First stop the bleeding! Then replace the amount of blood already lost!
The bodys defense mechanisms¶
The body has three lines of defense against blood loss.
The first line of defense – the body tries to stop the bleeding: Immediately after injury, nerve signals make the arteries around the wound contract. This reduces the blood flow and reduces blood loss. Platelets form blood clots to plug the tears in the blood vessels.
The second line of defense – the heart works harder: If the first line of defense is not good enough and blood continues to be lost, the heart works harder. The heart responds by beating faster so that it can speed up the blood flow: There are only a few red blood cells to carry oxygen but they flow through the body faster!
The third line of defense – shutting down blood flow to limbs and skin: If even more blood is lost, the arteries to the skin and the limbs contract. The skin and the limbs become cool – their share of the blood supply is delivered to the important organs. This is an emergency measure for the body – it “sacrifices” the limbs to save the life.
If all lines of defense are broken – the blood pressure starts to fall: This is a dangerous sign. Around 1/3 of the total blood volume has been lost – more than 1.5 liters in an adult. Even if the heart works as hard as it can, it is difficult to get enough blood supply to the brain and other main organs.
Stop the bleeding
Keep warm
Help the body stop the bleeding – keep the patient warm Even in tropical areas, mine victims become cold. Losing warm blood, having big wounds, wearing wet clothes, being carried in open pick-up cars, and surgical operations all make the body and the blood cold. Also beware of IV infusions: Even IV infusions at “room temperature” (20º C) makes the blood become cold. Cold blood platelets are “lazy”. Below 32º C they do not work at all.
Pack the wound
Help the platelets – pack the wound from outside Your friends, the platelets, work from the inside. They try to pack the wounds in the blood vessels with blood clots. This is how you can help them:
- Lift the bleeding limb and squeeze the artery to the injured limb with your hand. This reduces the speed of the blood flow, making it easier for the blood clot to stick to the wound.
- Pack the wound with gauze or cloth. Once you have placed a pack from outside onto the bleeding vessels, the platelets packing the wound from the inside have something to “lean on”.
- Apply a tight dressing with elastic bandages on the injured limb. The pressure from the dressing keeps the limb blood flow low and prevents blood clots from being “washed out”.
Replace blood loss
Try to find out how much blood the patients has lost: Talk to the victim. Feel the temperature of his limbs with your hand (and compare to your own skin). Count his heart rate. Read his systolic blood pressure. Typical the victim will be like one of three categories:
- Everything seems “normal”: He may still have lost some blood. A healthy adult may lose 1 liter of blood, and the only response will be a slight rise of the heart rate. Action: Examine again after 30 minutes. If the signs are still normal, he is not bleeding a lot.
- He is confused. The limbs are cool. Heart rate is more than 100 beats per minute. Blood pressure is still normal: He has lost much blood. His brain lacks oxygen. If he continues to bleed the defenses will break and the blood pressure will fall! Action: Stop the bleeding if you can! Then give 2 L of warm Ringer solution by two IV drips and see how he responds.
- He is very confused or unconscious. Heart rate more than 100 beats per minute. Blood pressure is less than 90 mm Hg: The blood loss is critical! He has too little blood to provide the main organs with the oxygen they need. There is immediate risk of heart failure, brain damage and death. Action: Give 2 L of warm Ringer solution by two IV drips rapidly and see how he responds.
Evaluating the patient
You have stopped the bleeding from the limb wounds. The victim has got 2 L of warm IV infusion. Now study the response:
- If the blood pressure rises to 90 mm Hg or more, and the heart rate is down to 100/ per minute, and they stay there, he is not bleeding much on the inside.
- If the blood pressure and heart rate do not respond, or they improve only for a short time: There is a lot of bleeding inside! Get that victim to an advanced medic or surgeon as soon as possible.
Think about it!
Why stop the bleeding first? Why not start with the IV infusions?
Answer: If you increase the blood flow and the blood pressure before the bleeding is safely stopped, the blood clots will be washed away. The wound will start bleeding again. Some doctors say we lose time by stopping the bleeding and giving IV infusions in the field. They say we should simply rush the patients to the hospital. Are they right?
Answer: They are wrong. They think in terms of Western rescue systems and helicopter ambulances. They don’t know how far you are from the hospital. But they know – and now you do – that the longer the victim is starving for oxygen, the greater the damage to his body.