
 ooccccuurrss iinn aallll wwoouunnddss,, aalltthhoouugghh bblloooodd lloossss mmaayy 
ssttaarrtt ooffff qquuiittee ffaasstt aatt ffiirrsstt,, bblloooodd lloossss iiss uussuuaallllyy 
sslliigghhtt.. 
CCaappiillllaarryy
BBLLEEEEDDIINNGG CCOONNTT.... 
HHOOWW MMUUCCHH BBLLOOOODD DDOO WWEE HHAAVVEE?? 
• VVaarriieess iinn rreellaattiioonn ttoo oouurr ssiizzee…… 
• RRuullee ooff tthhuummbb 11 ppiinntt ppeerr ssttoonnee iinn bbooddyy 
wweeiigghhtt……aavveerraaggee wweeiigghhtt 7700kkggss 
• AAvveerraaggee aadduulltt 88--112 ppiinnttss ((4..5 ttoo 6..5 lliittrreess))…… 
• CChhiillddrreenn hhaavvee lleessss ssoo tthheeyy ccaannnnoott aaffffoorrdd ttoo 
lloooossee tthhee ssaammee aammoouunntt…… 
• AAnn iinnffaanntt oonnllyy hhaass aarroouunndd 11 ppiinntt ooff bblloooodd,, ssoo 
tthheeyy ccaann oonnllyy lloooossee 11//33 ooff aa ppiinntt bbeeffoorree tthhee 
bblloooodd pprreessssuurree ffaallllss..
How much blood lloossss iiss ccrriittiiccaall 
TThhee bbooddyy ccaann ccoommppeennssaattee iiff iitt iiss lloossiinngg bblloooodd.. 
IItt ddooeess tthhiiss bbyy :: 
• CClloossiinngg ddoowwnn tthhee bblloooodd ssuuppppllyy ttoo nnoonn-- 
eemmeerrggeennccyy aarreeaass ooff tthhee bbooddyy ((iinncclluuddiinngg tthhee 
sskkiinn aanndd ddiiggeessttiivvee ssyysstteemm)) 
• SSppeeeeddiinngg uupp tthhee hheeaarrtt ttoo mmaaiinnttaaiinn bblloooodd 
pprreessssuurree..
How much blood lloossss iiss ccrriittiiccaall 
BBlloooodd vveesssseellss ccaann oonnllyy cclloossee ddoowwnn ssoo mmuucchh 
aanndd 
TThhee hheeaarrtt ccaann oonnllyy ggoo ssoo ffaasstt ssoo tthheerree iiss aa 
LLiimmiitt ttoo hhooww mmuucchh bblloooodd tthhee bbooddyy ccaann lloossee.. 
TThhee bbooddyy ccaann nnoo lloonnggeerr ccoommppeennssaattee aafftteerr 11//33 
ooff iittss bblloooodd hhaass bbeeeenn lloosstt.. 
AAfftteerr tthhiiss tthhee bblloooodd pprreessssuurree ffaallllss qquuiicckkllyy 
TThhee bblloooodd ssuuppppllyy ttoo tthhee bbrraaiinn ffaallllss aanndd ddeeaatthh 
wwiillll rreessuulltt
BBLLEEEEDDIINNGG CCOONNTT.... 
