Introduction

Bleeding from the nose most commonly occurs when tiny blood vessels inside the nostrils are ruptured, either by a blow to the nose, or as a result of sneezing, picking or blowing the nose. Nosebleeds may also occur as a result of high blood pressure.

A nosebleed can be dangerous if the casualty loses a lot of blood. In addition, if bleeding follows a head injury, the blood may appear thin and watery. The latter is a very serious sign because it indicates that the skull is fractured and fluid is leaking from around the brain.

Your aims

• To control blood loss.
• To maintain an open airway.

Treatment

• Ask the casualty to sit down.
• Advise them to tilt their head forwards to allow the blood to drain from the nostrils.
• Ask the casualty to breathe through their mouth (this will also have a calming effect) and to pinch the soft part of the nose.
• Reassure and help if necessary.
• Tell the casualty to keep pinching their nose.
• Advise them not to speak, swallow, cough, spit or sniff because this may disturb blood clots that may have formed in the nose.
• After 10 minutes, tell the casualty to release the pressure. If the bleeding has not stopped, tell them to reapply the pressure for two further periods of 10 minutes.
• Once the bleeding has stopped and with the casualty still leaning forwards, clean around their nose with lukewarm water.
• Advise the casualty to rest quietly for a few hours. Tell them to avoid exertion and in particular, not to blow their nose, because these actions will disturb any clots.

Caution

• Do not let the head tip back; blood may run down the throat inducing vomiting.
• If bleeding stops and then restarts, tell the casualty to reapply pressure.
• If the nosebleed is severe, or if it lasts longer than 30 minutes in total, take or send the casualty to hospital in the treatment position.

Minor cuts, scratches and grazes

Treatment

• Wash and dry your own hands.
• Cover any cuts on your own hands and put on disposable gloves.
• Clean the cut, if dirty, under running water. Pat dry with a sterile dressing or clean lint-free material. If possible, raise affected area above the heart.
• Cover the cut temporarily while you clean the surrounding skin with soap and water and pat the surrounding skin dry. Cover the cut completely with a sterile dressing or plaster.

Severe bleeding

Treatment

• Put on disposable gloves.
• Apply direct pressure to the wound with a pad (e.g. a clean cloth) or fingers until a sterile dressing is available.
• Raise and support the injured limb. Take particular care if you suspect a bone has been broken.
• Lay the casualty down to treat for shock.
• Bandage the pad or dressing firmly to control bleeding, but not so tightly that it stops the circulation to fingers or toes. If bleeding seeps through first bandage, cover with a second bandage. If bleeding continues to seep through bandage, remove it and reapply.
• Treat for shock.
• Dial 999 for an ambulance.

Remember: protect yourself from infection by wearing disposable gloves and covering any wounds on your hands.

If blood comes through the dressing do not remove it – bandage another over the original.

If blood seeps through both dressings, remove them both and replace with a fresh dressing, applying pressure over the site of bleeding.

Objects in wounds

Where possible, swab or wash small objects out of the wound with clean water. If there is a large object embedded:

Treatment

• Leave it in place.
• Apply firm pressure on either side of the object.
• Raise and support the wounded limb or part.
• Lay the casualty down to treat for shock.
• Gently cover the wound and object with a sterile dressing.
• Build up padding around the object until the padding is higher than the object, then bandage over the object without pressing on it.
• Depending on the severity of the bleeding, dial 999 for an ambulance or take the casualty to hospital.

Any break in the surface of the skin (wound), will not only allow blood and other fluids to be lost, but allow germs to enter the body. If the wound is minor, the aim of the first aider is to prevent infection. severe wounds may be very daunting to deal with but the aim is to prevent further blood loss and minimise the shock that could result from the bleeding.

Some closed wounds such as bruising could indicate an underlying injury and first aiders need to be aware of the cause of injury as this may alert you to a more serious condition, such as internal bleeding.

Any open wound is at risk of becoming infected, it is important to maintain good hygiene procedures to guard against prevent cross infection between yourself and the casualty.