100. Section Fist id in Emergency Situations HOW THE BODY RESPONDS TO INJURY? ‘The natural response of the body toa wound is to restrict local blogg flow in order to minimize blood loss. Almost immediately the eng, of the damaged blood vessels contract and nearby vessels become constricted so that local blood flow is reduced. The flow can pe further reduced by applying local pressure and elevating the affecteg part of the body. In addition, as the blood leaves the damaged vessels, it forms a clot. This may be sufficient to plug the hole in the vessel. Once this occurs, repair of the damaged tissues begins. Serum (a water liquid that separates from the blood after clotting) squeezes through the walls of the vessels, carrying antibodies to combat infection and cells, which aid the repair process. This causes local swelling ‘As a result any bandage applied over the wound may become too tight. If the wound is severe and the local mechanisms described are not sufficient to arrest serious bleeding, then all surface vessels constrict. This conserves blood flow to the brain and vital organs. Itis this with accompanying sweating, which gives skin the pale, clammy appearance of shock. HOW BLOOD CLOTS ARE FORMED? When bleeding occurs, platelets (small particles in the blood) congregate at the site of the injury and help plug the wound. Clotting factors are released and a protein present in blood (fibrinogen) is converted into fibrin. This forms a fine mesh across the break, trapping platelets and blood cells. The jelly-like mass shrinks @ serum oozes out and forms a solid clot over the wound. CONTROLLING BLOOD LOSS ‘The principle of controlling blood loss is to restrict blood flow to the wound and therefore encourage clotting. This is done in two way by pressure and elevation, There are two kinds of pressure, direct pressure over the wound and indirect pressure on the artery, which supplies the area. Direct pressure must always be applied first. only use indirect pressure, if it fails or proves to be impossible.Pare Chap’ lemorthage or Bleeding and First Aid 101 pirect Pressure in order to stop bleeding without interfering with the rest of the "culation, one should immediately apply pressure directly on the wound. This direct pressure flattens the blood vessels in the area and nelpsto slow down the flow of blood, so that clots can form. Pressure nas to be maintained 5-15 minutes because it takes time to halt the flow of blood. If there is a foreign body embedded in the wound, pressure has to be applied alongside it. If possible, one should also raise the injured part and support it in this position. This will slow down the flow of blood by lowering the local blood pressure. Apply direct pressure even if no dressing is available. If the wound is gaping, squeeze the edges together gently, put firmly. Ifthe casualty is capable ask them to apply direct pressure: 1. Cover the wound with a sterile dressing and apply direct pressure with thumb and/or fingers. 2. Lay the casualty down in a suitable and comfortable position. Raise the injured part as far as possible, support it. 3. Apply sterile dressing and sufficient padding to extend well beyond the edges ofa wound, and in case ofa limb, to encircle it: a, Ifno sterile dressing is available, an improvised dressing can be made from any suitable clean material. b. If bleeding continues, apply further padding and bandage firmly. Do not remove the original dressing, as this may disturb clots and restart the bleeding. 4. Press the padding down and secure with a bandage tied firmly enough to control bleeding, but not so tight as to cut off circulation and immobilize the injured part. Indirect Pressure If bleeding cannot be controlled by direct pressure or if it is impossible to apply direct pressure successfully (for example, if there ate severe lacerations), one may be able to control it by applying indirect pressure at the appropriate pressure point; however, this method can only be used to control arterial bleeding from a limb, and pressure point is the place, where one can compress an artery erlying bone to flatten it and prevent the flow of blood102 Section 1 First Aid in Emergency Situations ci beyond that point. However, since this cuts off the supply of blog, the tissues of the entire limb, this method should only be useq 4. last resort and must not be applied for longer than 15 minutes, Pressure Points There are two pressure points used to control severe bleeding, on, is on the brachial artery in the arm and the other is on the femnor, artery in the groin. Brachial artery: Runs along the inner side of the upper arm betwee, the muscles and its course roughly follows the seam of the sleeye. To apply pressure, place one's hands under the casualty’s arm an slide fingers between muscles. Press upwards and inwards pushing the artery against the bone. Femoral artery: Passes into the lower limb at a point corresponding to the center of the fold of groin and runs along the inside of thigh, To apply pressure, lay the casualty down with knee bent. Locate the artery in the groin and press it against the underlying bone with thumbs, fist or heel of hand. Note Compressing either the brachial or femoral arteries by pressing against the underlying bone will cut off the blood supply to the arm or Jeg respectively. MAJOR EXTERNAL BLEEDING ‘The bleeding occurs most often after a deep incision or laceration" in the skin. In major external bleeding, always remember that the casualty is not breathing, begin artificial ventilation. If he/sh® is unconscious, maintain an open airway, complete the aitw*\ breathing and circulation (ABC) of resuscitation, and then treat the bleeding. Otherwise, treat the casualty in the position, which make blood control most effective. Major bleeding must be treated as soon as possible. Follow ("® order of treatment laid out opposite. Apply direct pressure (0h wound and elevate the affected part. This slows down bleeding, 0"! if the direct pressure is not possible or effective and one suspe“ arterial bleeding, apply indirect pressure. Also position the cast!"Chapter 6: Hemorthage or Bleeding and First Aid 103 to control blood flow. In some cases, one may finds that it is only possible to reduce, not actually stop the flow of blood, but this may be enough to preserve life. Wash the hands with soap and water after treatment. Symptoms and Signs 1, Evidence of major external blood loss. 2, Symptoms and signs of shock include—casualty feel faint and giddy; face and lips become pale; skin feels cold and clammy; pulse becomes faster, but weaker; casualty may become restless and talkative. 