Episode 3: Circulatory system, Bleeds, and what to do.

Welcome to First Aid Unboxed: Episode Three

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Mark: Hello, and welcome to episode three of First Aid Unboxed. We are demystifying First Aid, everyday First Aid for you. And this is presented by Louise Madeley from Madeley's First Aid Plus. Hello, Lou, how are you?
Louise: I'm very well, thank you.
Topic Overview: The Circulatory System and Bleeding
Mark: Excellent. What are we going to be talking about this week?
Louise: We are talking about the circulatory system. So we're talking plumbing, blood and bleeding, and basic first aid for somebody who has cut themselves.

What Is Blood?

Mark: I'm going to ask the obvious question here. And we all know what blood looks like, but what actually is blood?
Louise: Okay, blood is made up of four constituents. You've got plasma, platelets, your red cells and your white cells. Don't need to know any more than that when it comes to first aid, okay? So your plasma is 90% water. If you see it without everything else in it, it sort of looks a straw-like colour. It basically carries everything around. Then you've got your platelets, which are vital when it comes to bleeding. If you cut yourself, you need your platelets. And when you start talking about conditions like haemophilia, that's part of a clotting problem. There's lots of other conditions causing that. But the important thing with platelets is that they are very sticky and they will clot and make a plug in the vessel that's been injured. Red cells, however, they transport the oxygen via haemoglobin, and your white cells manufacture antibodies, so they're for fighting the infection bacteria, et cetera. So basically, it carries everything around the body, oxygen, antibodies, all the different things that you need basically to sustain life and for your body to operate properly.

What Happens When a Vessel is Injured?

Mark: Yes. What happens when a vessel is injured, a blood vessel is injured?
Louise: Blood vessel gets injured, whether it's a small cut, large wound, same thing will happen. Blood will start leaking out. Same as if you get a leak in your radiator, water comes out. Blood will start to leak out of your system.

The Role of Blood Pressure in Bleeding

Mark: Is your blood always under pressure?
Louise: Yes, it is.
Mark: And if you've got higher blood pressure, will you leak, for the want of a better phrase, at a higher rate?
Louise: Yeah, absolutely. And again, it depends on the vessels and how healthy the vessels are, how healthy your system is, as to how fast you may bleed out, how slowly you may bleed out, et cetera. So yeah, that can make a difference. Blood will start to leak out. Body's response is to constrict, so to make smaller, the blood vessel and send platelets to the area. So they've got clotting factors on them, which will form a plug, stop the bleeding. Now, the great thing about constricting, when I say constricting, is literally making the vessel go thinner. If you can imagine a hosepipe, for example, and this is similar to how shock works. If you've got a very high bore hosepipe and you've got a lot of water in it, then what's going to happen is it's going to come out at a very fast rate. However, if it suddenly becomes very extended and very wide bore, and you have low pressure in there, then it's going to come out very slowly. And you've got the same thing with your body. It's a body's response to something, and that's when somebody can go into shock. It's part of the immune response that the body will automatically do. And then you're into some serious realms of shock.

Types of Wounds

Mark: There are a number of different types of wound, aren't there? It's not just, you know, cutting yourself accidentally with a knife or something.
Louise: Yeah, absolutely.
Mark: So tell me about the various types of wounds.
Louise: So you've got six different types of wounds. Incision, laceration, abrasion, contusion, puncture, velocity. Okay, so those are the six different types. Going back to the beginning, incision. Imagine a surgeon with a scalpel, and he cuts straight down into the skin, any knife blade, sharp, then that's an incision. Very dangerous because the first thing that's going to happen is it's going to go through a vessel, and that vessel will be wide open. So that's your first type of wound.

