Introduction

BLEEDING

 While dealing with a bleeding casualty you should always try to minimize the loss of blood otherwise it will lead to hypovolemic shock. Hypovolemic shock as the name suggests is the shock induced by the low volume of fluid in the body.

The blood volume in an adult is between 4 -1/2 and 6 liters of blood. Loss of blood in a large amount or in a short time can induce shock in the casualty.

400 ml of blood lost in a short time is enough to induce shock. It is critical in any incident that bleeding is managed as soon as possible.

EXTERNAL BLEEDING

Management of External Bleeding

1. Immediately call for an ambulance.

2. The use of direct sustained pressure is usually the fastest, easiest, and most effective way to stop bleeding. However, in some cases, the use of indirect pressure may be required.

3. To reduce the risks of cross-infection, personal protective equipment should be worn if readily available.

4. Inspect the wound for embedded objects that may increase damage if pushed further into the wound. If no embedded object is evident, use the direct pressure method.

5. However, if there is an embedded object indirect method is appropriate.

DIRECT PRESSURE METHOD

If a specific bleeding point can be identified, you should apply direct pressure to this point. This will lead to decreased blood flow. The normal clotting time of the blood is 6-8 minutes, by pressing it will lead to automatically cessation of blood loss. If not then you should do the following first aid

1. Instruct the casualty to place pressure directly onto the wound if he is able to do so.

2. If the casualty is unable to assist, apply direct pressure using gloved hands or a pad

3. Squeeze the wound edges together if possible

4. Elevate the bleeding part if possible

5. Apply a pad over the wound if not already in place and secure it with a bandage ensuring that the pad remains over the wound.

6. If the initial pad does not control the bleeding, leave the initial pad in place, apply a second pad, and bandage over the first.

7. If bleeding continues through the second pad, replace the second pad and bandage.

8. When major bleeding continues it may be necessary to remove the initial pad to ensure that a specific bleeding point able to be controlled by direct pressure has not been missed.

EMBEDDED OBJECTS

1. Never attempt to remove the embedded object because it may be plugging the wound and restricting bleeding from that part.
2. Place padding such as a ring pad around the object and bandage firmly over the padding

If the initial pad does not control bleeding leave the initial pad in place and apply a second pad over the first

CONSTRICTIVE BANDAGE

As a last resort where other methods of controlling bleeding have failed, a constrictive bandage may be applied to a limb to control life-threatening bleeding, for example, traumatic amputation of a limb or major injuries with massive blood loss.

Apply a WIDE bandage (at least 5cm) directly above the elbow or knee. The bandage should be tight enough to stop circulation to the injured limb and control bleeding. You should also use pressure points to control the bleeding. These are for the arm is the armpits, for legs at inguinal region or for lower limb is the knee joint. Through these areas, major blood vessels flow that supply the major part of the body such as the brachial artery in the hands, and femoral veins in the legs.

AMPUTATION

When a limb or part of a limb has been severed from the body due to any injury or sometimes by a doctor to save the life of the patient is known as amputation.

First Aid

• The first priority with an amputation is to manage the bleeding injury.
• After the bleeding is under control recover the amputated part wrap it in a clean cloth place put it in a plastic bag and seal it.
• Write the name of the casualty and time of the accident on the bag keep the bag in a container of ice water, or ice slurry to keep the temperature low.
• Avoid direct contact between the severed part and the ice.
• DO NOT PUT IT INTO FREEZER
• You should call the ambulance also.

 INTERNAL BLEEDING

Internal bleeding may be difficult to recognize, but should always be suspected after a traumatic or high-velocity injury.

 SIGNS AND SYMPTOMS

Symptoms of shock will be present

• Pale cold clammy skin
• Anxiety and restlessness
• Rapid weak pulse,
• Rapid shallow breathing, fainting)
• Pain, tenderness, or swelling over or around the affected area
• The appearance of blood from a body opening
• Bright red and/or frothy blood coughed up from the lungs
• Vomiting blood which may be bright red or dark brown (coffee grounds)
• Bloodstained urine
• Rectal bleeding which may be bright red or black and tarry

First Aid

As a first aider, we cannot control the internal bleeding but we can follow certain measures to save the life of the casualty

• Immediately call for an ambulance
• Reassure the casualty that you are with him or he is all right.
• Assist the casualty to lie down on the ground.
• Raise the legs if injuries permit
• Monitor airway, breathing, and circulation at frequent intervals
• Do not give any medications or alcohol
• Do not permit the casualty to have anything to eat or drink

CRUSH INJURIES

 These injuries are caused by the prolonged pressure caused by the impact of a car accident or by falling masonry, by a mineshaft collapse or a trench cave-in, by an industrial accident, or due to the body weight of an unconscious person.

 First Aid

If it is safe and physically possible, all crushing forces should be removed as soon as possible after the crush injury.

• Call an ambulance.
• Keep the casualty comfortable.
• DO NOT use a tourniquet for the first aid management of a crush injury.
• Continue to monitor the casualty’s condition and vital signs.

IMPORTANT: Although you can find the casualty alert and not unduly distressed but severe and irreversible damage may have been sustained and the casualty’s condition may deteriorate rapidly. If the crushing force is applied to the HEAD, NECK CHEST, OR ABDOMEN and is not removed promptly death may ensue from breathing failure, heart failure, or blood loss.

WOUNDS

A wound is an injury to the skin and soft tissue beneath caused by an accident, by any sharp or blunt object. The skin acts as a barrier keeping out infection, it carries blood vessels to warm and nourish the skin and it carries nerves and sweat glands. Any damage to the skin threatens the body as the barrier is broken and infection can enter the body very easily.

According to their nature cut wounds can be classified as

• Open when there is a break in the outer layer of skin.
• Closed when there is damaged but the skin is still intact.

 Types of wounds

Bruise

A bruise is a mark on the skin caused by blood trapped under the surface. It happens when an injury crushes small blood vessels but does not break the skin. Those vessels break open and leak blood under the skin. Bruises are often painful and swollen. A bruise can be on skin, muscle, and bone. Bone bruises are the most serious. It can take months for a bruise to fade, but most last about two weeks. They start off a reddish color and then turn bluish-purple and greenish-yellow before returning to normal.

First Aid

• To reduce bruising, ice the injured area.
•  elevate it.
• Never try to move it until unless necessary.

Abrasion- in this type of injury the outer layers of skin are scraped away. Bleeding is not usually severe, but as the skin is broken, you should take special care to take clean the wound.

Incision- cut, often from a sharp object. If the incision is deep then the underlying layers of tissue, muscle, and fat may be damaged. There may be profuse bleeding.

Laceration

It refers to a skin wound with separation of the connective tissue elements. Unlike an abrasion wound caused by friction or scraping, none of the skin is missing the skin is just separated. A cut is typically thought of as a wound caused by a sharp object such as a knife or a shard of glass. Cuts and lacerations are terms for the same condition.

Avulsion

If Part of the skin tissue is folded back or torn away completely. As an avulsion may involve deeper body tissues the bleeding could be severe.

Management Of Avulsion 

Direct Pressure on the wound 

Put the cut-off part in a plastic bag and secure it.

rush to the hospital.

Puncture wound

These injuries occur when a sharp object piercing of the skin with a pointed object. Because the skin will often close around the object bleeding may not be severe. If the object is still embedded DO NOT remove it.

Management

• Manage to bleed
• If bleeding is severe call an ambulance 

WOUNDS THAT NEED SPECIAL CARE

1. ABDOMINAL WOUNDS

The abdomen is the area between the chest and the pelvis. Compared with the whole body there is little protection for the abdomen. But it is one of the important parts of the body as vital organs are contained in the abdomen-liver, spleen, stomach, pancreas, kidneys, and intestine. Abdominal wounds may or may not be externally visible.

Signs and symptoms of a severe abdominal injury could include:

• Nausea and vomiting
• Pain, tenderness, or discomfort in the abdomen
• External bleeding
• Bruising
• Severe pain
• Skin redness

If the wound is open with internal organs exposed

The casualty should be placed in a half-sitting position, with legs slightly raised.

• Do not attempt to replace organs that are protruding.
• Cover the wound with a moist dressing to prevent the wound from drying out.
• Secure the dressing with a broad bandage.
• Do not apply pressure to the wound. Attempt to pinch the edges of the wound together to control bleeding
• Call an ambulance
• Continue to monitor- do not leave casualty alone

2. Penetrating Chest Wound

If an object penetrates the chest wall and punctures the chest cavity allowing air to enter the chest through the wound, this can cause the lung to collapse.

If air is entering the chest cavity through the wound you may hear air movement with every breath. You may see bubbly bright blood coming from the wound and the casualty will have distressed breathing.

Management of penetrating chest wounds

• Ask the casualty to cover the wound with his hand temporarily
• Place the casualty in a comfortable position, usually semi-sitting
• Cover the wound with a sterile dressing. Make a valve, using a nonabsorbent material e.g. cling wrap, or foil.
• Monitor the casualty and seek urgent medical assistance.
• If the casualty becomes unconscious place on the affected side and starts CPR

3. SCALP WOUNDS

 Scalp wounds are also very important in managing injuries. They can bleed profusely or little depending upon the trauma. In managing a scalp wound you must be aware that any feeling of swelling, sponginess, movement, or pain under the wound could indicate a skull fracture and must be managed accordingly.

Management

• Control bleeding with direct pressure.
• Apply a pad and bandage.
• Assist the casualty to a comfortable position.
• Monitor the casualty for changes in a conscious state.
• Refer to medical assistance.
• If the casualty becomes unconscious manage as DRABCD