Ch.26 Bleeding Flashcards
The cardiovascular system is the main system responsible for supplying and maintaining adequate blood flow. It
consists of three parts:
• The pump (the heart)
• A container (the blood vessels that reach the cells of the body)
• The fluid (blood and body fluids)
All organs depend on the heart to provide a rich blood supply. For this reason, the heart muscle has several unique features. First, because the heart cannot tolerate a disruption of its blood flow for more than a few minutes, the heart muscle needs a rich and well-distributed blood supply. Second, the heart works as two paired pumps (FIGURE 26-2).
Each side of the heart has an upper chamber (atrium) and a lower chamber (ventricle), both of which pump blood.
Blood leaves each chamber of a normal heart through a__, which keeps the blood moving in the proper direction by preventing backflow.
one-way valve
The right side of the heart circulates blood from the body to the lungs. The left side of the heart circulates oxygen-rich blood from the lungs to the rest of the body. It is the more muscular of the two pumps because it must pump blood into the____ in order to reach all cells of the body.
aorta and arteries
As blood flows out of the heart, it passes into the aorta, the largest artery in the body. The arteries become smaller the farther they are from the heart. The smaller blood vessels that connect the arteries and capillaries are arterioles.
Capillaries are small tubes, with the diameter of a single red blood cell, that pass among all the cells in the body, linking the arterioles and the venules. Blood leaving the distal side of the capillaries flows into the venules. These small, thin-walled vessels empty into the veins, and the veins then empty into the inferior and superior vene cavae. This is the process that returns blood in the venous portion of the circulatory system to the heart. Oxygen and nutrients easily pass from the capillaries into the cells, and waste and carbon dioxide___ from the cells into the capillaries (FIGURE 26-3). This transportation system allows the body to rid itself of waste products.
diffuse
Blood contains red cells, white cells, platelets, and plasma (FIGURE 26-4). Red blood cells transport oxygen to the cells and transport carbon dioxide (a waste product of cellular metabolism) away from the cells to the lungs, where it is removed from the body during___. Platelets are the key to formation of blood clots. Blood clots are an important response from the body to control blood loss. In the body, blood clot formation depends on several factors: blood stasis, changes in the blood vessel wall (such as a wound), and the blood’s ability to clot (affected by disease processes or medications). When tissues are injured, platelets begin to collect at the site of injury; this causes red blood cells to become sticky and clump together. As the red blood cells begin to clump, a protein in plasma reinforces the developing clot by converting to a threadlike mesh that forms a clot. Medical conditions that interfere with the normal clotting process will be discussed later in this chapter.
exhalation
The____ monitors the body’s needs and adjusts the blood flow by constricting or dilating blood vessels as required. During an emergency, the__ automatically redirects blood away from other organs to the heart, brain, lungs, and kidneys. Thus, the cardiovascular system adapts to changing conditions in the body to maintain homeostasis and perfusion. If blood volume is significantly diminished and the system fails to provide sufficient circulation for every body part to perform its function, then hypoperfusion, or shock, results. See Chapter 13, Shock, for a more detailed discussion of this process.
autonomic nervous system
____is the circulation of blood within an organ or tissue to allow it to meet the cells’ current needs for oxygen, nutrients, and waste removal. Blood enters an organ or tissue first through the arteries, then the arterioles, and finally, the capillary beds (FIGURE 26-5). As it passes through the capillaries, the blood delivers nutrients and oxygen to the surrounding cells and picks up the wastes they have generated.
Perfusion
___must pass through the cardiovascular system fast enough to maintain adequate circulation throughout the body and to avoid clotting, yet slow enough to allow each cell time to exchange oxygen and nutrients for carbon dioxide and other waste products. Although some tissues never rest and require a constant blood supply, most require a large volume of circulating blood only intermittently, with less required when at rest. For example, skeletal muscles require a minimal blood supply during sleep, as opposed to a large blood supply during exercise. Another example is the gastrointestinal tract, which requires a high flow of blood after a meal. After digestion is completed, however, the gastrointestinal tract functions well with a small fraction of that blood flow.
