First Aid - Haemorrhage

A: ARTERIAL
B: FROM THE VEIN. Both different.
UNLESS TREATED QUICKLY, THE VICTIM WILL DIE QUICKLY.

2 TYPES OF HAEMORRHAGE: INTERNAL & EXTERNAL.
The external one is highly visible. The internal one is either VISIBLE:Blood comes out by natural opening, either nose, mouth, rectum or coming either from the lungs, stomach or intestine.
Or it is INVISIBLE: Flowing inward in natural body cavity such as the brain, thorax or abdomen.

ARTERIAL: The blood comes out nice clean red, it comes out in spurt like water fountain, every time the heart pulses.

FROM VEIN: Blood is not as clear & clean, it comes out like a water leak, because the heart pulse is not received.

Unfortunately there is little you can do for the internal one; unless you are a doctor or near a hospital, & to move fast to bring the patient to it. So we will see what to do for external.

EXTERNAL HAEMORRHAGE:
1) You MUST stop the haemorrhage quickly & with efficiency.
2) Prevent infection.

SEVERED ARTERY?: ACT FAST!
No time to think. If you can not catch and splice the loose ends to stop them spurting, then grab your field dressing & burn it.
Cram the ashes in the open wound then bind it hard and bind it fast. Forget all that claptrap about tourniquet, that went out with Rock and Roll.

GENERAL RULES CONCERNING EXTERNAL HAEMORRHAGE:

1) Exert a direct pressure on the wound using a cloth as clean as possible. (To avoid infection)
2) Maintain this pressure, if necessary with a compressive dressing, which liberates your hand to do other wounds?
3) If bleeding persist: DON'T remove the first dressing nor bandage, but add another one with a tighter bandage. (Not too tight!)
4) One can reinforce the pressure by pressing your palm on the dressing.
5) Keep the patient calm, laid down if possible, & the wounded limb at rest as much as possible.
6) You can up lift the wounded limb, but only if practical.
7) Moisten the lips of the patient if he is thirsty.

INTERNAL HAEMORRHAGE SYMPTOMS:

HIDDEN: Think of this possibility according with the accident
details & with the presence of symptoms such as:
1) Victim comes suddenly very pale, is dizzy & can quickly lose consciousness. Or paleness spread slowly & is followed by dizziness, sighs & yawns. Breathing can afterward become quick & difficult.
2) Intense thirst & lack of air followed by agitation & anguish.
3) Gradual lost of consciousness.

VISIBLE: On top of the above symptoms, blood can flow by natural opening.

FIRST AID IN CASE OF INTERNAL HAEMORRHAGE:

1) Transport the victim quickly to nearest hospital. Fix a note to the victim's cloths telling the possibility of internal Haemorrhage.
2) Keep the patient in semi-prone position.
3) Cover him lightly with a blanket etc.
4) Reassure the victim.
5) Verify all evolution of symptoms such as difficulties to breath, choking, vomits.

NOSE:
1) Keep victim sitting or half-prone position.2) Press firmly on the bleeding nose side for 10 minutes.
3) Loosen necktie if needed.
4) You can apply cold compress on the nose.
5) Tell the patient not to blow his nose which would remove the blood cloth, not to swallow his saliva but to spit.

EAR:
Bleeding can indicate a fracture at the base of skull.
1) Don't block the ear, but cover it with a dressing dry and lightly bandaged.
2) Bring the victim to hospital, laid down & the head inclined on the bleeding side.

SKULL INJURIES: These wounds often bleed abundantly.
1) Give only a light pressure bandage, sufficient to stop the bleeding. An excessive pressure could aggravate the trauma to the brain if any or to the head.
2) Don't clean the wound.

VARICOSE VEIN RUPTURE:
Bleeding can be sudden & plentiful yet easy to stop.
1) Have the patient laid down immediately, take off all garters.
2) Lift up the leg as much as possible.
3) Put a dressing on the wound & strongly bandage.

HAND/ PALM:
1) If the wound doesn't have any foreign object, put a compress rolled on the palm, & bend the fingers upon the compress.
2) Bandage the hand to maintain the hand closed.

NECK & THROAT:
The possible danger here comes from the possible rupture of the main artery (carotid) or the jugular vein or both.

IT IS ESSENTIAL TO ACT FAST FOR THE BLOOD FLOW IS QUICK & PLENTIFUL. DEATH CAN COME IN A FEW MINUTES.
1) Immediately apply a pressure on the broken vein. A compress of any sort (clean) will help maintain the compression.
2) Maintain the compression till the patient gets surgical help. DON'T use a circular dressing compress.

EYE, EAR, CHEEK, FOREHEAD:
Place the centre of a bandage over the dressing, cross the ends at the back of the head & make a knot over the dressing if possible.

GROIN:
The great femoral artery can be in danger.
1) Apply a direct pressure.
2) Bend the victim's knee on his chest. A rolled compress & placed on the groin can increase the compression.

