Injuries wounds and haemorrhage

Bleeding

• While dealing a bleeding casualty you should always tries to minimize the loss of blood otherwise it will lead to hypovolaemic shock.
• Hypovolaemic 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

First Aid

• Immediately call for an ambulance.
• 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.
• To reduce the risks of cross infection, personal protective equipment should be worn if readily available.
• 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. However if there is an embedded object indirect method is appropriate.

(A) Direct Pressure Method

To control bleeding
If a specific bleeding point can be identified, you should apply direct pressure to this point. This will lead to the 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,

• Instruct the casualty to place pressure directly onto the wound if he is able to do so.
• If the casualty is unable to assist, apply direct pressure using gloved hands or a pad
• Squeeze the wound edges together if possible
• Elevate the bleeding part if possible
• Apply a pad over the wound if not already in place and secure with a bandage ensuring that the pad remains over the wound.
• If the bleeding is not controlled by the initial pad, leave the initial pad in place and apply a second pad and bandage over the first.
• If bleeding continues through the second pad, replace the second pad and bandage.
• When major bleeding continues it may be necessary to remove the initial pad to ensure that specific bleeding point able to be controlled by direct pressure has not been missed.
• Never attempt to remove embedded object because it may be plugging the wound and restricting bleeding from that part.
• Place padding such as a ring pad around the object and bandage firmly over the padding also Known as Doughnut bandage.
• If bleeding is not controlled by the initial pad leave the initial pad in place and apply a second pad over the first.
• If bleeding continues through the second pad replace only the second pad and bandage

(B) 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 arm is armpits, for legs at inguinal region or for lower limb is knee joint. Through these areas major blood vessels flows that supply the major part of the body such as brachial artery in hands, femoral veins in 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 patient is known as amputation .

Firstaid

• Do the Pressure bandage
• The first priority with an amputation is to manage the bleeding injury. After the bleeding is under control recover the amputated part wraps it in clean cloth place put in a plastic bag and seal it.
• Write name of the casualty and time of 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 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.

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
• 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)
• Blood stained 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