Blood
All organs and organ systems of the human body depend on adequate___ to function properly. Some organs require a rich supply of blood and do not tolerate interruption of blood supply for even a few minutes without sustaining damage. If___ to these organs is interrupted, then dysfunction and failure of that organ system will occur. The death of an organ system can quickly lead to the death of the patient. Emergency medical care is designed to support adequate perfusion of these critical organs and organ systems, listed in TABLE 26-1, until the patient arrives at the hospital.
perfusion
The heart requires constant___ to function optimally; without it, cells in the brain and spinal cord start to die after 4 to 6 minutes. (Remember that cells of the central nervous system do not have the capacity to regenerate.) Without adequate__, the lungs can survive only 15 to 20 minutes and kidneys can be damaged after 45 minutes. Skeletal muscle demonstrates evidence of injury after 2 to 3 hours of inadequate perfusion, while the gastrointestinal tract can tolerate slightly longer periods. These times are based on a normal core body temperature (98.6°F [37.0°C]). An organ or tissue that is kept at a considerably lower temperature may be better able to resist damage from hypoperfusion.
perfusion
___means bleeding. External bleeding is visible hemorrhage. Examples include nosebleeds and bleeding from open wounds. As an EMT, you must understand how to control external bleeding.
Hemorrhage
With serious external bleeding, it is often difficult to determine the amount of blood loss because blood will look different on different surfaces, such as when it is absorbed in clothing, when it has been diluted in water, or when the environment is dark. It is important to estimate the amount of external blood loss; however, treatment should be based on the patient’s presentation and__
mechanism of injury (MOl).
The typical adult male body contains approximately____ of blood per kilogram of body weight, whereas the adult female
body contains approximately____ of blood per kilogram of body weight. Therefore, a typical adult man weighing 175 pounds (79 kg) has a total blood volume of about 10 to 12 pints (6 L). The body cannot tolerate an acute blood loss of greater than 20% of this total blood volume, or more than 2 pints (approximately 1 L) in the average adult. With significant blood loss, adverse changes in vital signs will occur, including increased heart and respiratory rates and decreased blood pressure. Because infants and children have less blood volume compared with adults, these effects are seen with smaller amounts of blood loss. For example, a 1-year-old has a typical total blood volume of about 27 oz (800 mL); the child will show significant symptoms of blood loss after only 3 to 6 oz (100 to 200 mL) of blood loss, or less than half the volume of liquid in a 12-oz (350-mL) can of soda.
70 mL
65 mL
How well a patient’s body can compensate for blood loss is related to how rapidly the blood loss occurs. A healthy adult can comfortably donate ____within 15 to 20 minutes and adapt well to this decrease in blood volume. If this volume of blood loss occurs during a much shorter period, however, symptoms of hypovolemic shock, a condition in which low blood volume results in inadequate perfusion and even death, might develop. The age and preexisting health of the patient should also be considered
In any situation, severe blood loss presents an immediate life threat. Your priority is to quickly control major external
bleeding, even before you address airway and breathing concerns.
1 unit, or roughly 1 pint (500 mL) of blood
Injuries and some illnesses can disrupt blood vessels and cause external bleeding. You should consider bleeding to be severe if any of the following conditions exist:
• The patient has a poor general appearance and has no response to external stimuli.
• Assessment reveals signs and symptoms of shock (hypoperfusion).
• You note a significant amount of blood loss.
• The blood loss is rapid and ongoing.
• You cannot control the bleeding
• The bleeding is associated with a significant MOl.
Typically,___ bleeding from an open artery is bright red (because it is oxygen rich) and spurts in time with the pulse.
The pressure that causes the blood to spurt also makes this type of bleeding difficult to control. As the amount of blood circulating in the body drops, so does the patient’s blood pressure and, eventually, the arterial spurting.
arterial
___bleeding from an open vein is darker than arterial blood (because it is oxygen poor) and can flow slowly or rapidly, depending on the size of the vein. Because it is under less pressure, most venous blood does not spurt and is easier to manage; however, it can be profuse and life threatening.
Venous
___bleeding from damaged capillary vessels is dark red and oozes from a wound steadily but slowly. Venous and capillary blood is more likely to clot spontaneously than arterial blood
Capillary
On its own, bleeding tends to stop rather quickly, within about 10 minutes, in response to internal mechanisms and exposure to air. When a person’s skin is broken, blood flows rapidly from the open blood vessel. Soon afterward, the cut ends of the blood vessel begin to narrow (vasoconstriction), reducing the amount of bleeding. Then a clot forms, plugging the hole and sealing the injured portions of the blood vessel. This process is called___. With a severe injury, the damage to the blood vessel may be so great that a clot cannot completely block the hole. Bleeding will never stop if an effective clot does not form, unless the injured blood vessel is completely cut off from the main blood supply by direct pressure or a tourniquet.
coagulation
Despite the efficiency of the circulatory system, it may fail in certain situations. Movement, disease process, certain medications (such as blood thinners), removal of bandages, the external environment, or body temperature commonly affect the blood’s clotting factors. Occasionally, blood loss is very rapid. In these cases, the patient might die before clotting occurs.
A small portion of the population lacks one or more of the blood’s clotting factors, a condition called__. There are
several forms of hemophilia, most of which are hereditary and some of which are severe. Sometimes bleeding occurs spontaneously in patients with hemophilia. Because the patient’s blood does not clot effectively, all injuries, no matter how trivial, are potentially serious. Transport any injured patient with hemophilia immediately.
hemophilia
If a bandage has already been applied to control bleeding before your arrival on the scene, obtain a description of the wound and the amount of bleeding from the patient or bystanders. If blood has seeped through the dressing, do not remove it; most likely the clotting process has already begun and removing the dressing will disturb the clot. Instead, apply a clean dressing on top of the first one to reinforce it. You can also observe the old dressing to estimate the amount of blood loss.
Words of wisdom :)
___is any bleeding that occurs in a cavity or space inside the body. Internal bleeding can be very serious, especially because it is not easy to detect immediately. Injury or damage to internal organs commonly results in extensive internal bleeding, which can cause hypovolemic shock before you realize the extent of blood loss. A person with a bleeding stomach ulcer may sustain a large amount of blood loss very quickly. Similarly, a person who has a lacerated liver or a ruptured spleen may sustain a considerable amount of blood loss within the abdomen, yet the patient may have no outward signs of bleeding
Broken bones also may cause serious internal blood loss. A broken femur can easily result in the loss of 2 pints (approximately 1 L) or more of blood into the soft tissues of the thigh. Often, the only signs of such bleeding are local swelling and bruising (called a contusion, or ecchymosis) caused by the accumulation of blood around the ends of the broken bone. Severe pelvic fractures may result in life-threatening hemorrhage.
Always be alert to the possibility of internal bleeding. Assess the patient for related signs and symptoms, particularly if the MOl is significant. If you suspect that a patient is bleeding internally, treat for shock and promptly transport him or her to the hospital.
Internal bleeding
A bruise from an injury that causes bleeding beneath the skin without breaking the skin; also see ecchymosis
Contusion
A buildup of blood beneath the skin that produces a characteristic blue or black discoloration as the result of an injury
Ecchymosis
A high-energy MOl should increase your ___for the possibility of serious, unseen injuries such as internal bleeding in the abdominal cavity. Internal bleeding is possible whenever the MOl suggests that severe forces affected the body. These forces include blunt and penetrating trauma. Internal bleeding commonly occurs as a result of falls, blast injuries, motor vehicle crashes, and other blunt trauma. Remember that internal bleeding can also result from penetrating trauma.
As you assess a patient, look for signs of injury using the DCAP-BTLS as well as any other signs of injury. Always
suspect internal bleeding in a patient who has sustained a penetrating injury or blunt trauma.
index of suspicion
___is not always caused by trauma. Many illnesses can cause internal bleeding. Some of the more common causes of nontraumatic internal bleeding include bleeding ulcers, bleeding from the colon, ruptured ectopic pregnancy, and aneurysms.
Abdominal tenderness, guarding, rigidity, pain, and distention are frequent in these situations but are not always present.
In older patients, dizziness, faintness, or weakness may be the first sign of nontraumatic internal bleeding. Ulcers or other gastrointestinal problems may cause vomiting of blood or bloody diarrhea.
It is not as important for you to know the specific organ involved as it is to recognize that the patient is in shock. When combined with prompt transport decisions and limited time spent at the scene, the rapid recognition of a patient in shock should result in the rapid administration of potentially life-saving treatments.
