Title: External bleeding
Course: Non-Communicable Diseases, Emergency Care and Mental Health Part 1 - Ethiopia (Full)

External bleeding

External bleeding usually occurs following a deep cut, piercing with a sharp object or a superficial bullet wound. The most serious bleeding comes rapidly spurting from an artery. This can be life-threatening if the wound is too deep and the spurt is under too much pressure to control. Minor bleeding usually stops by itself within ten minutes when a blood clot develops which blocks the bleeding vessel or wound. You should suspect life-threatening external bleeding if:

- You see blood spurting from a wound
- Bleeding fails to stop after all measures to stop bleeding have been attempted (see Box 7.1)
- The person shows signs of excessive blood loss resulting in low circulating blood volume (shock).

You learned how to set up a pre-referral IV fluid infusion in Study Session 22 of the Antenatal Care Module and in your practical skills training sessions.

Box 7.1 First aid supportive care for external bleeding

- Apply direct PRESSURE to the wound, after removing any clothing or foreign body from the wound.
- Help the person to lie down and ELEVATE the injured part above the level of the heart.
- Apply a BANDAGE to the wound; it should be just tight enough to stop the bleeding, but not so tight that it obstructs the circulation.
- Start intravenous (IV) fluid therapy with Normal Saline solution or Ringer Lactate solution if the person shows signs of shock. Transfer the patient to the nearest hospital or health centre immediately after you have begun the infusion.

What are the signs of shock following severe blood loss? (You learned about shock in the Antenatal Care and Labour and Delivery Care Modules in relation to pre- and post-partum haemorrhage.)

Show answer

A person who is in shock displays weakness, confusion or an altered state of consciousness, and has a fast pulse rate (over 100 beats per minute), and low blood pressure: the diastolic pressure (the bottom number) is below 60 mmHg.