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Clinical Reference Systems: Pediatric Advisor 10.0
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Severe Bleeding


This guideline covers arterial bleeding (from an artery) or major venous bleeding (from a vein). In arterial bleeding, the blood pumps or spurts from the wound with each heartbeat. In major venous bleeding, the blood just runs out of the wound at a steady rate. The arterial bleeding is bright red compared to the dark red of venous bleeding. Minor bleeding (from capillaries), however, can also be bright red.


  1. Prevent shock

    Have your child lie down with the feet elevated 10 to 12 inches to prevent symptoms of shock (low blood pressure). If your child is pale and the hands and feet are cold, shock is imminent.

  2. Apply direct pressure

    If you know the arterial pressure points, apply strong, direct pressure to the artery between the wound and the heart until help arrives. If you do not know the arterial pressure points, place several sterile dressings or the first clean cloth at hand (towels, sheets, shirts, or handkerchiefs) over the wound and apply direct pressure. The pressure must be forceful and continuous. You can often apply this pressure with the palm of your hand. Act quickly because the ongoing blood loss can cause shock. Continue the pressure until help arrives.

  3. Rescue squad (911)

    Have someone call a rescue squad immediately while you tend to the bleeding.

  4. Arterial tourniquet

    A tourniquet is needed only if arterial bleeding cannot be controlled by direct pressure (for example, in the case of an amputated or mangled limb). Once applied, it should be released for 15 minutes of every hour (according to the American College of Emergency Physicians, 1985). During this time, direct pressure must be used to prevent excessive blood loss.


  1. Prevent shock

    Have your child lie down with the feet elevated 10 to 12 inches to prevent symptoms of shock.

  2. Apply direct pressure
    • Place two or three sterile dressings (or a clean towel or sheet) over the wound.
    • Apply direct pressure to the wound for 8 to 10 minutes, using your entire hand. Direct pressure can always stop venous bleeding if it is applied to the right spot.
    • Bandage the dressings tightly in place (elastic wrap gives excellent compression) and leave them there until arrival at the emergency room.

  3. Seek emergency care

    Drive to the nearest emergency room. EXCEPTION: Call the rescue squad (911) if your child is clearly in shock.

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems