Bleeding can arise from two sources:
- veins, which carry a slow and steady supply of blood back to the heart, or
- arteries, which carry blood under higher pressure from the heart to the rest of the body
An arterial injury is potentially more serious because blood escaping under pressure may be lost in large amounts in relatively little time. The amount of blood directly visible is not necessarily a reliable sign of the severity of an injury and may not reflect how much blood a person has lost. For example, some serious injuries do not bleed heavily or may bleed internally. Some minor wounds, such as scalp lacerations, may appear to bleed profusely but in fact the amount of blood lost is relatively insignificant.
- If possible, wear latex gloves or keep several layers of cloth or bandage, between you and the blood. This is a good idea because the bleeding person may have an infectious disease that could be transmitted through blood.
- If time permits, wash your hands before tending a wound. This will help prevent infecting the wound with any bacteria on your hands.
- If there is severe external bleeding or evidence of major trauma, call 911.
- Try to keep the child (and yourself) calm.
- Remove any loose debris from the wound.
- Apply direct pressure to the wound using a sterile dressing or a cloth unless there is an eye injury, skull fracture, or an embedded object. In these cases do not apply direct pressure.
- If an arm or a leg is bleeding, elevate it, unless movement causes increased pain or you suspect the arm or leg is fractured.
- If direct pressure has stopped the bleeding but it starts again, reapply pressure.
- If you must free your hands, apply a pressure bandage. If the wound is large enough to make direct pressure ineffective or if direct pressure has not stopped the bleeding after 15 minutes, pressure-point bleeding control may be necessary.
- If there is no indication of neck, head, or back injury and the bleeding is severe, take steps to prevent shock (a severe drop in blood pressure). Signs of shock include bluish color of the fingernails or lips, clammy skin, pale skin color, weakness, confusion, and decreasing alertness. If one or more of these occur, be sure that someone has called 911. Lay the person flat, and if possible elevate the feet about12 inches. Cover the victim with a blanket or coat.
- DO NOT move a child who may have an injury to the head, neck, or back.
- DO NOT attempt to clean a large wound because this could aggravate bleeding that would otherwise slow down.
- DO NOT probe, explore, or pull any embedded object out of a wound. This also may increase bleeding.
- DO NOT apply ice directly to a wound.
- DO NOT use a tourniquet.
- DO NOT remove a dressing that becomes soaked with blood or attempt to peek at the wound to see if bleeding has stopped. These actions can disturb the wound surface and may actually increase bleeding. If necessary, add more dressings.
Even when bleeding is controlled, many wounds require medical attention, including:
- gaping wounds
- animal or human bites
- wounds located directly over joints
- wounds associated with a broken bone, loss of muscular function, or loss of sensation applying a pressure bandage
If you need to free your hands to move the child or attend to other injuries, whether or not the bleeding has stopped, a pressure bandage can be applied. This holds the dressings in place while maintaining direct pressure on the wound.
- Apply a dressing of sterile gauze to the wound or clean cloth if gauze is not available. Wrap long strips of cloth or a long bandage around the area where the wound is located to hold the dressing in place.
- Cut or split the end of the bandage or cloth into 2 strips and tie these together to secure the bandage in place. The knot should be tied directly over the wound.
- Make sure the pressure dressing is not too tight! It should be tight enough to maintain pressure on the wound, but not so tight that it prevents the tissue beyond the wound (that is, more distant from the heart) from receiving the blood it needs. If the area beyond the dressing is throbbing with pain and/or becoming blue and cold, the bandage should be loosened.
Treatment for Pressure-Point Bleeding Control
Important: If you need to use this technique, be sure that someone has called 911 and medical help is on the way.
This technique is used to control bleeding from an extremity only when other methods have not worked. First try using direct pressure combined with elevation of the extremity. Pressure-point bleeding control is a last resort because areas of the body that are not bleeding will also have their blood flow reduced.
Each arm or leg has a major artery supplying it. When bleeding cannot be controlled by other means, pressure on that specific artery can reduce blood flow. When this approach is accompanied by direct pressure to the wound and (if possible) elevation of the injured area, bleeding can usually be controlled. When the bleeding is coming from the leg, the pressure point is over the femoral artery. If there are no suspected injuries to the head, neck, or spine and the child can be moved, place her on her back. Locate the femoral artery at the point where the leg and the groin meet, a little toward the groin side. Use four fingers to feel for a pulse. Once the pulse has been located, apply firm pressure with the heel of the hand to compress the artery against the underlying bone.
When the bleeding is coming from the arm, the pressure point is over the brachial artery. This can be found at the middle of the inner aspect of the arm, just underneath the biceps muscle on the top of the arm. After you have found the pulse, use four fingers along the path of the artery to apply pressure and compress the artery against the underlying bone. Remember: Elevation of the limb and direct pressure on the wound should be continued along with pressure-point bleeding control. When performed correctly, this technique will stop or significantly reduce major bleeding.
Bleeding without a Wound
Bleeding can occur without visible wounds. Bleeding can be significant in these situations:
- Blood in the stool. This can be bright red, which indicates bleeding from a source at or near the anal opening, or a deep purplish black, which usually is more characteristic of blood lost from the upper intestinal tract.
- An abnormal amount or duration of menstrual bleeding. Note: Any vaginal bleeding in a child who has no other signs of puberty (such as breast development) is abnormal and should be evaluated. Blood in the urine. This may be bright red, which usually occurs with bleeding from the bladder or urethra (the tube through which urine exits the body) or a darker (tea) color, which suggests an origin within the kidney. Blood in the urine should be fully investigated by your child’s doctor.
- Vomited blood. This may arise from bleeding within the stomach or esophagus (the passage between the throat and stomach), but more commonly in children and adolescents vomited blood arises from a nosebleed that drained down the throat rather than out the nose. An acute illness such as gastroenteritis (stomach flu) may produce blood-tinged vomited material but not blood itself. In general, any vomiting of bright red material should prompt an immediate call to your child’s physician.
In any of the above situations, call for medical evaluation or consultation.