HAEMORRHAGE

A haemorrhage is the loss of blood due to vessel damage (arteries or veins).

MANAGEMENT OF A HAEMORRHAGE

1. INTERNAL HAEMORRHAGES WHICH ARE EXTERIORISED
   
   We can suspect an internal haemorrhage if the patient experiences pain after trauma, and has pale skin, cold and sweaty skin, fast and weak pulse, quick breathing, low blood pressure, dizziness or loss of consciousness. We should act in the following way:
   
   
   • The patient must lay down horizontally, unless there is loss of consciousness; in which case, they should be placed in the lateral recumbent position (see Chapter 1.5).
   • Warm the patient with a blanket.
   • Do not give anything by mouth.
   • Try to get MEDICAL ADVICE VIA RADIO as soon as possible.
   • In case of epistaxis (blood through the nose), keep the head tilted forward, to check if the bleeding continues. Squeeze both nostrils close to the nasal bone for about ten minutes (see picture 7-30). Place a cold cloth over nose and forehead. If this is not enough, do not blow or pick the nose for at least 24 hours. If the haemorrhage does not stop after 30 minutes, try to place a narrow strip of sterile gauze using dissection tweezers (DRAWER 12, first aid kits A and B) to press on the bleeding vessel (see picture 7-31).
   
   
   
   
   
   Picture 7-30: Initial management
   of nasal bleeding.
   
   
   
   
   
   Picture 7-31: Nasal tampon.
   
   
   
2. EXTERNAL HAEMORRHAGE
   
   The treatment will be sequential, following very precise steps. It is important to do it this way, and if a method is able to stop the haemorrhage we should not go on to the Siguiente.


1. Direct pressure on the wound
   
   It is the most efficient way of stopping a haemorrhage. In case of an intense haemorrhage any cloth available may be used ; if we are able to choose, a sterile gauze should be used (DRAWER 14, first aid kits A, B and C). This pressure must be kept on the bleeding point for 10 minutes. If the bleeding continues, add more gauzes without removing the Anterior ones or stopping the compression (see pictures 7-32 and 7-33). If the bleeding is in a limb (arm or leg) the affected limb should also be raised.
   
   
   
   
   
   
   
   Picture 7-32 and 7-33: Direct pressure to stop the bleeding.
   
   
   If the blood comes out of a very specific point in great volum,e and the tampon is not enough, you should try to stop the bleeding using straight-toothed haemostatic tweezers (DRAWER 12, first aid kits A and B), if you have experience in using them.
   
   The tampon must be kept until the bleeding has almost stopped, and treatment will be provided as explained in the wounds section.
   
   In case of lip haemorrhage, squeeze it between the fingers, as shown in the picture.
   
   
   
   
   Picture 7-34: How to stop a lip haemorrhage.
   
   
   If despite these measures the bleeding continues intensely, proceed with the following method.



2. Pressure on the artery
   
   This technique is difficult to perform, as it requires knowledge of the areas where arteries flow (as shown in picture 7-35). It has the advantage of blocking the flow of blood through the damaged artery, but not through other arteries.
   
   
   
   
   Picture 7-35: Arterial pressure points to stop a haemorrhage.



3. Tourniquet
   
   This is required when the Anterior measures have not been successful and the bleeding is still important, or as a first measure only with very profuse haemorrhages (for example, the amputation of a limb). It has the risk of blocking blood flow to the entire limb, causing gangrene or nerve lesion (paralysis) if the tourniquet is used longer than the limb can tolerate.
   
   The tourniquet must be placed in limb areas where there is only one bone.
   
   The technique to place a tourniquet is easy. It requires a device to squeeze the arm or thigh circumference. There are two very easy and less traumatic ways to do this:
   
   
   • With the blood pressure cuff: place the cuff around the area where the tourniquet is to be placed and keep the pressure a few tenths above the patient's blood pressure
     (if the pressure is higher than that of the arteries, the blood flow is blocked) (see picture 7-36).
     
     
     
     
     Picture 7-36: Blood pressure cuff tourniquet.
   
   
   
   • With a cloth and stick: if a blood pressure meter device is not available, a tourniquet may be done as shown in the picture. This way no knots are tied directly over the skin, which could be difficult to undo in case of emergency. A triangular bandage may be used (DRAWER 14, first aid kits A and B) (see picture 7-37).
   
   
   
   
   
   Picture 7-37: How to place a tourniquet with a stick and cloth.
   
   When a tourniquet is done it is very important to:


• Note down the time when it was placed.
• Keep cool the lower limb end where the tourniquet has been placed by using ice or cold bags, which will not be in direct contact with the skin, but isolated with a bandage or cloth (refer to Chapter 6.5, HEAT AND COLD THERAPY).
• Release the tourniquet every fifteen minutes to allow blood to flow through the rest of the limb. If the haemorrhage continues, squeeze once more after 30 seconds.
• Ask for MEDICAL ADVICE VIA RADIO as soon as possible.