Bleeding, Shock & Wounds

A three-year-old has cut her forearm on broken glass and blood is flowing steadily from the wound. What is the first thing you should do?

• ARinse the wound under a cold running tap until the flow slows down
• BTie a scarf tightly above the elbow to act as a tourniquet
• CApply firm direct pressure over the wound with a clean pad✓
• DHold the arm below the level of her heart so the wound drains

Answer: Firm direct pressure with a clean pad or dressing is what stops severe bleeding, and the child should be laid down while 999 is called. Rinsing a heavily bleeding wound washes away forming clots and delays pressure, a tourniquet is not standard first aid for a limb cut like this, and lowering the arm increases blood flow to the wound rather than reducing it.

You are pressing a dressing onto a child's deep hand wound and it has soaked through with blood. What should you do next?

• ASwap to a dry pad every two minutes until the bleeding stops
• BLift the pad off and hold the wound under the cold tap instead
• CPut another pad on top of the soaked one and keep pressing✓
• DLoosen the pressure so the blood can clot underneath

Answer: When blood soaks through a dressing, a fresh pad goes over it and firm pressure continues without a gap, so the wound is never left uncovered or unpressed. Rinsing a heavily bleeding wound makes it bleed more, changing pads every couple of minutes or easing the pressure interrupts clotting, and the pressure is kept up until the ambulance arrives.

A child has lost a lot of blood from a leg wound. Which combination of signs suggests hypovolaemic shock is developing?

• AHot, flushed skin with slow, deep breathing
• BA slow, strong pulse and a bright red face
• CPale, cold and clammy skin with rapid breathing✓
• DWarm, dry skin and loud, steady breathing

Answer: Blood loss leaves the skin pale, cold and clammy, with rapid shallow breathing and a rapid weak pulse, and the child may become thirsty, drowsy or confused. Hot flushed skin, a slow strong pulse or a red face point away from shock, and warm dry skin with steady breathing is what you would expect in a child who is coping well.

A four-year-old with a deep leg wound is pale, drowsy and keeps saying he is thirsty. You have controlled the bleeding and called 999. How should you position him?

• ASitting upright in a chair with his leg hanging down
• BLying flat with his legs raised and supported✓
• CLying on his side with his head raised on a cushion
• DStanding supported so blood keeps flowing to the wound

Answer: Lying flat with the legs raised and supported helps blood return to the vital organs while you keep him warm and monitor his breathing. Sitting up or standing lets blood pool in the legs and can make him faint, and raising the head on a cushion works against the aim of keeping blood flowing to the brain.

A child being treated for shock after heavy blood loss says she is very thirsty and asks for a drink. What should you do?

• AReassure her, but give nothing by mouth✓
• BGive small sips of water to prevent dehydration
• CGive a warm, sugary drink to raise her energy
• DGive a cold glass of milk to settle her stomach

Answer: Thirst is itself a sign of shock, and standard guidance is that a child in shock has nothing to eat or drink because she may need urgent treatment in hospital. Water, a sugary drink and milk all break that rule however small the amount, so reassure her and explain that the ambulance crew will look after her.

A child has fallen onto a garden cane and a piece of it is sticking out of his thigh. How should you deal with the wound?

• ACut the cane level with the skin and cover it with a plaster
• BPull the cane out in one quick movement and press a pad on the wound
• CPush the cane slightly deeper so that it cannot move about
• DLeave the cane in place and press on either side of it✓

Answer: An embedded object is plugging the wound, so it is left where it is and pads are built up around it so pressure goes on either side rather than on the object. Pulling it out can cause severe bleeding and further damage, pushing it deeper or cutting it near the skin risks more injury, and a plaster is not a suitable dressing for a wound like this.

Which item of personal protection should a first aider put on whenever there could be contact with a child's blood?

• AA foil blanket
• BDisposable gloves✓
• CA disposable face mask
• DSafety goggles

Answer: Disposable gloves protect both the first aider and the child from infection passing through blood, and any cuts on your own hands should be covered too. A foil blanket keeps a casualty warm, while safety goggles and a face mask are not routine first-aid protection against blood contact.