Understanding Bruising and Internal Bleeding

Mark: And these blood vessels are just underneath the surface of your skin?
Louise: They are, yes. Next type is a laceration. Now imagine you've tried to jump over some barbed wire, and you get your skin caught and it tears. That's a laceration. So it's actually torn the skin. Certainly a lot of capillary bleeding there, not necessarily venous. We haven't talked about that yet though, have we? So yeah, it's a rough tear in the skin is what causes a laceration. Abrasion is the next one, which is we call it a gravel rash or a road rash. You're riding your bike, you fall off your bike, and you graze your knee. That's an abrasion. Usually comes involved with a lot of gravel and other things embedded in it, shall we say. Next type is a contusion. We call them bruising. It's a blunt blow, so somebody gets hit by a football and they get a bruise under their skin. That's a contusion.
Mark: And that's a bleed? A bruise is a bleed?
Louise: Yeah, absolutely. From the capillaries. Yeah.
Mark: Yeah, that's all the bruise is, bleeding underneath and it's going into the tissue of the skin.
Louise: And that's why you get the discolouration.

Why Blood Colour Matters

Mark: Yeah.
Louise: That's why when we look at bruises, we can pretty much gauge how long that bruise has been there by the colour of it. So as it's starting to reabsorb back into your body, you can tell how long it's been there. Quite useful for A&E. Punctures. This is a stabbing wound. So obviously somebody's been stabbed or somebody's been impaled with something. Could be a very nasty splinter, so to speak, but it's stabbing straight into the skin, through the skin. And the last type is a velocity or a gunshot wound, which unfortunately I have seen a few. And it can be fairly catastrophic. Quite often with a gunshot wound, you'll find that the entrance wound is nowhere near as bad as the exit wound. So with velocity, you're always looking for two wounds, not one.
Mark: I wouldn’t have picked six out, I must admit.

Types of Bleeding and How They Differ

Mark: So when you talk about Venus, you’re not talking about the planet, are you?
Louise: No, I’m not. No, you’ve got different types of bleeding. You’ve got your arteries, your veins and your capillaries. So we’re going back to the basic anatomy. Your artery are the big vessels that carry the oxygen around, et cetera. Your venous carries the dark red blood around, and the capillary is when it starts oozing. Those are the ones that feed all the nutrients and the goodness to your skin and your periphery, so the outside parts of your body. Those are the three different types. Within that, you’ve got what happens when you cut them. So with an arterial bleed, it will spurt from the wound in time to your heartbeat because it’s under pressure. So this is your blood pressure we were talking about earlier, and it will literally spurt out a great distance sometimes, and it’s bright red because it’s oxygenated. Then you’ve got your venous, which is a dark red, and it’s more like a gush from a wound, so you’ll suddenly find that somebody will have a pool of blood. Say they cut their leg and they’ll have a pool come out. That’s venous and it’s very dark. Then you’ve got your capillary, which is oozing. So you cut the top of your finger, for example, and you get some oozing coming out. Those are the little tiny capillaries that have just been cut. Those are the three different types.

Internal Bleeding: Causes and Symptoms

Mark: Now we know what the different cuts are and where the blood is coming from, whether it’s a vein, capillary or an artery. So there are all different types of bleeding, where we can bleed from. When we have someone and they say, oh, there’s internal bleeding, what’s happening there and how can that happen in an everyday situation?
Louise: Yeah, that’s generally caused by either a catastrophic event that’s occurred inside the body or trauma from outside the body. So there’s several different reasons why it can occur and something that when somebody is bleeding, you do need to be aware of. It’s literally that the vessels have been broken, they’ve been injured within the body, and there may not be an exit route for it. So it could well be that they have a bleed in their stomach, for example, and suddenly their stomach becomes very tense and sticks out. That could be that they’re bleeding inside. And of course, there’s no way for it to come out. So it’s compressing against organs. They’re leaking blood exactly the same as if it was leaking out of the body with just as many dangers of leaking outside the body, only you have no way of stopping the bleeding. So yeah, it’s a very serious problem. It would really need to be quite significant trauma if it’s an external cause. Usually for something like that, unless we’re talking a car accident, motorbike accident, something very traumatic to the body, you’re usually talking about something internal that’s gone wrong. It could be that an artery has ruptured, something pretty catastrophic, pretty nasty, has happened to get internal bleeding.
Mark: But this is quite rare.
Louise: It is, yeah. Still something that you need to be aware of as a First Aider, but yeah, it’s less likely, put it that way.