Internal bleeding
The most common symptom of internal bleeding is__. Significant internal bleeding will generally cause swelling in the area of bleeding, but swelling is often undetected until massive blood loss has occurred. Internal bleeding is most common in head, extremity, and pelvic injuries and is often associated with significant abdominal trauma. Intra-abdominal bleeding will often cause pain and abdominal distention. Bleeding into the chest cavity or lung may cause dyspnea, tachycardia, hemoptysis (the coughing up of bright red blood), and hypotension. A hematoma, a mass of blood that has collected in the soft tissues beneath the skin, indicates bleeding into soft tissues and may be the result of a minor or a severe injury. Bruising or ecchymosis may not be present initially, and the only sign of severe pelvic or abdominal trauma may be redness, skin abrasions, or pain
Bleeding from any body opening, however slight, is serious. It usually indicates internal bleeding that is not easy to see or control. Bright red bleeding from the mouth or rectum or blood in the urine (hematuria) may suggest serious internal injury or disease. Nonmenstrual vaginal bleeding is always significant.
pain
The coughing up of blood
Hemoptysis
A mass of blood that has collected within damaged tissue beneath the skin or in a body cavity
Hematoma
Blood in the urine
Hematuria
Other signs and symptoms of internal bleeding in trauma and medical patients include the following:
•_____. The vomiting of blood. The vomitus may be bright red or dark red. If the blood has been partially digested, the vomitus may look like coffee grounds.
•_______. Black, foul-smelling, tarry stool that contains digested blood
• Pain, tenderness, bruising, guarding, or swelling. These signs and symptoms, particularly in an extremity, may mean that a closed fracture is bleeding.
• Broken ribs, bruises over the lower part of the chest, or a rigid, distended abdomen. These signs and symptoms may indicate a lacerated spleen or liver. Patients with an injury to one of these organs may have referred pain in the right shoulder (indicating the liver is injured) or left shoulder (indicating the spleen is injured). Suspect internal abdominal bleeding in a patient with referred pain.
Hematemesis
Melena
The first sign of ___is a change in mental status, such as anxiety, restlessness, or combativeness. In nontrauma patients, weakness, faintness, or dizziness on standing can all be early signs. Changes in skin color or pallor (pale skin) are often seen in both trauma and medical patients with severe bleeding. Later signs of hypovolemic shock suggesting internal bleeding include the following:
• Tachycardia
• Weakness, fainting, or dizziness at rest
• Thirst
• Nausea and vomiting
• Cold, moist (clammy) skin
• Shallow, rapid breathing
• Slightly dilated pupils that are slow to respond to light
• Capillary refill time longer than 2 seconds in infants and children
• Weak, rapid (thready) pulse
• Decreasing blood pressure
• Altered level of consciousness
hypovolemic shock
In___ patients, dizziness, syncope, or weakness may be the first sign of nontraumatic internal hemorrhage.
older
If the patient has obvious, life-threatening external bleeding, remember to address it first (even before airway and breathing) by. controlling it quickly; then assess the___ and provide treatment. If direct pressure is ineffective in controlling massive hemorrhage from an arm or leg, the patient may require a tourniquet before the airway is opened.
XABCs
Non-life-threatening bleeding, such as from an abrasion, can be bandaged later in the assessment as necessary. However, significant and ongoing bleeding, whether internal or external, is an immediate life threat.
Words of wisdom :)
When you encounter a patient with minor or superficial bleeding, avoid focusing solely on the bleeding. With significant trauma, assess the entire patient, looking for the source of the problem, any preexisting illnesses, and other issues.
If the patient is responsive, obtain a SAMPLE history. It is important to ask the patient if he or she takes blood-thinning medications because bleeding is generally more profuse and difficult to control in patients who take blood thinners.___ are often prescribed for patients with a history of stroke, pulmonary embolism, or heart attack. Common___ include antiplatelets such as aspirin, clopidogrel (Plavix), and ticagrelor (Brilinta), and anticoagulants such as warfarin (Coumadin), rivaroxaban (Xarelto), dabigatran (Pradaxa), apixaban (Eliquis), and edoxaban (Savaysa).
Blood thinners
Obtain baseline vital signs; this allows you to more easily identify any changes that may occur during treatment. In an adult patient, a systolic blood pressure of less than 100 mm Hg with a weak, rapid pulse and cool, moist skin that is pale or gray are signs of___ that require immediate attention. In patients with dark skin, because skin paleness may be difficult to detect, you may instead need to assess for paleness of the mucous membranes or slow capillary refill.
hypoperfusion
In geriatric patients and patients who take certain blood pressure medications, the pulse rate____ with early shock; therefore, try to determine the patient’s baseline blood pressure and quickly obtain a medical history and list of medications to help you better assess the patient’s condition.
