Bleeding control, shock and wound care
This domain tests control of external bleeding, recognition and first aid for shock, and safe wound management. Marks are lost by improvised techniques that cause more harm than the bleeding itself.
Controlling external bleeding
Apply firm, direct pressure over the wound with a sterile dressing or clean cloth. Elevate the limb if no fracture is suspected and bandage firmly, checking that the fingers or toes remain warm and pink. If blood soaks through, add another dressing on top - never remove the soaked one. For catastrophic limb bleeding that direct pressure cannot control, apply a manufactured tourniquet 5–7 cm above the wound (not over a joint), tighten until bleeding stops and record the time. Never use a tourniquet on the neck.
Recognising and treating shock
Shock is inadequate tissue perfusion. Look for pale, cold, clammy skin, a rapid weak pulse, rapid shallow breathing, thirst, anxiety, nausea and a falling level of consciousness. Call for urgent help, lay the casualty flat, raise the legs unless fracture or spinal injury is suspected, keep them warm, give nothing by mouth and monitor airway and breathing continuously.
Wound care
Wash your hands and wear gloves. Irrigate with clean water or saline, remove small superficial foreign bodies, and cover with a sterile non-adherent dressing. Do not remove a large impaled object - pad around it and stabilise it. For an amputation, control bleeding, wrap the severed part in sterile gauze, seal it in a bag and place the bag in ice water; never place tissue directly on ice.
Worked example
A kitchen worker has a spurting forearm wound. Reasoning: spurting bright red blood suggests arterial bleeding. Apply direct pressure with a dressing, call 999, and if bleeding still soaks through after a second dressing, apply a tourniquet above the wound and note the time.
Traps that cost marks
- Removing a soaked dressing and losing the forming clot.
- Applying a tourniquet loosely, over a joint, or without recording the time.
- Giving an injured casualty food or drink.