3. Wounds & Bleeding (2).pptx

June, 2021 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Basic First Aid and Emergency Care
By:- Ame Mehadi (BSc, MSc)
WOUNDS & BLEEDING

Objectives
Define wound and bleeding.
Identify common causes of wound
Classify different types of wound.
Give first aid measures for different types of wounds.
Apply first aid measures to stop severe bleeding.
Explain the preventive measures of contamination and infection of wounds.

Handling an Exposure Incident
If the exposure incident occurred in a workplace setting,
►notify your supervisor and follow your company’s exposure control plan for
reporting the incident and receiving post-exposure follow-up care.
Some workplaces have additional requirements dictated by regulations and
legislation:
►ensure that you are aware of any local, provincial/territorial, or organizational laws
and regulations that apply to you.

Wound
Wound is a break in to the continuity of the tissue of the body either
internally or externally which allows the blood to escape, entrance of germs
and causing infections.
Can be accidental or intentional such as abrasion (rubbing off the skin’s
surface); a puncture wound (stab wound); or laceration (a wound with torn,
ragged edges).
A wound that occurs accidentally is contaminated whereas intentional
wounds are made under sterile conditions.

Wound
The aim of dealing with wounds:
►To control bleeding
►To prevent the wound from further injury & contamination
►To keep edges of the wound together.

Wound
Cause
►Wound can be caused secondary to planned therapy such as surgical incisions,
needle introduction or an unintentionally results from external physical forces.
►The most common accidents resulting in open wounds are:
 Fall, Direct blowing
 Animal or human bite
 Machinery, weapon
 Motor vehicle accidents
 Mishandling of sharp tools

Common causes of wound
Accident with sharp object such as knife, blade
Sudden attack with stone
Accident from gun shot
Accidents by vehicles and other machineries
Falling from elevated places
Stabbed with cattle horn
Accident from animals (domestic or wild) dog bite, snake bite etc.
7

Consequences of wound accident
Pain
Hemorrhage -
Infection (sepsis)
Septicemia
Shock – septic or hypovolemic/hemorrhagic
Disabilities
Scar
Death… etc
8

WOUND CLASSIFICATION
I. Based on cleanness
►Aseptic wound – has a discharge that may be fresh blood
►Septic wound- has discharge like pus, exudates and dead tissue.
II. Based on opening of skin
►Closed wound: - involves injury to the underlying tissue with out a break to
the skin and mucus membrane.
►Open wound: - is a break in the skin and/or mucus membrane.
9

WOUND CLASSIFICATION ……
III. Based on tissue damage
• Abrasion
• Incision
• Laceration
• Puncture (stab)
• Avulsion
• Contusion (bruise)
***All of these are types of open wounds***
10

WOUND CLASSIFICATION
IV.Based on invading of micro organisms
►Clean wound- is no containing pathogenic organisms or the wound heals with out
infection.
►Clean contaminated wound:- is made under aseptic conditions but it involves a body
that normally harbours micro – organisms
► Contaminated wound: - is a wound in which potential for infection is relatively great
such as open, accidental or traumatic wound.
►Dirty & infected wound: - is traumatic wound with retained dead tissue or
intentional wound created in situations where purulent drainage was present.
11

Abrasions
is a superficial and minor wound in which the surface
of the skin or mucus membrane is worn away by
rubbing or scraping.
Abrasions or grazes are superficial wounds,
only the outermost layer of the skin (the epidermis) is
rubbed away.
The outer layers of the protective skin are damaged.
Usually
►results when the skin is scraped against a hard surface.
►Bleeding is limited.
►Danger of contamination and infection is high.

Incision
Incised wound is wound made by clean cut with
sharp instrument such as knives, rough edges of
metal, broken glass, or other sharp objects.
is relatively a clean wound.
Characteristics
►Bleeding may be rapid and heavy.
►Deep cuts may damage muscles, tendons & nerves
►No bruising of wound edges occurs
►Wound is usually linear

 First aid measures
►The first step is to stop the bleeding – Apply pressure on the
incised area.
►Place clean sterile absorbent gauze or a cloth over the wound.
►Keep it pressed for some time.
►Press it with your fingers or a clean cloth.
►If the wound is on the leg or on hands, keep it elevated above
the heart level to reduce the flow of blood near the cut.
►Clean the wound with just plain water to prevent infection.
►It will also help to remove dirt and debris.
►If the wound is still bleeding severely you probably need to
consult a doctor immediately.
►If incised wound is on leg or hand, put a tourniquet above the
wound, but loose the tourniquet often to prevent cutting off of
blood circulation.

