Module 2 of 2 · 35 minutes
Bleeding, burns, seizures and choking
By the end of this module you will be able to
- Control severe bleeding, including a catastrophic bleed
- Treat a burn correctly, and know what makes it worse
- Support somebody through a seizure without restraining them
- Manage choking in an adult, and know when to call 999
Work through it
1 interactive for this module, built on the WAJD Teach engine. Nothing moves until you ask it to, and every one has a written version if you would rather read it.
Amara Heavy bleeding. What do I actually do?
Nadia Firm direct pressure on the wound. Something clean if you have it, your bare hand if you do not. Pressure stops bleeding; a dressing is just a more comfortable way of applying pressure.
Amara There is glass in the wound.
Nadia Then leave it. Do not pull it out, because it may be the only thing stopping much heavier bleeding. Pack around it and press either side.
Amara The dressing has soaked through.
Nadia Add more on top. Never remove the first one, because you strip off the clot that was forming underneath it.
Amara Both of those feel like the wrong thing to do.
Nadia They both feel like helping, and they both increase blood loss. That is why they are worth learning before you are standing over somebody.
Amara Burns. How long do I cool it for?
Nadia Twenty minutes under cool running water. Twenty, not a couple, and it is still worth doing up to three hours afterwards.
Amara Twenty minutes is a long time.
Nadia It is, and it is the single most effective thing anybody does for a burn. People stop at two minutes because the person says it feels better, and the burn carries on cooking underneath.
Amara Should I take a ring off?
Nadia Yes, and quickly, unless it is stuck to the burn. Swelling comes fast and a ring becomes a tourniquet on a finger.
Amara Then cover it?
Nadia Cling film laid on, not wrapped around, because wrapping constricts as it swells. Or a clean non fluffy cloth. Cling film is ideal: it does not stick, and the wound stays visible.
Amara My grandmother swore by butter.
Nadia Your grandmother was wrong, and so is toothpaste, cream and ice. Butter and creams trap heat and get scraped off in hospital, which is as unpleasant as it sounds. Ice causes additional tissue damage. And never burst a blister.
Amara Seizures frighten me. Do I hold them?
Nadia No. Do not restrain them, and do not put anything in their mouth. Both are actively harmful.
Amara What about swallowing their tongue?
Nadia It does not happen. It is not anatomically possible, and people have broken teeth and fingers acting on that belief.
Amara So what do I do?
Nadia Protect their head, move the furniture, note the time it started, and stay with them. When it stops, recovery position, and let them come round in their own time. Confusion and exhaustion afterwards are normal and they may not know where they are.
Amara When do I call 999?
Nadia More than five minutes. Another one before they have recovered. Their first ever. If they are injured. Or if they do not regain consciousness.
Amara Choking. Back blows first?
Nadia If the cough is ineffective, yes. Five back blows between the shoulder blades, then five abdominal thrusts, alternating. Unresponsive, start CPR.
Amara And if they are coughing well?
Nadia Leave them to it and encourage it. A person coughing forcefully is moving far more air than you will move for them, and interfering can turn a partial obstruction into a complete one.
Amara Afterwards?
Nadia Anyone who has had abdominal thrusts gets medical assessment, even if they feel completely fine, because of the risk of internal injury.
The written material
Severe bleeding
Firm, direct pressure on the wound, with something clean if you have it and with your bare hand if you do not. Pressure is what stops bleeding; a dressing is just a more comfortable way of applying it.
Do not remove an object embedded in a wound. It may be the only thing preventing far heavier bleeding. Pack around it and apply pressure either side.
Lie the person down, keep them warm, and ring 999. If blood soaks through, add more on top rather than removing the first dressing, because removing it strips away the clot that was forming.
For a catastrophic bleed from a limb where direct pressure is not controlling it, a tourniquet is appropriate if one is available and you know how to use it. Note the time it went on and tell the ambulance crew.
Burns
Cool the burn under cool running water for at least twenty minutes. Twenty minutes is a genuine number, not an approximation, and it remains worth doing up to three hours after the injury.
Remove clothing and jewellery from the area unless it is stuck to the burn, because swelling comes fast and a ring becomes a tourniquet.
Then cover loosely with cling film laid on, not wrapped around, or a clean non fluffy cloth. Cling film is ideal because it does not stick and the wound stays visible.
Never use ice, butter, creams, toothpaste or any home remedy. Ice causes further tissue damage; the rest trap heat and have to be scraped off in hospital. Never burst a blister.
Ring 999 for burns that are large, deep, on the face, hands, feet, genitals or across a joint, any chemical or electrical burn, and any burn to a child.
Seizures and choking
During a seizure: do not restrain them and do not put anything in their mouth. Both are actively harmful, and the swallowing of the tongue that people fear is not a thing that happens.
Protect their head, move furniture out of the way, note the time it started, and stay. When it stops, place them in the recovery position and let them recover in their own time. Confusion and exhaustion afterwards are normal.
Ring 999 if it lasts more than five minutes, if another follows without recovery in between, if it is their first, if they are injured, or if they do not regain consciousness.
Choking with an ineffective cough: five back blows between the shoulder blades, then five abdominal thrusts, alternating. If they become unresponsive, start CPR. If the cough is still effective, encourage them to keep coughing, because they are moving more air than you will move for them.
Anyone who has received abdominal thrusts needs medical assessment afterwards, even if they feel fine, because of the risk of internal injury.
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