1. Bleeding And Wounds

2. Sources of External Bleeding u Arteries u Veins u Capillaries

3. Arterial Bleeding u Most serious / arteries are usually deep in the body u Rapid and profuse blood loss u Bright red / spurts u Less likely to clot u Must use external means to stop blood flow

4. Venous Bleeding u Steady flow / bluish-red u May be profuse u More easily controlled u Veins are closer to the body surface u Can be serious

5. Capillary Bleeding u Easily controlled u Blood oozes –Road rash

6. Blood Vessel Spasm u Severed arteries –Artery draws back into the tissue –Artery constricts and slows bleeding u Partially severed arteries –Associated with greater blood loss –Example: amputations

7. Definitions u Hemorrhage: Rapid blood loss –Adult: 1 quart may lead to shock –Child: 1 pint loss of blood u Dressing –A protective covering for a wound – u Bandage –A material used to hold a dressing in place

8. Dressings u Used to control bleeding u Prevents contamination u Dressings should be: –Sterile –Larger than the wound –Thick, soft, compressible –Lint free (no cotton balls)

9. Types of Dressings u Gauze pads u Adhesive strips u Trauma dressings u Improvise u Donut shaped

10. Dressings u Application –Wash hands –Dressing should extend over edges of wound –Do not touch dressing surface that is to be next to the wound –Place medications directly onto pad –Cover with a bandage u Removal of Dressings –Soak “stuck” dressing in warm water

11. Bandages Are Used For: u Holding dressings in place u Applying pressure u Prevent or reduce swelling u Provide support or stability

12. Application of Bandages u Leave toes and fingers exposed if possible –Bandage too tight? Check for color, circulation, temperature u Wrap towards the heart –Small end of bone to large end

13. Types of Bandages u Roller gauze u Improvised u Triangular u Cravat u Adhesive / paper tape u Adhesive strips u Tourniquets are rarely recommended –Damage to nerves and vessels

14. Someone Has A Cut Leg: What Should You Do? (external bleeding / depends on severity) u Call for help when necessary u Protect yourself from bodily fluids u Expose the wound u Apply sterile gauze pad (dressing) u Apply constant, direct pressure for 10 minutes (don’t peak)

15. Cut Leg u If dressing becomes blood soaked – do not remove dressing, add others over it u After 10 minutes, if bleeding persists –apply pressure harder and over a wider area for 10 more minutes (seek help)

16. Additional Options u Elevate limb above heart level u Apply pressure at a pressure point u When bleeding stops: –Apply pressure bandage (roller gauze) –Wrap towards the heart

17. Problem Bleeders u Hemophiliacs u Aspirin

18. When Not To Apply Direct Pressure u Protruding bone u Skull fracture u Embedded object u May use a donut shaped pad

19. Types of Open Wounds u Abrasion – scrape u Incision – smooth edged cut (not in text) u Laceration – jagged irregular edges u Puncture – deep, narrow stab wound –High rate of infection (animal bites) –Should heal from inside out –Gently press on wound edges to promote bleeding – rinse wound -dress u Avulsion – flap of skin torn loose u Amputation – cutting off a body part

20. Minor Open Wounds: What To Do u Wear gloves and expose wound u Control bleeding u Clean wound –To prevent infection –Wash shallow wound gently with soap and water (betadine) –Wash from the center out / Irrigate with water for 5 minutes u Severe wound? Control bleeding and get help

21. Wound Care u Do not close wound with steri-strips u Use roller bandages (or tape dressing to the body) u Keep dressings dry and clean –Change at least daily »More frequently if wet or dirty u Use antibiotic ointments for shallow wounds only

22. Wound Care #2 u Do not apply: –Mercurochrome, merthiolate, iodine, alcohol, or hydrogen peroxide –Do not make dressing air tight –If dressing sticks? soften with warm water prior to removal

23. Signs of Wound Infection u Swelling, redness, pain, warmth u Fever / chills u Swollen lymph nodes u Red streaks –Tetanus (lock jaw) –Receive injection in first 72 hours u Throbbing u Pus

24. When To Seek Medical Attention ** Indicates High Chance of Infection u Arterial or other uncontrolled bleeding u Deep incisions, lacerations, avulsions u Severe injury in “bend” u Wound gapes open (stitches) u Large or deeply imbedded objects u **Significant debris (bike wreck, chainsaw, tattoo u **Animal bites, ragged wounds u **Large or deep puncture wounds

25. When To Seek Medical Attention #2 u If scarring would be significant u Eyelids (prevent drooping) u Slit lips u Extremely dirty u Injury to bone, joint, tendon u Any situation in doubt –(ear ring) u If no tetanus shot in past 10 years –5 years for dirty wound u Significant infection

26. Amputations u Crushing –Poor chance of reattachment u Guillotine –Clean cut –Good chance of reattachment »(fingertips of kitchen counter) u De-gloving –Skin peeled off

27. Amputation: What To Do u Control bleeding u Treat for shock u Recover body part u Transport

28. Care For Amputated Part u Wrap in dry clean cloth –Do not wrap in wet dressing u Place in waterproof container u Place bag on bed of ice u Transport immediately