Laceration
Laceration wound displays jagged, irregular, or blunt
tearing or breaking of the soft tissues, and usually caused
when great force exerted against the body.
Characteristics
►Rapid and extensive bleeding
►Destruction of tissue is greater than that of wound in a cut
►Deep contamination of the wound increases the chance for later
infection.

Laceration…..
First aid measures
►Stop bleeding immediately.
►Cover the wound with gauze and apply pressure and elevate the
limb if not contraindicated.
►Lay the victim quiet
►If the wound is still bleeding severely after ten minutes of
pressure, get medical attention.
►Dress the wound to prevent contamination and infection.

Punctures
 is the wound made by:
►accidentally or deliberately sharp instrument;
►an object piercing skin layers, creating a small hole in the tissues.
►pointed objects like bullets, pins, nails and splinters
 Characteristics
►Limited external bleeding
►Damage to internal organ causes internal bleeding
►Increased risk of infection due to lack of flushing action of bleeding
►Tetanus may develop.
►Stop the bleeding – Apply gentle pressure with a bandage or clean
cloth.
►Clean the wound – Rinse the wound with clear water.
►Clean the area around the wound with soap and a washcloth.

Avulsions
An avulsion involves the tearing or forcible
separation of part of body structure.
Avulsions can be minor, such as slamming a
finger in a door and crushing the tip, or life-
threatening, such as the amputation of an arm
or leg in an industrial or motor vehicle
accident.
Characteristics
►Occurs in accidents such as motor vehicle, gunshots,
explosions, animal bites and other crushing injuries.
►An incised and lacerated wound
►Heavy and rapid bleeding

Avulsions
►First stop the bleeding
►If the victim is bleeding heavily, has lost a limb or is
unconscious, call for ambulance.
►Apply direct pressure using sterile gauze or as clean a piece
of cloth
►Find the missing piece of tissue.
►After you find the body part (or that large chunk of skin),
don’t try to clean it, but handle it with clean hands, gloves or
a cloth to decrease risk of infection.
►Wrap it in sterile or clean gauze and put it in a plastic bag.
►Place that bag on top of some ice—do not put the tissue
directly onto the ice.
►May be reattached by a surgeon
►Send the body part along with victim to the hospital.

1/10/2024 20

Some DO NOTs:
Do NOT assume that a minor wound is always clean.
Do NOT breathe on an open wound.
Do NOT try to clean a major wound.
Do NOT remove deeply stuck object – Seek medical attention
Do NOT push or pick debris from a wound – Seek medical attention.
Do NOT push body parts back in – But cover them with clean material until
medical help arrive.

Closed wounds
injury to underlying tissue without a break in the skin or mucus membranes
soft tissue damage present;
may have internal injury and bleeding.
Characteristics of closed wound
►may occur anywhere with the body.
►There is no break in the skin.
►Blood is not lost through the skin, but may flow through outer openings of body
cavities.
►less likely to become infected than open wounds, since they are subject to less
contamination.
►Many closed wounds are relatively small injuries involving soft tissue- the familiar
black eye is an example.

Closed wounds …..
Causes
►external forces such as fall or other accidents.
►closed fracture which is mishandled or is moved before applying splints properly.
►tissue damage and any bleeding occur below the surface.
►The simplest closed wound is a bruise.
►violent force hitting the body

Closed wounds ……
Sign and Symptoms
►Cold, clammy, pale skin
►Very rapid but weak pulse
►Tachypnea,
►Dizziness
►Pain and tenderness
►Restless
►Thirsty
►Hemoptysis
►Hematemesis
►Melena
►Hematuria
►Swelling
►Dislocation
►Deformity

Closed wounds ……
First Aid and Emergency cares
►Maintain open air ways, initiate artificial respiration if indicated
►If a closed fracture is suspected, immobile the affected part.
►If an internal injury is suspected, get medical for the victim as soon as possible.
►If the victim must be moved, carefully transport in lying position; give special
attention to preventing shock.
►Do not give fluids by mouth to victim suspected of having
 internal bleeding and
 associated closed fracture.

BLEEDING
Bleeding is the loss of blood from blood vessels any where in the body.
Categorized in to
►External:
 Visible bleeding from the injured body parties
►Internal:
 May be hidden within the torso or even in the extremities secondary to
fractures
1/10/2024 26

Internal bleeding
 Bleeding inside body cavity may follow an injury,
such as a fracture or a penetrating wounds, but can
also occur spontaneously for example, bleeding from
a stomach ulcer.
 The main risk from internal bleeding is shock and
pressure from hematoma to the target organs.
 Check for any bleeding from body openings (orifices)
such as the ear, mouth, urethra, or anus.