Steps to Take When You Cut Yourself

Mark: So if we do cut ourselves, what's the first thing we need to do? What's the immediate reaction that you should do if something like that happens to you?
Louise: Stay calm is the first thing. Not everybody likes blood. And when it's leaking out of somebody else's body, we like it even less. I like blood, but I like it inside people where it's supposed to be. And when it starts leaking, that can put people into a great deal of stress. So the most important thing is to stay calm, because you can't help anybody unless you are calm. Okay, and what to do will not happen if you're in a panic state at the time. So stay calm about it for starters. If at all possible, you do need to put some gloves on. You're dealing with somebody else's body fluid, and there are risks. So always recommended to get gloves on if you have any available.

Importance of Gloves in First Aid Kits

Mark: In a first aid kit that you would have in the home or in the office, are there usually gloves in those? Is that something they put in a normal first aid kit?
Louise: Yeah, you should find in an average compliance, HSE compliant first aid kit, two pairs. Non-sterile, they do not need to be sterile at this point. So you need to put your gloves on, expose and examine the wound. So you need to take off whatever is covering the wound and have a look at it. Now, do it carefully, because if it is an arterial bleed, it will pretty much hit you with the force. It's amazing. So if you think that it is a particularly traumatic injury, then take it off very, very slowly. Put it straight back on. If it starts to spurt, this would be bad. So yeah, absolutely. Examine the wound, expose it, examine it. Apply direct pressure is the most important thing.

Understanding Wound Dressings

Louise: So you've got your wound dressing. Now, the thing with the wound dressings that are in the compliant first aid kits, they look like bandages. Everybody calls them bandages. They have an expiry date on them. A lot of people tend to leave them there thinking, well, it's only a bandage. You know, what harm can it do? The problem is that it's not actually a bandage. It's a wound dressing. They used to come separately. So you'd get the wound dressing. Then you get a bandage to apply around it. And it looks as though it's the bandage to apply around it. It's not. It's actually the dressing itself. So when you open it up, you'll find that there's a pad, basically, a dressing pad. Now, on the inside of that pad, it's embedded with something called alginate. Other things as well, but it's the alginate that's the problem. Because if it's expired, then when you go and put it on, it's very shiny side. It's always shiny side down. When you put it down onto the wound, when you take it off, it may well stick to that clotted blood, and that's not what you want. Because as soon as you do that, you're taking off all the fresh clotting and all the good stuff that is happening underneath that wound dressing. You should be able to peel them off and nothing will stick to it. It'll go red. It absorbs the blood, but it's not going to stick to the wound. So if it's expired, you can't guarantee that it's not going to stick to that wound. So with your first aid kit, anything that's expired, the expiry date really is there for a reason. I know it's really irritating. I think it's every three years, roughly, that they last for. But you do need to change them.

Checking First Aid Kit Expiry Dates

Mark: So if you've got a first aid kit in your home or in the office or in the factory where you work...
Louise: You must check them...
Mark: ...check the expiry date of the dressings.
Louise: Absolutely. What I tend to do is put an expiry date on the outside of the first aid kit. And I've got a list of our first aid kits and when the expiry dates are. Check everything in it, and I tend to put the date of the first thing that's going to expire and write that on the outside of the box and put it on a piece of paper that I've got on my hard drive. So every six months, I'll have a look, see what's due to expire and get it changed.