EEFFFFEECCTTSS OOFF BBLLOOOODD LLOOSSSS –– HHYYPPOOVVOOLLEEAAMMIICC 
SSHHOOCCKK 
BLOOD LOSS 10% 20% 30% 40%+ 
CONSCIOUSNE 
NORMAL MAY FEEL 
SS 
DIZZY STOOD 
UP 
LOWERED LOC 
RESTLESS, 
ANXIOUS 
UNRESPONSIV 
E 
SKIN NORMAL PALE CYANOSIS, 
COLD & 
CLAMMY 
SEVERE 
CYANOSIS, 
COLD & 
CLAMMY 
PULSE NORMAL 
(THIS IS 
AMOUNT 
DONATED) 
SLIGHTLY 
RAISED 
RAPID (OVER 
100/MIN) HARD 
TO DETECT 
UNDECTABLE 
BREATHING NORMAL SLIGHTLY 
RAISED 
RAPID DEEP SIGHING 
BREATHS (AIR 
HUNGER)
METHODS OOFF CCOONNTTRROOLLLLIINNGG 
EEXXTTEERRNNAALL BBLLEEEEDDIINNGG 
• PPrriimmaarryy ssuurrvveeyy 
• CCoorrrreecctt ccaassuuaallttyy ppoossiittiioonniinngg 
• EExxaammiinnee // EExxppoossee wwoouunndd…… 
• DDoo nnoott rreemmoovvee ffoorreeiiggnn oobbjjeeccttss…… 
• EElleevvaattiioonn…… 
• DDiirreecctt PPrreessssuurree,, aappppllyy ddrreessssiinnggss ((22 mmaaxx))…… 
• TThhiinnkk SSHHOOCCKK
PPRREESSSSUURREE PPOOIINNTTSS
IINNTTEERRNNAALL BBLLEEEEDDIINNGG 
• BBlloooodd iiss nnoott aaccttuuaallllyy lloosstt ‘‘eexxtteerrnnaallllyy’’ ffrroomm tthhee 
bbooddyy,, iitt iiss lloosstt oouutt ooff tthhee aarrtteerriieess aanndd vveeiinnss ssoo 
sshhoocckk ccaann qquuiicckkllyy ddeevveelloopp 
• CCaann bbee ddiiffffiiccuulltt ttoo rreeccooggnniissee iinn iitt’’ss eeaarrllyy 
ssttaaggeess 
• CCaann bbee ooff aa rreessuulltt ooff ddiirreecctt ttrraauummaa ttoo cchheesstt oorr 
aabbddoommeenn 
• CCaann hhaappppeenn ssppoonnttaanneeoouussllyy ii..ee.. bblleeeeddiinngg iinnttoo 
tthhee ssttoommaacchh ffrroomm aann uullcceerr oorr wweeaakk aarrtteerryy
IINNTTEERRNNAALL BBLLEEEEDDIINNGG 
SSIIGGNNSS && SSYYMMPPTTOOMMSS 
• HHiissttoorryy…… 
• SSiiggnnss aanndd SSyymmppttoommss ooff SShhoocckk…… 
• PPaaiinn…… 
• BBrruuiissiinngg aanndd // oorr sswweelllliinngg…… 
• OOtthheerr ssyymmppttoommss rreellaatteedd ttoo tthhee ssiittee ooff 
bblleeeeddiinngg ((ii..ee.. ddiiffffiiccuullttyy iinn bbrreeaatthhiinngg iiff tthhee 
bblleeeeddiinngg iiss iinn tthhee lluunngg))..
IINNTTEERRNNAALL BBLLEEEEDDIINNGG 
CCOONNTT…… 
Bleeding Appearance Possible causes 
from 
Bleeding from the lower 
bowel/rectum. Possibly 
haemorrhoids or injury. 
Bleeding from the large 
intestines/bowel 
Bright red fresh blood 
Black ‘offensive smelling’ stools 
Anus 
Menstruation, miscarriage, 
injury or disease to the vagina 
or womb. 
Vagina Fresh blood or clots 
Bleeding in the kidneys or 
bladder. 
Urethra Smoky red colour 
Bleeding in the lungs. 
Bleeding in the stomach. 
Bright red, frothy 
Vomited, or brown ‘coffee grounds’ 
appearance 
Mouth 
Nose bleed. 
Fractured skull, leaking 
cerebrospinal fluid from 
around the brain. 
Bright red / clots 
Blood with a ‘watered down’ appearance 
Nose 
Perforated ear drum, fractured 
skull. 
Fractured skull, leaking 
cerebrospinal fluid from 
around the brain. 
Bright red / clots 
Blood with a ‘watered down’ appearance 
Ear
Bleeding

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Bleeding

  • 2. LLeeaarrnniinngg oouuttccoommeess • Identify three types of bleeding. • Describe the types and severity of bleeding. • Explain the effect of severe blood loss on an infant and a child. • To identify the signs of internal bleeding. • Demonstrate how to control external bleeding.