© 2019, Jimma University
School of Nursing and Midwifery.
By:- Ame Mehadi (BSc, MSc) 28
Internal bleeding
Sign & symptoms of internal
bleeding
►Initially, pale, cold, clammy skin.
►If bleeding continues, skin may turn
blue grey(cyanosis).
►Rapid, weak pulse
►Thirst
►Rapid, shallow breathing
►Confusion, restlessness, and irritability.
►Possible collapse and unconsciousness
►Bleeding from body openings
(orifices)
Signs and symptoms of life-
threatening internal bleeding
include the following:
►Bruising in the injured area
►Soft tissues (e.g., the
abdomen)that are tender, swollen,
or hard
►Blood in saliva or vomit
►Pain
►Severe thirst, nausea, and
vomiting
►Anxiety

Internal bleeding
Control Methods For Internal Bleeding:
►What to Do: For severe internal bleeding, follow these steps:
 Monitor ABC’s (Airway Breathing Circulation)
 Keep the victim lying left
 Elevate the victim’s legs –shock position
 Seek immediate medical care

SOURCES OF BLEEDING ……
 Three types of bleeding and the type can usually be identified by how fast the blood
flows:
30
• Venous bleeding
– Veins transport blood under low
pressure
– Bleeding from a vein is flowing type.
– Flows at steady (slow) rate.
– Dark red or maroon in color
– Easier to control than arterial
bleeding.
• Capillary bleeding
– Capillaries also carry blood under low pressure.
– usually slow and oozing in nature
─ Often clots spontaneously
─ has a higher risk of infection.
• Arterial bleeding
– Arteries transport blood
under high pressure
– is spurting type
– Rapid, profuse and
pulsating
– Difficult and hard to control
– Bright red in color

First Aid for Severe Bleeding
Severe Bleeding Need Immediate Action:
►to stop any large rapid loss of blood and
►to treat for shock and prevent death.
Techniques to stop severe bleeding are:
A. Direct Pressure
B. Elevation
C. Pressure on the Supplying Artery/Pressure point technique
D. Tourniquet

First Aid for Severe Bleeding
A. Direct Pressure
►stops most bleeding
►preferred method
 Place a sterile gauze pad or a clean cloth over
wound
► In very severe bleeding, it can be combined with:
 pressure on main supplying artery, nearest to the
bleeding point.
► If dressings become soaked with blood, apply new
dressings over the old dressings and continue the direct
hand pressure even more firmly.

First Aid for Severe Bleeding …..
B. Elevation
►is elevation of injured part above the heart level.
►Unless there is evidence of a #, a severely bleeding open
wound of the hand, neck, arm or leg should be elevated
above the heart level.
►help reduce blood flow,
►help reduce BP in the injured area by gravity and,
►slows down bleeding.
►should be aided by direct pressure.

C. The pressure point technique
►is temporarily compressing the main artery which supplies
blood to the affected area against the underlying bone and
near-by tissues.
►Used if severe bleeding not stopped after the application of
direct pressure for 15 minutes and elevation.
►the technique also stops circulation within the distal part.
►Use it for short duration of time.
►Does not substitute for direct pressure and elevation.
►Pressure on the Supplying Artery
34

Apply Gloved Fingertip Pressure over a
Dressing Directly on the Point of Bleeding
If the Bleeding Does not Stop, Remove the
Dressing and Apply Direct Pressure with
Gloved Fingertips to the Point of Bleeding
Bleeding from a Wound to the Forearm

Pack Large, Gaping Wounds with Sterile
Gauze and Apply Direct Pressure
An Impaled Object in the Cheek May Be Removed.
Dress the Outside of the Wound and Inside the
Mouth, between the Cheek and Teeth
An Impaled Knife
Stabilize the Knife Stabilize and Bandage the Object in Place

D. Tourniquet application
►is dangerous
►as a last option
►only for a severe life threatening
bleeding
 that can not be controlled by other
means
►The decision to apply tourniquet in
reality
 has a risk sacrifice of a limb in
order to save life
►Precaution:
 tourniquet should not be
covered
 should be notified to others
that:
• tourniquet is applied
• its applied site, not to forget
• time applied

Embedded/Impaled Object
First aid measures
►DO NOT remove it but apply padding on either side
of the object and build it up to avoid pressure on the
object.
►Hold the padding firmly in place with a roller bandage
or folded triangular bandage applied in a crisscross
method to avoid pressure on the object.
►Rest the affected part, not to use the part, to minimize
further tissue damage.
►Transport to health facility

3. Wounds & Bleeding (2).pptx

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