Applying Pressure to Control Bleeding

Mark: After we've looked at the wound and then applied the dressing, what's our next step?
Louise: Pressure. If blood seeps through the dressing, remove the dressing and then apply another dressing on top. What you don't want to do is put lots of dressings on top. You don't keep the first dressing on, then apply another and another. Because if you do, you're not going to get good pressure when you compress. So take them off, put a fresh one on, wait till it seeps through. Hopefully it won't. If it does seep through, then take it off and apply another one and keep doing that. Apply a bandage once the bleeding is under control. Support the limb with a sling or a bandage, whatever you have.

Using Slings for Support

Louise: I would say, and I always teach this in my First Aid lessons, I'm not one for using broad-ard slings and fancy slings that you might see some people teaching how to do. I don't do any of that. I literally just take the triangular bandage, which is the sling from the First Aid box, just whip it round so that it's into a tube and tie it together, and then just pop it round. I don't know if you've seen somebody who leaves A&E and they've got what we call a collar and cuff. It's a blue strip of foam. That's exactly what you need to do. You can use anything to do it. If you've got a sling with you, then great. If you haven't got a sling, it doesn't matter. Just use anything. Use a cardigan or anything you've got to hand, a belt, just so that they can support it. That's all you're doing. As long as they are out of pain, then it's in the right position.

The Role of Pain in First Aid

Louise: Pain is there for a reason, and we'll talk about pain in another session. The thing to remember with pain is that if you are in pain, the reason you're getting that message to your brain that you're in pain is because something is wrong. It's the body telling the brain that there's damage somewhere. So if you are out of pain and it's in a comfortable position, leave it like that. That's the right thing to do always. Don't try and put a really fancy sling that's done exactly the way some trainers like to do it and leave them in pain. That's obviously in the wrong position. Just make sure they're out of pain.

Deciding When to Seek Professional Help

Mark: So the arm's in a sling, you're not in pain. What's the next thing we need to do?
Louise: Decide whether or not it is suitable for you to treat yourself. So if it's just that it needs a plaster on it, then apply a plaster once it stops bleeding. If it's anything more significant than that, if it's still bleeding or you're concerned about infection, that the wound may be dirty, then it needs to be a trip to either an urgent care centre or A&E, but it needs professional help.

Monitoring and Changing Dressings

Mark: So if you're not going to A&E or an urgent care centre, how often do you need to change that dressing? Is it when the bleeding stops, you put a plaster on it, and then that's that?
Louise: Yes. Anything more than a plaster and you're heading to A&E anyway. If there's any risk of it becoming a nasty scar, if it's in a place where you are concerned, then you do need to get professional help. But from a first aid point of view, you need to monitor the patient really, see how they're doing, whether or not they become very pale and clammy, signs of shock, which we'll talk on another episode, in which case you want to help them to the floor, lie them down, raise and support their legs. And if there's any signs of any of this, then you're talking about an ambulance anyway.

Essential Items for First Aid Kits

Mark: So if you've got a first aid kit and you need to check what you've got in there for a cut or a bleed, what's the essential things you need to make sure that are in that first aid kit?
Louise: You need to make sure it's got gloves. It needs to have a pair of scissors in it, tough cut scissors, so things that you can cut clothes with. It needs to have bandages in it, which are actually wound dressings, but they do look like bandages, medium and large. Make sure that the dressings are in date as well. Absolutely. Everything that is packed in plastic effectively should have an expiry date on it. Check all your expiry dates, because some will expire earlier than others. So you need to make sure that every single thing that you use, especially if it's in the workplace with compliance, make sure everything is definitely in date, remove anything that's not. Non-alcohol wipes are very good as well. If it's a small cut, capillary cut, for example, or a small venous cut, then you can just wipe the dressing, try and get rid of that infection. If there's anything on the skin, and that includes what's supposed to be there, which is your natural flora, the natural bacteria on your skin is supposed to be there, but it's not supposed to be inside. So if you've cut yourself, things can get inside your body that you don't want to be there. Then you get infection. So giving it a wipe only once, then throw it, get another one, wipe once, throw it. You don't want to sit there and keep rubbing it. Make sure it's non-alcohol as well. If it's got anything else in it, then it can be quite painful to use. So yeah, make sure that it's non-alcoholic wipes that you're using.