  • 3. TTYYPPEESS OOFF WWOOUUNNDDSS • WWhhaatt ttyyppeess ooff wwoouunnddss ccaann yyoouu tthhiinnkk ooff?? • BBRRUUIISSEESS OORR CCOONNTTUUSSIIOONNSS • LLAACCEERRAATTIIOONNSS • IINNCCIISSIIOONNSS • GGRRAAZZEESS • PPUUNNCCTTUURREE • GGUUNN SSHHOOTT
  • 4. TTYYPPEESS OOFF BBLLEEEEDDIINNGG AArrtteerriiaall  ffrroomm aann aarrtteerryy uunnddeerr ddiirreecctt pprreessssuurree ffrroomm tthhee hheeaarrtt.. RRiicchh iinn ooxxyyggeenn ssaaiidd ttoo bbee bbrriigghhtt rreedd,, ssppuurrttss ffrroomm aa wwoouunndd…… VVeennoouuss  nnoott uunnddeerr ddiirreecctt pprreessssuurree ffoorrmm tthhee hheeaarrtt bbuutt mmaayy ccaarrrryy ssaammee vvoolluummee ooff bblloooodd aass aarrtteerriieess.. DDeepplleetteedd ooff ooxxyyggeenn ssoo iiss ssaaiidd ttoo bbee ddaarrkk rreedd,, mmaayy ‘‘oooozzee’’ pprrooffuusseellyy..  ooccccuurrss iinn aallll wwoouunnddss,, aalltthhoouugghh bblloooodd lloossss mmaayy ssttaarrtt ooffff qquuiittee ffaasstt aatt ffiirrsstt,, bblloooodd lloossss iiss uussuuaallllyy sslliigghhtt.. CCaappiillllaarryy
  • 5. BBLLEEEEDDIINNGG CCOONNTT.... HHOOWW MMUUCCHH BBLLOOOODD DDOO WWEE HHAAVVEE?? • VVaarriieess iinn rreellaattiioonn ttoo oouurr ssiizzee…… • RRuullee ooff tthhuummbb 11 ppiinntt ppeerr ssttoonnee iinn bbooddyy wweeiigghhtt……aavveerraaggee wweeiigghhtt 7700kkggss • AAvveerraaggee aadduulltt 88--112 ppiinnttss ((4..5 ttoo 6..5 lliittrreess))…… • CChhiillddrreenn hhaavvee lleessss ssoo tthheeyy ccaannnnoott aaffffoorrdd ttoo lloooossee tthhee ssaammee aammoouunntt…… • AAnn iinnffaanntt oonnllyy hhaass aarroouunndd 11 ppiinntt ooff bblloooodd,, ssoo tthheeyy ccaann oonnllyy lloooossee 11//33 ooff aa ppiinntt bbeeffoorree tthhee bblloooodd pprreessssuurree ffaallllss..
  • 6. How much blood lloossss iiss ccrriittiiccaall TThhee bbooddyy ccaann ccoommppeennssaattee iiff iitt iiss lloossiinngg bblloooodd.. IItt ddooeess tthhiiss bbyy :: • CClloossiinngg ddoowwnn tthhee bblloooodd ssuuppppllyy ttoo nnoonn-- eemmeerrggeennccyy aarreeaass ooff tthhee bbooddyy ((iinncclluuddiinngg tthhee sskkiinn aanndd ddiiggeessttiivvee ssyysstteemm)) • SSppeeeeddiinngg uupp tthhee hheeaarrtt ttoo mmaaiinnttaaiinn bblloooodd pprreessssuurree..