may not increase
In patients with severe___, it is important to recognize, estimate, and report the amount of blood loss that has occurred and how rapidly or over what period of time it occurred. For example, you may report that approximately 2 pints (approximately 1 L) of blood loss occurred or that the bleeding soaked through three trauma dressings. Report this information to hospital personnel during transport to allow the hospital to evaluate needed resources, such as the availability of surgical suites, surgeons, and other specialty providers. Your transfer report at the hospital should update hospital personnel on how your patient has responded to your care. Be sure your paperwork reflects all of the patient’s injuries and the care you have provided.
external bleeding
Several methods are available to control external bleeding
• Direct pressure
• Pressure dressings and/or splints
• Tourniquets
• lunctional tourniquet
• Hemostatic dressing
• Wound packing
A device that provides proximal compression of severe bleeding near the axial or inguinal junction with the torso
Junctional tourniquet
A dressing impregnated with a chemical compound that slows or stops bleeding by assisting with clot formation
Hemostatic dressing
Use of____ for extremity hemorrhage is strongly recommended if sustained direct pressure is ineffective or impractical; Use a commercially-produced, windlass, pneumatic, or ratcheting device, which has been demonstrated to occlude arterial flow and avoid narrow, elastic, or bungee-type devices; Utilize improvised____ only if no commercial device is available; Do not release a properly-applied tourniquet until the patient reaches definitive care.
tourniquet
Apply a___, in combination with direct pressure, for wounds in anatomic areas where tourniquets can not be applied and sustained direct pressure alone is ineffective or impractical; Only apply topical hemostatic agents in a gauze format that supports wound packing; Only utilize topical hemostatic agents which have been determined to be effective and safe in a standardized laboratory injury model.
topical hemostatic agent
Most cases of external bleeding can be controlled simply by applying direct, local pressure to the bleeding site. This method is by far the most common way to control external bleeding and is usually effective. (Previously, elevation of the extremity was also recommended, but there is no evidence it helps control bleeding and it may aggravate other injuries.) Pressure stops the flow of blood and permits normal___ to occur. You may apply pressure with your gloved fingertip or hand over the top of a sterile dressing if one is immediately available.
coagulation
If there is an object protruding from the wound, never remove it unless it is in the cheek and blocking the patient’s airway. Apply bulky dressings to stabilize the impaled object in place, and apply pressure as best you can for at least____ without interruption.
5 minutes
If direct pressure fails to immediately stop hemorrhage, then apply a____ above the level of the bleeding. If this is not possible because the bleeding is too proximal, then consider a junctional tourniquet or wound packing with a hemostatic dressing if available (follow local protocols).
tourniquet
In most cases, direct pressure will stop the bleeding. Once you have applied a dressing to control bleeding, create a pressure dressing to maintain the pressure by firmly wrapping a sterile, self-adhering roller bandage around the entire wound. Use 4 x 4-inch (101 × 101-mm) sterile gauze pads for small wounds and sterile universal dressings for larger wounds.
Cover the entire dressing with the bandage above and below the wound and stretch the bandage tight enough to control bleeding. If you were able to palpate a___ before applying the dressing, then you should still be able to palpate a distal pulse on the injured extremity after applying the pressure dressing. If bleeding continues, then the dressing is insufficient. If the bleeding oozes slowly through the dressing, then reinforce it by applying more dressings on top of it. Do not remove a dressing until a physician has evaluated the patient.
Bleeding will almost always stop when the pressure of the dressing exceeds arterial pressure. This will assist in
controlling bleeding and helping blood to clot.
distal pulse
Much of the bleeding associated with broken bones occurs because the sharp ends of the bones cut muscles and other tissues.
As long as a fracture remains unstable, the bone ends will move and continue to injure partially clotted blood vessels. Therefore, immobilizing a fracture and decreasing movement will help control bleeding. Often, a simple splint will quickly reduce the bleeding associated with a fracture (FIGURE 26-9). If the patient is unstable, however, do not spend excess time splinting a fracture.
Words of wisdom
Gauze can be packed into larger wounds to control hemorrhage when direct pressure is not adequate or application of a tourniquet is not possible. A____ is a dressing impregnated with a chemical compound that slows or stops bleeding by promoting clot formation.
Hemostatic dressings can be used together with wound packing and direct pressure when direct pressure alone is ineffective or when tourniquet placement is otherwise impossible. These dressings have the potential to improve prehospital bleeding control, especially when transport time to definitive care is prolonged. Be aware of and follow your local protocols regarding use of wound packing and hemostatic dressings.
