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Chapter III - Second-degree emergencies, injured persons with hemorrhages

A hemorrhage represents the blood drained from a blood vessel.

In the human body the quantity of blood varies quite a lot depending on factors such as age, sex, state of health, etc. Men have more blood in the body than women even if they have the same height and weight as the respective men.

An adult with an average weight between 70 - 81 kg has between 4.7 - 5.5 liters of blood and a child with a weight between 30 - 40 kg will have approximately half of the quantity of blood of an adult.

The severity of a hemorrhage is assessed depending on the quantity of blood lost.

Thus depending on the quantity of blood lost the hemorrhage can be:

• small (less than 500 ml);
• medium or moderate (1/3 of the quantity of blood);
• large (approximately half of the quantity of blood);
• lethal (more than half of the quantity of blood).

According to the type of vessel through which the blood circulates, the hemorrhages can be:

• arterial (the blood will flow rhythmically in the wound and its colour will be light red);
• venous (the blood will flow in waves and its colour will be dark red);
• capillary (the blood oozes in the wound).

According to the place where the blood drains they can be:

• externalized bleedings (the blood drains into an organ which communicates with the outside);
• internal bleedings (the blood drains into a closed cavity);
• external bleedings (the blood appears directly, on the surface of the body).

The signs which lead to the recognition of a hemorrhage are:

• dizziness;
• paleness (pale colour);
• agitation;
• rapid pulse;
• chills;
• accelerated breathing;
• fainting.

First aid in case of a hemorrhage

• the victim will be positioned on the back, so that the head is lower than the level of the trunk, this helping the easier irrigation of the brain;
• the type of hemorrhage will be established.
• stopping the hemorrhage:
• in case of a venous hemorrhage a sterile gauze compress will be applied on the wound, on it a gauze and then it is fixed.
• in case of an arterial hemorrhage the injured limb will be raised above the heart then we look for an arterial compression point.
• in case of a capillary hemorrhage a compressive dressing will be applied.

When the severity of the hemorrhage endangers the life of the victim and the bleeding cannot be stopped by other means, a tourniquet will be applied.

The tourniquet is an elastic cord which is used for stopping the bleeding in case of hemorrhages which cannot be stopped otherwise, usually in the case of limb wounds. It is applied above the wound, to reduce the arterial pressure in the area of the wound. In the absence of a tourniquet one can use: a scarf, belt, belt strap, tie, string, elastic etc.

The tourniquet is placed above the wound but without touching the wound and it must be long enough to be wrapped 2 times on the respective limb. Once applied it will no longer be loosened and will no longer be moved. To it a note will be attached on which the hour and date when it was applied will be specified.

Indications for tourniquet application:

• the tourniquet cannot be kept applied to a victim for more than two hours, after more than two hours the tissues can be affected;
• every 15 minutes the tourniquet will be loosened for a short time to allow the feeding with blood of the limb;
• during the transport to the hospital to avoid the appearance of chills the victim will be covered with a coat or a blanket;
• in case the injured person is conscious it is recommended that they be hydrated (without drinks with alcoholic content).

The wound

The wound represents a rupture of the tissues of the body caused by a cut, by a blow or an injury, thus becoming an entry gate for microbes into the organism.

Depending on the depth they can be:

• excoriations (scratches);
• superficial (concern the layers of the skin);
• deep (the muscle mass, the blood vessels, different organs, nerves).

First aid in case of a wound:

• the wound will be cleaned, disinfected and bandaged;
• the skin around the wound is degreased and cleaned, this always being done from the edge of the wound towards the outside. For this water and soap will be used;
• the wound is disinfected with antiseptics (hydrogen peroxide, medical alcohol, iodized alcohol);
• in case of deep wounds no disinfectant substances will be used, because they could penetrate inside and injure the internal organs;
• the foreign bodies which have penetrated deep into the muscle or other tissues will not be removed, because this could trigger a severe hemorrhage;
• above the wound sterile compresses will be applied (cotton will never be applied) which will be fixed with gauze bandages or adhesive tape;
• the injured area will be placed in resting position;
• the victim will be transported to the hospital.