Final Thoughts on Cuts and Bleeding

Mark: I think we've covered everything we need to cover on cuts. Is there anything else you wanted to add before we come to the end?
Louise: No, I mean, we are talking about minor cuts here. We're not talking about catastrophic bleed, arterial bleeds, and this sort of thing. We will talk about that in a later episode. But they are 999 events.
Mark: Absolutely. And if you've any concerns whatsoever, it's always seek professional help.
Mark: And Madeley's First Aid Plus provide first aid kits as well, am I correct?
Louise: Yes, I'm just about doing that now. So yeah, my new website, which is the same, madeleysfirstaidplus.co.uk. I've got a new site coming out that, fingers crossed, will be out in the next couple of weeks. And that will have a shop on it as well, where you can purchase different types of first aid kits, all HSE compliant.
Mark: And when that website is live, we will put it onto the podcast notes, so you'll be able to link from the podcast straight to the website for stuff that you need. Should people in their own home have a proper first aid kit?
Louise: Yes, yes, and yes, absolutely. And for the right reasons as well. So having one in the house, you need to think about what it is you have in your house and what dangers there are. So having, if you have lots of different cookery equipment and so on, making sure that you have the right things for burns and skulls, for example. We'll talk about that on another episode, obviously, because we're going to quite a bit of detail about burns and skulls. But making sure that you have an adequate first aid kit, but also in your car or in your garage, if you have tools in your garage that may hurt you, make sure you have the right first aid equipment in there. I'm a huge fan of if you have the right equipment on you, chances are you're not going to need it. People who come into A&E and they say, we had nothing with us, and they come in with an oily rag around a wound or whatever, happens far too frequently, unfortunately. And they then talk about buying all sorts of expensive equipment for first aid after they've done something quite serious to themselves. So yeah, make sure you've got it. It's a preventative every bit as much as it is there for eventualities.
Mark: So what's your one takeaway from this week's episode to do with cuts and bleeding?
Louise: I think firstly, stay calm at all times, which is hard to do, I know, but just remember your stress response. And probably that your knowledge can make a real difference when it counts the most. And that's what you've got to keep in mind. Make sure that you listen to the podcast twice, so it goes in. Make sure that if you do come across a situation where somebody is bleeding, you remain calm, apply pressure, elevate the wound if necessary, and just remember that your knowledge is what can make the difference when it counts the most. But intervene. You must do something. Something is always better than nothing.
Mark: And if people want to get in contact with you at Madeleine's First Aid Plus, how do they do that?
Louise: So my website is madeleinesfirstaidplus.co.uk. My email address is madeleinesfirstaidplus.gmail.com. Or you can follow me on Facebook, LinkedIn, Instagram, Twitter, Pinterest, any of the above at Madeleine's First Aid Plus.
Mark: As someone once said, you're all over the place.
Louise: Oh, tell me about it.
Mark: And as you say, there will be products from Madeleine's First Aid Plus available within the next few weeks via a new website, and we will give you information on that. Thank you ever so much. You've taught me an awful lot today.
Louise: Hopefully people listening will have learned a lot as well. And the main thing is stay calm and don't worry about getting involved, because the knowledge that you have from this and from any other first aid that you have will help people. And like you say, the worst thing is to do nothing.
Mark: Absolutely, it is.
Mark: So thank you, Louise. We will be back in a couple of weeks, and we're going to be talking about shock.
Louise: Yes.
Mark: Okay, and that's following on from this week's, and it's the next thing we're going to be talking about. So, yeah, two weeks' time, that'll be with you. Until then, look after yourselves.
Mark: This is a 1386 audio production.
Louise: Thank you.

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