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Venous Bleeding

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- So, now let's talk about venous bleeding. Venous bleeding is normally characterized by dark red oozing blood, not bright red spurting blood, like arterial. In this case, most of the time, venous bleeding stops on its own in four to six minutes if you did nothing. But, we can easily control it with direct pressure and then a bandage and then decide whether or not the person needs to go in by ambulance, or whether they're stable enough that they can actually go in by private automobile or someone drive them in. I always encourage driving them in, even if you do take them in by another co-worker or someone else by there own vehicle, because if they, maybe have a hard time seeing their own blood, maybe they, you know, for whatever reason, they have kind of a psychogenic shock thing going on, not a true hypovolemic shock, then it's always good that they're a passenger. Plus, it might hurt, you just never know, okay? So, it's always a good idea to have somebody drive them in, or have an ambulance bring 'em in. He obviously lacerated the tip of his finger. He was holding direct pressure on it with just his thumb. But it smiles at me, in other words, I can look at the cut and when he opened up his finger, it kinda of did this fish mouth opening. That means that it was a full thickness cut and is probably gonna need some stitches. If it didn't, if it stayed together when he showed me, and it was just kinda oozing, that might be okay to bandage and heal on its own after its cleaned and we use a triple antibiotic ointment to be sure to combat the possible bacteria. There's also the concept that if this person has not had a tetanus shot in awhile, it's important that they find out what their records are, and if they need a booster, they might get that, because the material was dirty. And so, I'm just gonna get this four by four. I see that the wound is right there. I apply direct pressure over the finger tip. There's a blood because he's been holdin' it for awhile and a little bit of blood goes a long, long ways. So, what looks like a massive amount of blood, might just be that the red blood cells have smeared around, dripped, and don't be distracted by that. But, you might take another bandage and kinda dry that off. Ask the person, did you, do you, you know, have pain anywhere else, did you get cut anywhere else. If he says no, it's just right here. It's just been, I've been holdin' it and it's been running into my hand. So, I put that direct pressure on there. I wait to see if it leaks through. Most venous bleeding will stop with direct pressure unless he has a bleeding disorder or is on blood thinners of some sort for another condition. In this case, he says he's not on any other medications, he's not taking any behind the counter pills. He's pretty much a healthy guy, so I'm not too worried about it. He's stable, he's pink, he's warm, he's dry. He had no loss of consciousness. There are no other life threatening conditions. I don't believe I have to call EMS at this point, unless we wanted the ambulance to transport him. At this point though, it's not leaking through, so I'm now gonna wrap it with tape. What we're doing is we're basically making our own bandaid. It's kind of a hefty bandaid at that, but it's still a bandaid. It's just there to control the bleeding a little bit and to cover the wound so it doesn't get any dirt or debris in it, while we either transport this individual to the Med Center, for stitches or for getting it cleaned out, get his tetanus booster or until we decide what our next step treatment needs to be. Again, bleeding is under control, patient is stable, it's probably not a 9-1-1 call. We can decide to take them in with another co-worker safely or whatever the protocol is for the workplace.

Uncontrolled bleeding is the number one cause of preventable deaths due to a trauma. While venous bleeding is usually less serious than arterial bleeding, it still can pose a serious health risk to the victim.

Venous bleeding can be the result of external trauma, as in something cutting or puncturing a vein, or internal trauma, due to a broken bone or organ damage. Venous bleeding involves blood that is returning to the heart, so there won't be as much pressure as arterial bleeding. However, the blood loss can still be severe.

Venous bleeding distinctions are:

  • The blood is dark red, not bright like arterial bleeding
  • The blood flow is steady but not spurting; it can still be quick, though
  • The pressure is lower than arterial bleeding so it's usually easier to control

How to Provide Care

A person who is the victim of venous bleeding will likely be applying pressure to the wound or cut by the time you arrive to help. Some things to keep in mind with venous bleeding are:

  • It will often stop on its own in 4-6 minutes
  • It's usually easy to control with direct pressure
  • What may seem like a lot of blood is likely to just be smeared, dripping blood which often looks like more than it really is

As always, the first thing you should do is make sure the scene is safe. After that, proceed with the following steps.

  • Put on latex-free gloves if available or wash your hands thoroughly using soap and water or a sanitizer of some kind, preferably with alcohol.
  • Find the source of the bleeding and ask the victim if he or she is cut anywhere else to make sure you're not missing another wound.
  • Place a dressing pad or cloth over the wound.
  • Apply pressure.

At this point, the one dressing pad will usually be enough to control venous bleeding. However, you may also want to consider assessing the severity of the cut.

Pro Tip 1: When you remove pressure, do the folds of skin around the cut begin to come apart, or does the skin appear to be staying together. If the skin is coming apart, stitches are likely necessary. If not, the wound will probably heal on its own and stitches can be avoided. As can a trip to the emergency room.

If a trip to the emergency room is warranted but EMS services are not, it's still a good idea to have someone else drive the victim. 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.

Before you wrap the wound, make sure it's properly cleaned using a bacterial ointment if you have one. This will combat any bacteria that may have gotten into the cut and reduce the chances of infection.

Pro Tip 2: Consider the chances of tetanus. If the victim was cut by something dirty and hasn't had a tetanus shot in the last 10 years, a trip to the emergency room is a necessity regardless of the severity of the wound.

After cleaning the wound, reapply a dressing pad that completely covers the area. Wait and see if the bleeding stops or if it leaks through. Most venous cuts will stop after applying the first pad.

Warning: There are reasons why venous bleeding cannot be easily controlled and these include: the victim has a bleeding disorder or is on blood thinners. Make sure to ask the victim if it appears that the bleeding is difficult to stop.

It's now time to wrap the wound, and taping the pad is usually sufficient. Just be aware to maintain constant pressure while you tape. And as before with arterial bleeding, pinch the finger or toe nails if the extremities are involved and see if blood returns to the nails. You don't want to cut off blood supply.

Your goals in tapping or bandaging the wound are:

  • Maintain pressure and control bleeding
  • Cover completely so dirt and debris cannot get inside the cut

At this point it's always a good idea to make sure the patient is stable and not in shock. If their skin has good color and isn't cold or clammy, and if they haven't lost consciousness, EMS probably will not be needed.

A Word About Disease Transmission

To reduce your risk of disease transmission, there are a few guidelines to keep in mind:

  • Avoid contact with the victim's blood by wearing latex-free gloves and protective eyewear if you have them.
  • Avoid touching your mouth, nose, and eyes while providing care, and don't drink or eat anything before washing your hands.
  • Wash your hands thoroughly after providing care, even if you wore gloves.
  • Always dispose of the gloves or change gloves before helping someone else.

As venous bleeding is often not a severe injury, it's still important to remember that it still has the potential to become a serious situation, especially if bleeding cannot be controlled or the victim goes into shock. When in doubt, it's best to call 911 and let the EMS professionals handle the situation.