External bleeding control and shock management
This domain tests control of external bleeding and recognition of shock. The exam expects direct pressure, appropriate dressings, and recognition that shock is a life-threatening emergency. It also tests safe use of tourniquets only when trained and available.
Core rules and concepts
- Control severe bleeding with direct pressure. Wear gloves, press firmly on the wound with a sterile dressing or clean pad, and maintain pressure. Add further dressings on top if bleeding continues; do not remove the first dressing.
- Elevate if appropriate. Raising a bleeding limb can help reduce flow if there is no suspected fracture or spinal injury.
- Embedded objects: leave them in place and apply pressure around the object. Do not remove it.
- Tourniquet: use only if trained, available, and bleeding is catastrophic and not controlled by direct pressure. Apply above the wound, not over a joint, and record the time.
- Recognise shock: pale, cold, clammy skin; rapid weak pulse; thirst; anxiety; nausea; rapid breathing; confusion or reduced consciousness. Shock may follow severe bleeding, burns, vomiting, diarrhoea, or allergic reactions.
- Treat shock: call 999, lie the casualty down, keep them warm, loosen tight clothing, and do not give food or drink. Raise the legs if no fracture, spinal, or breathing difficulty; monitor breathing and responsiveness.
Worked example
A kitchen worker has a deep cut to the forearm with heavy bleeding. The first aider puts on gloves, presses a sterile dressing firmly onto the wound, and raises the arm. The bleeding slows. They call 999, keep the arm elevated, check the fingers for warmth and colour, and cover the casualty with a blanket. They do not give water despite the casualty complaining of thirst. Reasoning: direct pressure and elevation control bleeding; thirst is a shock sign, and oral fluids are unsafe if consciousness may deteriorate.
Traps that cost marks
- Removing a blood-soaked dressing instead of adding another.
- Pulling out an embedded object.
- Giving food or drink to a casualty with signs of shock.
- Applying a tourniquet without training or without recording the time.
- Raising the legs when a fracture or spinal injury is suspected.