Haemorrhage or bleeding is a flow of blood from an artery, vein or capillary.

Type of haemorrhage or bleeding

There are three different types of haemorrhage or bleeding.

1-Arterial bleeding

• Blood is bright red in colour.
• It spurts at each contraction.
• Flow is pulsatile.

2-Venous Bleeding

• Blood is red in colour.
• It does not spurt.
• Steady flow

3-Capillary bleeding

• Blood is red in colour.
• It does not spurt.
• Slow but even flow.

Effect of Haemorrhage or bleeding

• The loss of red blood cells causes a lack of oxygen to the body system.
• A decrease in blood volume causes a decrease in blood pressure.
• The heart's pumping rate increases to compensate for reduced blood pressure.
• the force of the heartbeat is reduced since there is less blood to pump.

Effect of unchecked haemprrage

• If the bleeding is checked, the above symptoms quicken and shock deepens.
• The loose of two pints in the average male (15 percent of blood volume) produces a moderate shock.
• Loss of 30 percent or more of blood volume produces a severe or fatal shock.

Bleeding may be external or internal

These external or internal bleeding may be arterial, venous or capillary.

How to diagnose bleeding or haemorrhage

External bleeding

1. evidence of the major external blood loss.

2. symptoms and signs of the shock.

3. The casualty complains of thirst.

4. blurring of vision, fainting, and giddiness.

5. face and lips become pale.

6. skin feels cold and clammy.

7. the pulse becomes faster but weaker.

8. restlessness

9. Breathing becomes shallower

Internal Bleeding

1. History of sufficient injury to cause internal bleeding.

2. a wound that has penetrated the skull.

3. a wound that has penetrated the chest or abdomen.

4. pain and tenderness around the affected area, swelling, and tension may be felt.

5. Blood may appear from one of the body orifices, nose, ear, mouth, rectum, urethra, and vagina.

6. fractures of bones especially long bones of the upper arm and thigh.

General Management of bleeding

1. Place the victim in such a position that he/she will be least affected by the loss of blood.

2. Lie the victim down and elevate the legs in a semi-flexed position. This prevents aggravation of spinal injury or breathing impairment.

3. Control the bleeding.

4. Maintain airway.

5. Prevent the loss of body heat by putting blankets under and over the victim.

6. The victim should be kept at rest, as movement will increase heart action, which causes the blood to flow faster and perhaps interfere with clot formation or dislodge a clot already formed.

Management of Minor External Bleeding

If possible, wash your hands before dealing with the wound. If the wound is diry lightly rinse it with running water if available, until it is clean.

Protect the wound with a sterile swab, and clean the surrounding skin with water and soap if available. Swab the wound dry.

Dress a small wound with an adhesive dressing

Raise and support the injured part unless you suspect an underlying fracture.

If the wound is larger, apply a sterile unmedicated dressing or gauze and clean pad and bandage firmly in position.

If in doubt, seek medical help.

Management of Major External Bleeding

There are four methods to control external bleeding.

1. Direct pressure

2. Elevation

3. Pressure points

4. Applying a tourniquet

1. Direct Pressure to control external bleeding

Do not waste time hunting for a dressing. Place your hand directly over the wound and apply pressure. Keep applying firm and steady pressure. If the wound is large, squeeze the edges together.

If dressing is available, then apply a sterile dressing or clean cloth. Apply pressure until the bleeding has stopped. This may take 10 to 30 minutes of longer.

Now tie the bandage firmly enough to control bleeding but not so tight as to cut off circulation.

Immobilize the injured part. Never place any dressing once it is in place if the dressing is soaked with blood, place another dressing directly over the blood-soaked dressing and hold both in place with firm pressure.

2. Elevation to control external bleeding

This is used in combination with direct pressure when dealing with bleeding of the arm of leg

Elevate the bleeding part of the body above the level of the heart so that flow of blood will slow down in that part and clotting will speed up.

3. Pressure Points to control the external bleeding

Arterial bleeding can be controlled by digital thumb or finger pressure applied at pressure points.

Pressure points are the places over a bone where arteries are close to the skin.

Pressing the artery against the underlying bone can control the flow of blood to the injured part.

Pressure Points for bleeding from the arm

Grasp the middle of the victim's arm with the thumb on the outside of ther arm and fingers on the inside

Press the fingers towards the thumb.

Use the flat, inside surface of the fingers not the fingertips. This inward pressure closes the artery by pressing it against the humerus.

Pressure Points for bleeding from the leg

Position the victim flat on the back, if possible

Kneeling on the opposite side from the wounded limb, place the heel of one hand directly on the pressure point, and lean firward to apply the small amount of pressure needed to close the artery.

If bleeding is not controlled, it may be necessary to press directly over the artery with the flat surface of the fingertips and apply additional pressure on the fingertips with the heel of the other hand.

Pressure Points for bleeding from the neck and face

Never apply pressure to both sides of the neck at the same time.

Stay alert for the patient becoming faint or becoming unconscious.

Do not put pressure on the trachea

Put pressure over the carotid artery.

4. Applying a tourniquet to control the bleeding

A tourniquet is a device used to control severe bleeding. It should be used only for severe, Life-threatening haemorrhage that can not be controlled by other means It can be used only in extremities.

The standard tourniquet is a piece of web belting about thirty-six inches long with a buckle of snap device to hold it tightly in place, when applied, Ith should be at least three to four inches wide to distribute pressure over the tissues.

Tourniquet can be improvised from a strap, belt, suspender, towel, cloth of other suitable material.

Wire card should never be used otherwise they will cut into the flesh.

Procedure for Applying Tourniquet

1. Put pressure over proper pressure point to control the bleeding temporarily. Place the tourniquet between the heart and wound with sufficient uninjured flesh between the wound and tourniquet.

2. Apply a pad over the artery to be compressed.

3. In using an improvised tourniquet, wrap the material tightly around the limb twice and tie in a ball knot on the upper surface of the limb.

4. Place a short stick or similar stout object at the half knot and tie a full knot.

5. Twist the stick to tighten the tourniquet only until the bleeding stops.

6. Secure the stick in place with the base ends of the tourniquet, and another strip of cloth of suitable material.

7. Do not cover the tourniquet.

8. Make a written note of the tourniquet location and the time it was applied. Attach the note to the victim's clothing.

9. Shift the patient to the hospital immediately.

Once the tourniquet is tightened it should not be loosened except by or on the advice of a doctor. Losing may dislodge clots and result in sufficient loss of blood to cause severe shock and death.