Haemorrhage-Symptoms,Effects On Brain,First Aid.
Before i move directly to the signs and symptoms of haemorrhage, let me briefly talk about the formation of a clot and constriction of blood vessel wall.
Reactionary haemorrhage is likely to occur when the blood-pressure returns to normal and the blood clot is pushed out. In haemorrhage of any extent, there is also likely to be shock present and in this condition, there is a lowered blood-pressure. When shock is treated effectively, the blood-pressure rises and returns to normal and again the clot may be pushed out by this pressure and bleeding starts again.
Fortunately, this type of haemorrhage hardly occurs but if it does, it takes place in anything from seven to ten days after the injury or operation and it is due to infection. If micro organisms have infected the wound, they break down the clot. This usually takes several days to occur, secondary haemorrhage is slow to develop. It is extremely dangerous and shows the importance of keeping wounds clean.
SIGNS AND SYMPTOMS OF HAEMORRHAGE
It is important to recognize the signs and symptoms of haemorrhage, they are the same whether the bleeding is internal or external and to appreciate that signs and symptoms, it only vary in degree depending on the amount of blood lost. Recognition of internal haemorrhage is vital if the patient’s life is saved. The following below are the signs and symptoms of haemorrhage:
Changes in the skin are quite marked. It becomes pale, and feels cold and damp to touch. This is due to the constriction of the superficial blood-vessels. The blood-vessels near the surface of the body constrict and by this, means physiological adjustment are made to improve the blood supply to deeper and more important organs such as the brain, kidneys, heart and liver. Because of this restricted blood supply to the skin, the body temperature also becomes subnormal; that is 35 degrees centigrade or below.
THE PULSE :
This is rapid and weak. How rapid and weak it becomes depends upon the severity of the haemorrhage. Due to loss of blood, a lowered blood-pressure and volume of blood, the heart does not fill completely between contractions, thus it tries to compensate by contracting more quickly but gradually losing in strength. It may become as rapid as 140 beats per minute. If the haemorrhage is allowed to continue, the pulse may become imperceptible.
THE RESPIRATION :
In haemorrhage, the respiration is unique and unmistakable and is described as air hunger respiration. The patient is sighing and gasping for air. This is the reaction due to loss of the red corpuscles. There is less oxygen circulating in the blood stream and the patient is literally gasping for oxygen and has fear of suffocation.
THE EXPRESSION :
The patient if conscious will look anxious, afraid, restless and may be plucking at his or her clothes or the bed clothes.
The patient commonly complains of thirst. This is the reaction of the body to the loss of fluid not only due to bleeding but due to the fact that the fluid is withdrawn from the tissues into the blood stream. If fluid is not administered by intravenous infusion, dehydration occurs.
EFFECTS OF HAEMORRHAGE ON THE BRAIN
Due to the brain not receiving enough blood supply, the patient may show or complain of the following signs and symptoms:
- Dimmed or blurred vision
- Buzzing or ringing in the ears
- Dilated pupils
- Mental confusion
- Unconsciousness and postrate
ARREST OF HAEMORRHAGE
Nature immediately tries to stop excessive bleeding by performing three physiological tasks:
- By the formation of a clot : The clot when formed acts as a cork to the injured blood-vessel and prevents further loss of blood.
- The elastic coat of the blood-vessel recoils and turns in, thereby narrowing the lumen of the vessel and holding the clot in place.
- The blood-pressure is lowered, there is less volume and pressure of blood in the vessels. This gives the walls of the blood-vessels time to turn in and also clot time to form.
FIRST AID TREATMENT FOR ARREST OF HAEMORRHAGE
Internal Haemorrhage :
It is of great importance that any first aid worker or nurse recognizes the signs and symptoms of haemorrhage although no bleeding can be seen and wastes no time in starting treatment.
- Rest and Quiet: The patient must be laid down, lying flat either on the floor, bed or couch and kept absolutely still. If the patient is allowed to move about in any way, there is danger of further bleeding.
- Reassurance : The patient will require to be reassured as he or she will be anxious and possibly afraid.
- Position if possible, the lower end of the bed or couch can be raised. This may help the flow of blood by gravity to the brain and may prevent fainting or unconsciousness.
- Clothing : Undo tight clothing round the neck, chest and waist. This may help the patient to breathe more easily and prevent the feeling of suffocation.
- Medical aid : If a doctor can be located, he or she will be able to inject; example, morphia, which will help to relieve any pain or anxiety and prevent restlessness.
- If by signs and symptoms it is realized that the haemorrhage is severe, then it will be necessary to get the patient to the hospital as soon as possible. This must be done with the minimum amount of movement and handling.
External Heamorrhage :
The general care of the patient will be the same as for internal haemorrhage. If the bleeding point can be seen then further local treatment will be necessary:
- The wound must be covered immediately with a clean dressing as possible. The cleanest dressing most readily obtainable is probably the inside of a newly laundered towel or pillow slip. This should be applied to the wound and bandaged in position. By covering the wound at once, it is hoped to prevent infection. It is doubtful if outside a hospital, a sterile dressing will be immediately available.
- If the part involved is a limb, it should be raised as high as possible and maintained in position. This limits the amount of blood flowing to the part and also help to reduce the amount bleeding.
- Pressure may be directly applied to the wound ( if there is no glass present). This can be done by placing a pad over the clean dressing and bandaging it firmly into position. A pad may be made from any available material; for example, a rolled-up scarf or hand towel. The first-aid worker can also apply pressure with his or her fingers over the pad.
- Digital pressure can be applied to the nearest artery known to supply the part. The pressure is applied to the artery where it passes near the surface and superficially over a bone. This area is described as a pressure point.
- Only as a last resort should a Tourniquet be applied as its application is fraught with danger. If it has to be applied, it can only be done for bleeding from a limb. The following points are important
a) It must be tight enough.
b) There must be a piece of material between the tourniquet and the skin.
c) It must not be left on for any longer than fifteen minutes.
d) An indication of the presence of a tourniquet must be made obvious. This can be done by putting the letter T and the time of application on the patient’s forehead.
DANGERS WITH THE APPLICATION OF A TOURNIQUET
- It is quite likely to damage nerves and muscles.
- It is quite likely not to be tight enough and may only limit venous blood flow and may not stop arterial blood flow.
- If it is in the form of a narrow band, it may easily damage the skin. Broad rubber bands constitute the best form of tourniquet and it is doubtful if this can be obtained for first-aid work.
- There is serious danger if the tourniquet is left on for longer than twenty minutes.
To apply a tourniquet as a first-aid measure a tie, scarf can be used. This is applied round the upper arm or thigh, a knot tied and a pencil or piece of stick used to tighten the band. This is done by placing the pencil in the knot and rotating it.