Follow your local protocols and the steps in SKILL DRILL 26-2 to pack a wound
hemostatic dressing
If direct pressure does not control extremity bleeding, then use a__. The tourniquet is only useful if a patient has substantial bleeding from an extremity injury. Several different types of commercial tourniquets are available (FIGURE 26-10). Make sure you are familiar with the type of tourniquet used by your service.
tourniquet
Apply pressure over the bleeding site and place the tourniquet___ to the injury (in the axillary region for upper extremity injuries and at the groin for lower extremity injuries).
proximal
• Do not apply a tourniquet directly over any__. Always place the tourniquet proximal to the injury in the axillary region for upper extremity injuries and at the groin for lower extremity injuries).
joint
• If the tourniquet does not immediately control bleeding,___
• Make sure the tourniquet is tightened securely.
apply a second one adjacent to the first.
Do not___ the tourniquet after you have applied it, unless directed to do so by medical control. Hospital personnel will loosen it once they are prepared to manage the bleeding.
loosen
A____ allows for proximal compression of life-threatening bleeding in areas where standard tourniquet application is not possible, such as the groin or the axilla. A____ may be indicated for severe hemorrhage at the junction of the torso with the arms (axillary area) or legs (inguinal area). Use of junctional tourniquets have been approved by the Food and Drug Administration for use in prehospital medicine and have been shown to be at least 75% effective in controlling hemorrhage when used properly. Some junctional tourniquets may also be used as a pelvic binder for suspected unstable pelvic fractures.____ are presently used primarily in military and tactical settings.
junctional tourniquet
___(commonly known as soft splints or pressure splints) can help control internal or external bleeding associated with severe extremity injuries, such as fractures (FIGURE 26-11). They also immobilize the fracture itself. An air splint acts in a manner similar to a pressure dressing applied to an entire extremity rather than to a small, local area. Use only approved, clean, or disposable valve stems when orally inflating air splints.
Air splints
Use of a___(pelvic compression device) is now common in prehospital care (FIGURE 26-12). A pelvic binder is a type of splint that may be indicated for a suspected closed unstable pelvic fracture. Research indicates that a pelvic binder is an effective method to reduce the width of and to stabilize pelvic ring injuries. This helps to control internal bleeding, specifically bleeding associated with a life-threatening open-book pelvic fracture. It is applied when pelvic fracture is suspected and the patient has signs of shock.
pelvic binder
A life threatening fracture of the pelvis caused by a force that displaces one or both sides of the pelvis laterally and posteriorly
Open-book pelvic fracture
apply a pelvic binder, slide the binder under the supine patient with the device centered over the___ (hips). Secure and tighten the device according to manufacturer’s instructions. It is important to provide the correct amount of force when applying a compression device.
Pediatric patients who weigh less than 50 pounds (23 kg) may be too small for an adult pelvic binder; however, there are commercial pediatric pelvic binders available. Follow local protocols regarding use of a pelvic binder.
Rigid splints will help immobilize fractures as well as reduce pain and further damage to soft tissues. After you have
applied a splint, be sure to monitor pulse and motor and sensory function in the distal extremity.
trochanters
___, or nosebleed, is a common emergency. Occasionally, it can cause blood loss great enough to send a patient into shock. Keep in mind that the blood that is visible may be only a small part of the total blood loss. Much of the blood may pass down the throat into the stomach as the patient swallows. A person who swallows a large amount of blood may become nauseated and start vomiting the blood, which is sometimes confused with internal bleeding.
Most nontraumatic nosebleeds occur from sites in the septum (the tissue dividing the nostrils). You can usually handle this type of bleeding effectively by pinching the nostrils together. SKILL DRILL 26-4 illustrates the basic techniques to control epistaxis.
Epistaxis
Bleeding from the nose or ears following a head injury may indicate a skull__. In these cases, do not attempt to stop the blood flow. This bleeding may be difficult to control. Applying excessive pressure to the injury may force the blood leaking through the ear or nose to collect within the head. This could increase the pressure on the brain and possibly cause permanent damage. If you suspect a skull fracture, loosely cover the bleeding site with a sterile gauze pad to collect the blood and help keep contaminants away from the site. Apply light compression by wrapping the dressing loosely around the head (FIGURE 26-13). If blood or drainage contains cerebrospinal fluid, you will see a characteristic staining of the dressing much like a target or halo shape
fracture
When ___ is present in blood or drainage, a stain in the shape of a target or halo will appear
Cerebrospinal fluid
Never use a ____ to control the bleeding from closing, internal, soft-tissue injuries.
Tourniquet