A toddler has grazed his knee on the nursery path. How should the graze be cleaned?

• ADab it with neat antiseptic on cotton wool
• BWipe it with a damp cloth and leave it wet
• CRinse it under running water and pat it dry✓
• DScrub it with a nail brush and soapy water

Answer: Minor cuts and grazes are cleaned under running water, patted dry and covered with a sterile dressing. Scrubbing damages the skin and is painful, neat antiseptic on cotton wool can sting and leave fibres in the wound, and leaving the graze wet softens the skin and lets the dressing stick.

A five-year-old starts a nosebleed at story time. How should you position her and what should you do?

• ALie her on her side and pack the nostril with cotton wool
• BSit her leaning forward and pinch the soft part of her nose✓
• CSit her with her head tipped back and pinch the bridge of her nose
• DLie her flat on her back and place a cold flannel on her forehead

Answer: Sitting and leaning forward with the mouth open lets blood drain out rather than down the throat, and pinching the soft part just above the nostrils compresses the bleeding vessels. Tipping the head back or lying flat sends blood into the throat and stomach, pinching the bony bridge does nothing, and packing the nostril is not first aid.

For how long should the soft part of a child's nose be pinched during a nosebleed before checking whether it has stopped?

• A1 to 2 minutes
• B20 to 30 minutes
• C3 to 5 minutes
• D10 to 15 minutes✓

Answer: NHS guidance is to pinch the soft part of the nose for 10 to 15 minutes while the child breathes through the mouth. Releasing after only a few minutes usually lets the bleeding restart, and if it has not stopped after 10 to 15 minutes the child needs A&E rather than continuing for half an hour.

A 20-month-old had a short nosebleed which stopped after a few minutes of pinching. He is now settled and playing happily. What follow-up does NHS guidance advise?

• AHe needs to go to A&E straight away
• BHe needs no follow-up because the bleeding stopped
• CThe parents should take him to see a GP✓
• DHe should be kept off nursery for a week

Answer: The NHS advises that any child under 2 who has had a nosebleed should be seen by a GP, even when it stopped easily. A&E is for a nosebleed that lasts more than 10 to 15 minutes, is very heavy or follows a blow to the head, so it is not needed here, and there is no reason to keep him away from nursery.

A six-year-old's milk tooth is knocked out in a playground fall and the socket is bleeding a little. What should be done with the tooth?

• ARinse it under the tap and wrap it in a tissue for re-implanting
• BPut it in milk and rush the child to a dentist to have it re-implanted
• CPush it straight back into the socket and hold it there
• DKeep it for the parents because milk teeth are not re-implanted✓

Answer: A baby tooth is never put back, so it is kept to show the parents and the accident is recorded. Re-implanting and storing in milk are the steps for a knocked-out adult tooth, which is handled by the crown; a milk tooth still needs a dentist to check the socket and the adult tooth beneath, and rinsing or wrapping it serves no purpose.

A child's fingertip has been severed in a door. You have controlled the bleeding and 999 has been called. How should the severed part be looked after?

• AWrap it, seal it in a plastic bag and rest the bag on ice✓
• BKeep it in your pocket so that it stays at body temperature
• CPlace it directly into a cup of ice so it freezes quickly
• DWash it under the tap and wrap it in a warm, dry cloth

Answer: The part is wrapped, sealed in a bag and kept cool by resting the bag on ice so it can travel with the child. Direct contact with ice causes frost damage, warming the part or letting it dry out reduces the chance of it being reattached, and keeping it at body temperature lets the tissue deteriorate.

You have treated a cut on a child's hand during the nursery day. What does the EYFS require you to do afterwards?

• ATell the parents verbally at the next scheduled review meeting
• BNotify Ofsted within 14 days of every cut or graze treated
• CWrite a record only if the child needed hospital treatment
• DWrite a record of it and tell the parents the same day✓

Answer: The EYFS requires a written record of every accident, injury and first aid treatment, and parents must be told the same day or as soon as reasonably practicable. Recording only hospital cases or waiting for a review meeting falls short of that, and Ofsted notification within 14 days applies to serious accidents, illness, injury or death, not minor cuts.