29. Blisters u Prevention –(hike up mountain) u Duct tape u Donut shaped moleskin u Spenco second skin u Do not remove “roof”

30. Open or Painful Blister u Clean blister site – treat as a minor wound u To drain a blister: –Sterilize needle –Make several holes at blister base –Apply antibiotic ointment and dressing –Change daily –Check for infection

31. Impaled Object u Do not remove u Control bleeding u Stabilize object u Shorten object only if necessary u One exception: –If impaled in cheek and > l hour from help »Control bleeding »Dressings inside and outside of cheek »(frog gig) u Houston, TX, Dec. 2000 –Child with pencil

32. Impaled Eye u Do not apply pressure to eye u Place padding around object u Stabilize object –Paper cup u Cover both eyes –Explain to victim u Seek medical attention

33. Blow to the Eye u Call 911 or transport if: –Eye is bleeding –Eye is leaking fluid u Cold Pack u Do not remove contacts

34. Particles in the Eye u Do not rub u Flush with water u Potentially, brush out particle with a sterile dressing

35. Chemical Burn to the Eye u Flush 20 minutes with low pressure water –Milk or other non-irritating liquid –Remove contacts –Flush outward –Roll eyeball u Loosely bandage both eyes with cold, wet dressings u Seek medical attention

36. Dry Chemical Burns u Dust off chemical u Protect yourself u Then rinse 20 minutes

37. Eye Avulsion u Do not replace in socket u Cover loosely with moistened sterile dressing u Pad around area u Cover with paper cup etc. u Cover uninjured eye u Medical attention

38. Unconscious Victim’s Eyes u Keep eyes closed by: –Taping –Cover with moist dressings

39. Ear Injuries u Insect in ear: (cricket) –Irrigate – pour lukewarm water into ear and try to float it out u Do not try to float out a bean or popcorn u (Wooden bead in ear)

40. Bleeding from within the Ear u Watery blood could mean a skull fracture u Allow victim to sit up and tilt the affected ear lower to let blood drain out u Cover ear with loose dressing but DO NOT apply pressure

41. Nosebleeds u Prevention: –Humidifier, vaporizer, vaseline u Types: –Anterior –Posterior

42. Nosebleeds: First Aid u Sitting position u Tilt head slightly forward u Pinch nose 10 minutes u Bleeding persists? u Repeat pressure for 10 more minutes –Ice bridge of nose –If available, spray with Afrin or Neo-Synephrin

43. When to Seek Medical Attention for Nosebleeds u Second attempt to control bleeding fails u Bleeding keeps reappearing u Posterior bleeding u Weakness or faintness u Taking anticoagulants / aspirin u Other health problems (son)

44. Foreign Objects in Nose u Peanuts, beans, french fries… u (little sister smelled) u Do not have a child try to “blow” an object outGently blow u Tweezers? Possibly for adults – not children

45. Broken Nose u Ice pack u Treat as nose bleed –(nephew)

46. Dental Injuries u Knocked out tooth u Broken tooth

47. Knocked Out Tooth u Rinse mouth / rinse tooth if dirty u Place roll of gauze in the socket u Do not scrub or use alcohol or mouthwash on the tooth u Never touch root u Transport in cold, whole milk

48. Broken Tooth / Fractured Jaw u Broken tooth? –Clean area –Cold compress –Remote area? Candle wax, gum –See dentist u Fractured jaw? –Immobilize –Medical attention »(mom w undiagnosed broken jaw)

49. Scalp Wounds u Suspect spine injury u Profuse bleeding u Skull or brain exposure? u Indentation in skull? u Control bleeding

50. Scalp Wounds #2 u Depressed skull fracture? –Use donut shaped dressing –Apply pressure around edges of wound –Elevate head and shoulders if appropriate »Lessens bleeding u Do not remove impaled objects –Immobilize with bulky dressings

51. Skull Fractures u Signs and symptoms –Penetrating wound –Point tenderness –Deformity

52. Skull Fractures #2 –Bleeding from ears or nose –Leakage of clear or pink watery fluid from ears or nose (CSF fluid) »Halo effect –Discoloration under eyes or behind ears –Unequal pupils –Profuse bleeding

53. Skull Fracture: What To Do u Monitor ABC’s u Apply dressing u Control bleeding as best as possible u Stabilize neck (elevate head if appropriate) u Do not clean open skull fracture u Do not stop CSF flow u Medical attention

54. Fish-hook Removal u Do not remove if near eye or other problem areas u Tape in place, transport u Otherwise: –Ice area –Push hook through –Cut off barb and back hook out

55. Internal Bleeding u Look for abdominal: –Pain –Tenderness –Rigidity –Bruises

56. Internal Bleeding u Look for: –Black stools –Bright red stools –Cough or vomit with blood –Fractured ribs or bruises

57. Internal Bleeding: What To Do u Monitor ABC’s u Lay on side if appropriate (expect vomiting) u Treat for shock –Raise legs 8-12 inches (if conscious) –Cover victim u Bruises: Ice, ace wrap, elevate