This document discusses different types of wounds and bleeding management. It describes laceration, puncture, abrasion, contusion, and avulsion wounds. For external bleeding, direct pressure, indirect pressure, and tourniquets are recommended. Direct pressure is the primary method, while tourniquets are a last resort. Internal bleeding signs include pale skin, pain, vital sign changes, and blood from body openings. Management prioritizes ABCs, blood transfusion, fluids, and possibly surgery. The document advises against probing wounds or removing dressings to avoid more bleeding.

1. BLEEDING MANAGEMENT
Muhammad Fitri bin Yusuf

2.  Incision: Straight edges to the wound margins,
as if sliced with a knife
Types of wounds

3. • Laceration: The wounded tissue is random rather than
straight in direction, and may have multiple branches.
• Most often caused by an object with a broken or
serrated edge, such as a piece of broken glass or metal,

4. • Puncture: Sharp object penetrates the tissue, and travels
internally.

5. • Abrasion: A scraping or scratching. Generally quite
superficial, and affecting only the surface layers of the
epidermis.

6. • Contusion: Simple bruising. In this type of injury, the
capillaries in the epidermis and dermis are
damaged, without breaking the skin.[8] Blood oozes out
of these vessels into the spaces between cells or
interstitial space, causing swelling and discoloration.
Blood loss is generally limited, and not of serious
consequence

7. • Avulsion: A full thickness laceration-type wound, often
semi-circular in shape.
• Avulsions are difficult to repair, and no avulsion should
ever be considered a minor injury.

9. Principles for bleeding
Sources of
bleeding
Arteries
Veins
Capillaries

10. External Bleeding Management
Direct Pressure Method.
a) Apply firm, direct pressure sufficient to stop the bleeding.
b) Apply pressure using hands or pad ensuring that sufficient pressure is
maintained and that pressure remains over the wound.
c) To assist in controlling bleeding; where possible:
- elevate the bleeding part.
- restrict movement.
- immobilize the part.
- advise the victim to remain at total rest.

11. In Direct Pressure Method:
a) Don’t remove the embedded object it may plugging the
wound and restricting bleeding.
b) Pace padding around or above and below the object and
apply pressure over the pads.

13. Tourniquet method
• As a LAST resort and only when other methods failed.
• It may be applied to a limb to control life – threatening
bleeding like traumatic amputations of limb or injury with
massive blood loss.

14. Important
• Check the tourniquet every 10 to 15 minutes. If
the bleeding becomes
controllable, (manageable by applying direct
pressure), release the tourniquet

15. Internal Bleeding
• Some times it difficult to recognize.
• Signs and symptoms – Universal :
Pale Skin
Pain. Tenderness or swelling over or around the affected
area.
Changing of vital signs (Tachycardia +
Hypotension), Orthostatic hypotension
Drop of RBC, HgB, Platelets,
The appearance of blood from a body open:
a) Bright red and / or frothy blood coughed up from the lungs.
b) Vomited blood which may be bright red or dark brown “ coffee
grounds”.
c) Blood - stained urine, Vaginal bleeding.
d) Rectal bleeding which may be bright red or black “tarry”.

16. Remember
• Blood tests may be performed to check for a low red
blood cell count, or anemia. However, if the bleeding
occurs rapidly, the initial hemoglobin reading or red
blood cell count may be normal.
• The initial treatment plan of any patient with internal
bleeding begins with assessing the patient's stability and
making certain the ABCs are well maintained.

17. Management
• Airway.
• Breathing.
• Circulation.
• Blood Transfusion,
• Fluids.
• Surgery

18. DON’T
1. apply a tourniquet to control bleeding, except as a last
 resort.
2. peek at a wound to see if the bleeding is stopping.
3. probe a wound or pull out any embedded object from
a wound. This will usually cause more bleeding and
harm
4. remove a dressing if it becomes soaked with
blood. Instead, add a new one on top
5. try to clean a large wound. This can cause heavier
bleeding
6. try to clean a wound after you get the bleeding
under control. Get medical help

19. Thank
You
Q & A