  • 7. How much blood lloossss iiss ccrriittiiccaall BBlloooodd vveesssseellss ccaann oonnllyy cclloossee ddoowwnn ssoo mmuucchh aanndd TThhee hheeaarrtt ccaann oonnllyy ggoo ssoo ffaasstt ssoo tthheerree iiss aa LLiimmiitt ttoo hhooww mmuucchh bblloooodd tthhee bbooddyy ccaann lloossee.. TThhee bbooddyy ccaann nnoo lloonnggeerr ccoommppeennssaattee aafftteerr 11//33 ooff iittss bblloooodd hhaass bbeeeenn lloosstt.. AAfftteerr tthhiiss tthhee bblloooodd pprreessssuurree ffaallllss qquuiicckkllyy TThhee bblloooodd ssuuppppllyy ttoo tthhee bbrraaiinn ffaallllss aanndd ddeeaatthh wwiillll rreessuulltt
  • 8. BBLLEEEEDDIINNGG CCOONNTT.... EEFFFFEECCTTSS OOFF BBLLOOOODD LLOOSSSS –– HHYYPPOOVVOOLLEEAAMMIICC SSHHOOCCKK BLOOD LOSS 10% 20% 30% 40%+ CONSCIOUSNE NORMAL MAY FEEL SS DIZZY STOOD UP LOWERED LOC RESTLESS, ANXIOUS UNRESPONSIV E SKIN NORMAL PALE CYANOSIS, COLD & CLAMMY SEVERE CYANOSIS, COLD & CLAMMY PULSE NORMAL (THIS IS AMOUNT DONATED) SLIGHTLY RAISED RAPID (OVER 100/MIN) HARD TO DETECT UNDECTABLE BREATHING NORMAL SLIGHTLY RAISED RAPID DEEP SIGHING BREATHS (AIR HUNGER)
  • 9. METHODS OOFF CCOONNTTRROOLLLLIINNGG EEXXTTEERRNNAALL BBLLEEEEDDIINNGG • PPrriimmaarryy ssuurrvveeyy • CCoorrrreecctt ccaassuuaallttyy ppoossiittiioonniinngg • EExxaammiinnee // EExxppoossee wwoouunndd…… • DDoo nnoott rreemmoovvee ffoorreeiiggnn oobbjjeeccttss…… • EElleevvaattiioonn…… • DDiirreecctt PPrreessssuurree,, aappppllyy ddrreessssiinnggss ((22 mmaaxx))…… • TThhiinnkk SSHHOOCCKK
  • 11. IINNTTEERRNNAALL BBLLEEEEDDIINNGG • BBlloooodd iiss nnoott aaccttuuaallllyy lloosstt ‘‘eexxtteerrnnaallllyy’’ ffrroomm tthhee bbooddyy,, iitt iiss lloosstt oouutt ooff tthhee aarrtteerriieess aanndd vveeiinnss ssoo sshhoocckk ccaann qquuiicckkllyy ddeevveelloopp • CCaann bbee ddiiffffiiccuulltt ttoo rreeccooggnniissee iinn iitt’’ss eeaarrllyy ssttaaggeess • CCaann bbee ooff aa rreessuulltt ooff ddiirreecctt ttrraauummaa ttoo cchheesstt oorr aabbddoommeenn • CCaann hhaappppeenn ssppoonnttaanneeoouussllyy ii..ee.. bblleeeeddiinngg iinnttoo tthhee ssttoommaacchh ffrroomm aann uullcceerr oorr wweeaakk aarrtteerryy
  • 12. IINNTTEERRNNAALL BBLLEEEEDDIINNGG SSIIGGNNSS && SSYYMMPPTTOOMMSS • HHiissttoorryy…… • SSiiggnnss aanndd SSyymmppttoommss ooff SShhoocckk…… • PPaaiinn…… • BBrruuiissiinngg aanndd // oorr sswweelllliinngg…… • OOtthheerr ssyymmppttoommss rreellaatteedd ttoo tthhee ssiittee ooff bblleeeeddiinngg ((ii..ee.. ddiiffffiiccuullttyy iinn bbrreeaatthhiinngg iiff tthhee bblleeeeddiinngg iiss iinn tthhee lluunngg))..
  • 13. IINNTTEERRNNAALL BBLLEEEEDDIINNGG CCOONNTT…… Bleeding Appearance Possible causes from Bleeding from the lower bowel/rectum. Possibly haemorrhoids or injury. Bleeding from the large intestines/bowel Bright red fresh blood Black ‘offensive smelling’ stools Anus Menstruation, miscarriage, injury or disease to the vagina or womb. Vagina Fresh blood or clots Bleeding in the kidneys or bladder. Urethra Smoky red colour Bleeding in the lungs. Bleeding in the stomach. Bright red, frothy Vomited, or brown ‘coffee grounds’ appearance Mouth Nose bleed. Fractured skull, leaking cerebrospinal fluid from around the brain. Bright red / clots Blood with a ‘watered down’ appearance Nose Perforated ear drum, fractured skull. Fractured skull, leaking cerebrospinal fluid from around the brain. Bright red / clots Blood with a ‘watered down’ appearance Ear