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[Laughter] [Loud noise, shattered glass] [Crying] Now I'm gonna cut your shirt sleeve and make sure there isn't any glass still in the cut. Okay, I'm gonna need a pressure dressing. Now I'm gonna hold pressure on your arm here and put a dressing over it, okay? I know this may be scary but I'm gonna take good care of you. Now, in this case we're talking about arterial bleeding. Arterial bleeding is mostly noted by the fact that it's a large amount of it, number one. Number two it pulsates or actually even spurts. What we did here is we revealed the wound so we knew what we were working with. Obviously saw the arterial spurt and then immediately, you might have seen, I was able to cover it with my gloved hand first. One note here is that we're obviously around broken glass. So as a rescuer it's important to keep yourself safe as well by noting where you're kneeling. Are you in glass itself? Don't become another victim. But then immediately direct pressure over the wound as long as there's not protruding objects coming out of it. Then, as soon as possible, able to get a bandage to put over the wound with direct pressure. We're no longer elevating above the heart nor are we using pressure points. We're using direct pressure and then moving to possible tourniquet consideration if the person's life is in danger. In most cases, in my experience as a paramedic, direct pressure with a pressure dressing is usually substantial enough to be able to control even the most major arterial bleeds and to be able to get that bleeding to stop and control it until we get the patient to definitive care at the hospital where they can repair the wound in a definitive manner. We put this direct pressure here on the arm. We make sure that we're not getting any more seepage. If it keeps soaking through we're going to grab another four by four or a five by nine gauze bandage and direct pressure there. Once we believe the bleeding is under control we can now move to a gauze dressing. If you're not confident to be able to use a gauze dressing you could just hold direct pressure, call 911, obviously if it's an arterial bleed it's enough to call an ambulance or call 911. In this case we've controlled the bleeding, she's not cool, pale, sweaty, or showing signs of shock. We're setting her down because she might get a little light headed and we don't want her to fall down. Then we're going to go ahead and start with our gauze bandage. We're going to start the distal end, or the furthest away from the patient's body. We're going to start wrapping off the bandage and then kind of wrap around the bandage until we get to the top. Then we can bring it back down again. Then once we have it covered we can cut the cling, get a piece of tape or even just tuck this in to a part of the band just so it doesn't unravel. Now it's going to be important for us to get the patient carefully into either the vehicle that we're going to bring her in or wait for EMS to arrive. While we're waiting for EMS to arrive we're going to look for other injuries that we may not have noticed right away. We're going to check her breathing, her circulation. We're going to make sure that she's not going into a form of shock that we might have to actually support with laying her down, covering her with a sheet-coat or blanket which we're going to cover under shock. But in this case we've got the bleeding under control and we're doing pretty well.
Arterial bleeding is the most severe and urgent type of bleeding injury. It can occur due to a penetrating injury, blunt trauma, or from damage to organs or blood vessels.
As arterial bleeding is pumped directly from the heart to the rest of the body, this type of bleeding has a few distinctions:
- The blood is bright red in color due to its high oxygen concentration
- The blood tends to spurt due to the heart pumping it to the wound
- The pressure is higher than other types of bleeding, so it will not clot or stop as easily
Warning: The pressure will only subside as blood volume decreases. This is a life-threatening situation and tissue will quickly begin to die due to lack of oxygen.
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.
Pro Tip #1: The most important thing with an arterial bleeding wound is to apply pressure and stop the bleeding. Apply pressure. Stop the bleeding. Keep these in mind as you progress through this lesson.
- Find the source of the bleeding. You may have to remove or cut away clothing to reveal the wound.
Pro Tip #2: An arterial bleed can be a frightening situation. Reassure the victim and let them know that you'll stay with them until additional help arrives and that you'll take good care of them while you wait.
- Cover the wound as long as no impaled objects are protruding from it. Ideally, a sterile pad or bandage would work best, but use whatever you have available, so long as it's clean.
- Apply direct and constant pressure to the wound. If the victim is conscious and can assist, this will help.
Warning: Remember, arterial wounds will be pulsating or spurting, and it will likely take several dressing pads to control the bleeding. So, don't be surprised by the amount of blood or the difficulty you may experience in controlling it.
- Apply new pressure pads or bandages as needed, if blood begins to soak through the one(s) already applied. DO NOT remove the old bandage or pad, as this can strip the wound of blood trying to clot and only delay your ability to control the bleeding.
- After bleeding is controlled, you can begin to wrap the wound using an elastic bandage. Start at the furthest point from the body and wrap over any and all dressing pads you placed over the wound. (If the wound is on the arm, begin wrapping at the end where the fingers are.)
- Wrap around the wound at least an inch on each side and overlap the bandage as you wrap. Go down the arm, up the arm, and repeat as many times as necessary.
Pro Tip #3: To apply even more pressure to a difficult wound, twist the bandage one time directly over the wound and repeat as necessary. This will tighten-up the pressure where pressure is most needed.
- When done wrapping, cut the end of the bandage and either tape it down or tuck it into the wrap to hold it in place.
An arterial bleed is an automatic 911 call. It's always a good idea to activate EMS in an emergency. You can always cancel the call or send them away once they arrive. But if the situation suddenly turns dire, you'll be glad knowing they're on the way.
Warning: Watch for signs of shock. Does the victim appear pale, sweaty, or cold? (Shock is very dangerous and something we'll get into more in a subsequent lesson.) Also monitor the victim for difficulties breathing, circulation problems, or other injuries you may not have noticed earlier.
At this point, the victim should be stabilized and the bleeding under control. If you activated EMS, simply wait for them to arrive. If EMS is not on the way, you can find another way to get the victim to the next level of medical care, most likely an emergency room.
A Few Common Arterial Bleeding Questions
Should I elevate the wound above the heart?
No, not anymore. While this was once the protocol for dealing with a bleeding wound, we're no longer doing this.
Should I apply a tourniquet if I cannot control the bleeding?
Yes, but only if you can't stop the bleeding and it's a matter of life and death. Cutting off circulation to any part of the body is a serious event and best left to professionals.
Can I let the victim drive himself or herself to the hospital?
No, especially not in this case, as blood loss from an arterial wound can be severe and cause reactions that don't mix well with operating a moving vehicle. However, in general, this should be avoided. There may be a chance that the victim has difficulty seeing his or her own blood, which could cause psychogenic shock. It's always better if the victim is a passenger rather than the driver.
How do I know if I wrapped the wound too tightly?
This can be a real concern and one reason we only use tourniquets in serious situations, as you don't want to cut off blood supply to ANY part of the body for too long.
Look at the fingers or toes or whatever extremities are closest to the wound. Are the nail beds still pink or are they beginning to turn blue? Pinch a nail and the fleshy underside between two of your fingers. The nail should turn pale and then return to a pink color a couple seconds later. If it doesn't, the bandage is too tight.
It's important to try and not cover fingers and toes with the bandage if possible, so that this test can be performed.