GENERAL INFORMATION:

1) It is ESSENTIAL to know that small wounds will stop bleeding by themselves, without treatments. Nature sees to it.
2) Bleeding will ALWAYS be mastered if a compression is sufficiently applied on the wound. We insist on direct pressure to save time when there is bleeding.
3) Blood coagulates itself or forms a blood cloth in 3 to 7 minutes usually. Direct pressure speeds up the coagulation process.
ONCE BLOOD CLOTH HAS TAKEN PLACE, NEVER REMOVE IT.
4) Blood vessels retract & contract when they are injured thus reducing their size, which helps coagulation.
5) Prevent infection is a goal of first-aid. So as much as possible, cover a wound with a clean or sterile dressing. Yet in some cases a bare hand on an open wound is necessary in order to save life.

HAEMORRHAGE ADD ON PRESSURE BANDAGE:
The pressure bandage stays the best method used to control haemorrhage. You MUST elevate the wounded limb if possible as well as to exert a digital pressure.
The tourniquet is to be used when pressure bandage doesn't work.
Application of sterile dressing doing pressure helps coagulation of the blood, compress blood vessels and protects all infection.

Before putting the pressure bandage, one MUST check for other wounds, for ex. in case of bullet wound, the wound is bigger at the exit than at the entrance. You can find those bandages in drug stores or make them.
If added pressure is needed, press strongly your hand on the dressing for 5 to 10 minutes. It should work.

To exert an extra pressure, you MUST place a thick bandage near the wound, just above the original one, which you maintain in place using a necktie, belt etc.

DON'T take off the original dressing, rather add to it.

LIFTING UP THE WOUNDED LIMB:
Even with direct pressure on the wound, one can diminish the importance of haemorrhage, by lifting up the wounded limb above the heart.
However; If there is fracture, don't do it. Because moving a broken limb without splint gives loads of pains to the victim & aggravate his state. Without counting the risk to damage nerves,
muscles & blood vessels.

TO MAKE A PRESSURE POINT WITH THE FINGERS, ON HAEMORRHAGE:
When blood pours out (arterial H..)a pressure of the fingers can control the Haemorrhage till you apply a sterile dressing.
The pressure done on a pressure point with fingers, thumbs, hands. A pressure point is the place where a main artery (feed wounded region) is located near the skin surface or above a bone.

By putting pressure on one of those points the blood flow coming from the heart to the wound will be blocked or slow down. You have correctly found the pressure point when you feel the pulse at the tip of your fingers.
You MUST ABSOLUTELY find the pulsation before putting a pressure.

HOW TO APPLY A TOURNIQUET (GARROTTE):
beware!!! dangerous!
A tourniquet is a tissue band or strip placed around an arm or leg to compress the artery in order to stop haemorrhage.
Tourniquet is rarely used & better not use it whenever possible.
Because it has in the past damaged the blood vessels & the nerves of the victim. Use it when after having made a strong pressure on a wound, or on a pressure point or that the elevation of the wounded limb are useless.

Too long a compression by tourniquet can result in the loss of the arm or leg, as was often the case during both World Wars.
An Arterial haemorrhage of the thigh, leg, arm or many arteries (result of traumatic amputation: i.e.: bomb blast) becomes at times uncontrollable by simple pressure.

If a vigorous (strong) pressure of the hand upon the dressing don't slow down the blood flow, you MUST quickly make a tourniquet.
Once in place, don't loosen it after the haemorrhagehas stopped, otherwise it could result by a shock followed by a blood lost WHICH WOULD BE FATAL.
Victim needs medical care quick. If you don't have a true garrotte, you can use a tissue being soft, strong & flexible as cotton gauze, or silk, clothing etc.
Such a garrotte needs a stick or anything rigid, stiff. In order not to damage too much the skin, the garrotte width MUST be that after tightening, it is of 3cm wide.

GARROTTE & HOW TO PROCEED:
1) Place the garrotte around the wounded limb, (between the heart & the wound) & at: 4 to 10cm ABOVE the wound. NEVER directly on the wound or on a fracture.

2) When possible, do the garrotte over the sleeve or pant leg in order not to pinch or twist the skin. If the skin is damaged or bruised it can not be of any use to the surgeon when he wants to cover up the amputation. So he needs to do a greater amputation to obtain the same results. Protecting the skin diminishes the pain.

3) Once the bandage in place, slide the stick under the knot, twist it around just enough to block the blood circulation at this place.
If the pulsation of the wrist or ankle still intact can be felt before putting on the garrotte, the stop of this same pulsation will be a sign that sufficient pressure is done.

4) TO DETECT A PULSE:
Place 2 fingers (not the thumb) on the pressure point of the wrist or ankle.
Don't use your thumb because the small artery in the thumb would mix the count of the pulse you search.
If you can't trust this pulsation as control element, use your own good judgement to decide of the reduction of blood flow coming to the wound. In such case, uncover temporarily the wound
to check up.

5) The arterial haemorrhage will cease after a correctapplication of the garrotte, but the bleeding which are located in the inferior part of the wounded limb will keep on bleeding till they are empty of blood.
Don't persist in tightening the garrotte in order to stop this blood flow, IT IS USELESS.

6) When the garrotte is well in place, put a dressing and bandage on the wound.

GARROTTE MUST BE RELEASED EVERY 15 MINUTES IN ORDER TO AVOID FURTHER DAMAGE.