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Wounds and Bleeding

 

 

 

DEVELOPMENT CLASSES

 

Notes

WOUNDS & BLEEDING

 

Archie Cuthbertson – Class Facilitator

 

DEVELOPMENT CLASSES

 

WOUNDS AND BLEEDING

 

DEFINITION OF WOUNDS

 

A wound is a break in the continuity of tissues; it frequently includes a break in the surface of skin or mucous membrane (an open wound), making it exposed to infection. Management of wounds centres on;

 

  • CONTROL OF BLEEDING
  • PREVENTION OF INFECTION
  • PREVENTION OF FURTHER COMPLICATIONS

 

TYPES OF WOUNDS

 

CONTUSION         -        caused by a blunt instrument for example, tyres, rollers

                                           kicking and punching. May have underlying fractures

                                           or crushed tissues.

 

LACERATION       -       usually results from snagging or tearing of tissues by for

                                          example, machinery, barbed wire, jagged metal. Bleeds

                                          less freely, healing can be prolonged.

 

INCISION               -       usually made by a shape edged object for example, a

                                           knife or razor, bleeds freely, heals quickly. 

 

PUNCTURE            -       caused by a pointed object. A small wound which may

                                           Have penetrated deeply causing damage to underlying

                                          Structures such as, blood vessels and organs. Very

                                           Difficult to assess the severity of the wound, degree of

                                           Internal bleeding or deep contamination.

 

GUNSHOT              -        caused by bullet, shot or bomb shrapnel. May have

                                            Exit wound much larger than entry wound depending

                                            On the calibre and velocity of the projectile.

                                            Main complications are;

 

                                            Bleeding, internal and external

                                              

                                            Damage to underlying structures such as bones,

                                            Organs and blood vessels

 

                                            Foreign bodies and Infection

 

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WOUNDS AND BLEEDING

 

REMEMBER

 

A minor wound may be related to a more serious one. For example, a small wound to the head may be associated with a skull fracture, internal bleeding of the brain or a cervical spine injury.

 

BLEEDING AND BLOOD LOSS

 

Types of bleeding are;

 

  • INTERNAL
  • EXTERNAL

 

EXTERNAL BLEEDING

 

Can be seen at source and can be;

 

*   ARTERIAL     -    Spurts to the pulse rate (bright red)

*   VENOUS        -     constant flow (dark red)

*   CAPILLARY   -    Oozes to the wound surface (mid red)

 

 

INTERNAL BLEEDING

 

Internal bleeding may not  emerge from but sometimes be detected by

Swelling (haematoma). It may occur;

 

  • IN THE ABDOMINAL CAVITY  (from damage to internal organs)
  • WITH CLOSED FRACTURES  (swelling)
  • WITH CONTUSIONS  (bruises)

 

Internal bleeding may be difficult to diagnose because quite often, blood cannot be seen. However, if internal organs are affected, blood may appear via existing channels from the body and have certain characteristics;

 

LUNGS   -   bright red and frothy and coughed up through the trachea and

                     Airways.  (Haemoptysis)

STOMACH  -   A dark coffee colour is vomited up – can be from frank blood

                           To coffee grounds in appearance.  (Haematemesis)

KIDNEYS   -   Stains the urine into smoky grey colour – can range from frank

                         Blood to staining the urine.  (Haematuria)

LARGE INTESTINE   -   Passed by the bowel as a black, sticky tarry

                                            Substance  (Melaena)

BRAIN   -   escapes through the ears, nose and eye orbits.

 

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WOUNDS AND BLEEDING

 

Children

 (By age)

 

 

  Blood

 Volume

   (litres)     

 Adults

 (height)  

Blood

Volume

(litres)

6 months

1 year

2-3 yrs

3-5 yrs

6-9 yrs

10 –11yrs

12-13 yrs

   0.5

   0.7

   1.0

   1.3

   1.7

   2.3

   3.2

  4’ 10”

  5’ 10”

  6’ 8”

    2.5

    5.0

    6.8

 

BLOOD VOLUME

 

In adults blood volume is related to height or weight. The volume is 70ml per kilo of body weight. Thus the blood volume of an average adult weighing 70 kg would be 4.9 ltrs. In children blood volume is related to age.

 

 

PREGNANT PATIENTS

 

Total blood volume increases steadily from early pregnancy, reaching a peak in the last quarter of pregnancy. Both red cells and plasma volume increase, but the increase in plasma volume is disproportionate. Blood volume may increase by 48%.

 

BLOOD LOSS

 

It is the percentage of blood volume loss that is of importance in the development of the clinical picture. Small amounts of haemorrhage may be of serious significance where as, a similar volume in an adult may be of no consequence.

In pregnancy many women become anaemic, and in association with blood loss, this may result in disproportionate shock.

 

 

(3)

 

WOUNDS AND BLEEDING

 

BLOOD LOSS (continued)

 

To assess blood loss look out for blood lost;

 

  • in body tissues  (swelling)
  • on the floor – taking into account the type of surface
  • in wound dressings ect.

 

 

EXTERNAL BLOOD LOSS

BLOOD LOSS IN CLOSED WOUNDS

 LITRES

Fractured ankle (moderate/severe swelling)

  0.25 – 0.5

Fractured femur (moderate swelling)

   0.5  – 1.0

Fractured femur (severe swelling)

   Up to 4

Fracture lower leg (moderate swelling)

   0.5  – 1.0

Fractured forearm (moderate swelling)

   0.5  -  1.0

Fractured pelvis

    Up to 5

x2 for an open fracture

 

BLOOD LOSS IN OPEN INJURIES

 
A wound about the size of the patient’s hand losses approximately 10% of the patient’s blood volume.

 

 

FACTORS AFFECTING BLEEDING

 

Bear in mind the;

  • Depth, type and size of the wound.
  • Size of the blood vessel (the bigger the vessel the greater the bleeding)
  • Duration of bleeding (natural arrest takes about 15 mins)
  • Position of the injury
  • Age or size of the patient
  • Serious scalp wounds, even small ones bleed profusely.

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WOUNDS AND BLEEDING

 

CLINICAL CONSEQUENCES

 

 

 

COMPENSATED

 

DECOMPENSATED

 

   PULSE

 

 

TACHYCARDIA

TACHYCARDIA CAN PROGRESS TO BRADYCARDIA

 

   SKIN

 

WHITE, COOL

AND MOIST

WHITE, ‘WAXY’

COLD, MARKED

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