3, Casualty complains of thirst. Breathing may become shallower, sometimes accompanied by yawning and sighing. In more severe cases, deep sighing or gasping (air hunger) may occur. Vision may be blurred; unconsciousness may be possible. First Aid Measures Aims + Control bleeding * Minimize the risk of infection « Arrange urgent transportation to hospital. Treatment 1. Expose the wound and look for foreign bodies. Apply direct pressure to control bleeding by pressing with fingers or palm of hand over a clean dressing. If no dressing is immediately ayailable, use the hands. Alternatively, ask the casualty to use theirs, Ifthe wound is gaping, squeezing the edges together may be more effective. 2, Raise and support the part, if the wound is on a limb; if Suspecting a fracture. 3, Place a sterile or clean dressing and padding over the wound, ‘ making sure that it extends well beyond the edges of the wound. Press down firmly and secure with a bandage. The bandage made firmly is enough to control bleeding, but not so tight as to ‘Cut off circulation, Immobilize the injured part. Ino sterile dressing is available, an improvised dressing can be ‘made from any suitable material. 4,fe 104 Section I: First Aidin Emergency Situations 5. If the bleeding continues, do not ee peeeine, but apy, further dressings or pads on top of the original op, ang bandage firmly: ‘ a. If injury is on a limb and direct pressure and elevation fe ineffective, apply indirect pressure to the main artery, supplies the limb. b. Do not apply indirect pressure for any larger (more than minutes) nor apply a tourniquet. 6. To minimize shock, follow the treatment procedure as mentioned for shock. 7. Arrange urgent transportation to hospital. eT Demonstrate the method of applying external pressure ang bandaging. ne Amputations Recent advances in surgery have made the reattachment of amputated limbs, fingers and toes possible. The chances of a good result are greater, if the casualty and the severed part are taken to hospital at the earliest. Always place the severed part in suitable container and inform the ambulance service to protect it. Inform the ambulance service of an amputation injury immediately, so that the hospital can prepare for specialist surgery. Aims Control bleeding and arrange urgent transportation to hospital with the severed part, Measures 1. Control bleeding using elevation and direct pressure, take great Care not to damage the stump. 2, Place the severed part in a clean plastic bag to keep it clean at! Prevent it drying out. If possible, put the bag, in a containet ©! ice. e must be wrapped in suitable material Prevent severed part touching the ice, ie Mark the Package clearly with the casualty's name "4 occurred, 4a. Arrange urgent admission to hospital,Chapter 6: Hemorrhage or Bleeding and First Aid 107 Casualty may complain of thirst Blood may appear from one of the body's orifices, United Measures Aims ‘Arrange urgent transportation to hospital, because it is not , usually possible to control internal bleeding using first aid. Treatment 1. Lay the casualty down with head low and to one side, to ensure a good blood supply to brain. Advise not to move. 2. Ifthe injuries allow, raise legs to aid the return of blood flow to the vital organs. . Loosen any constricting clothing around neck, chest and waist. . Reassure and explain the necessity for him/her to relax. 5, Checkbreathingrate (refer Chapter4, topic on ‘breathing’), pulse (refer Chapter 14, topic on ‘pulse’) and level of responsiveness (refer Chapter 1, topic on ‘level of responsiveness’) at 10-minute intervals. Record these for the doctor. 6. Examine the casualty for other injuries (refer Chapter 1 topic on ‘How to carry out an examination?’) and treat as necessary. . If he/she becomes unconscious, open airway and check breathing. Complete the ‘ABC of Resuscitation} if required and place him/her in the recovery position (refer Chapter 4, topic on ‘respiratory resuscitation’). 8. Keep the casualty covered and place a blanket underneath him/ her, if possible. Keep a record of any specimen passed or vomited by the casualty. If possible, send samples to the hospital with him/her. Atrange urgent transportation to hospital. Transport as a stretcher case, maintaining the treatment position. Do not give the casualty anything by mouth. ar Ks. L FORMS OF BLEEDING ber of wounds and special forms of bleeding, where nt does not follow the general rules of direct and indirect t position of the injured part. Treatment for these bed on the following page.108 Section II: First Aidin Emergency Situations Scalp Wounds Injuries to the scalp most often occur during falls and are p, common amongst the elderly, ill or intoxicated. Othe, “!!*! include road traffic accidents, fights, sporting accidents ny debris. Scalp wounds can bleed profusely due to the rich ., blood to the scalp and because the skin covering the skull" stretched. When damaged the skin splits open, leaving . ."* wound. This bleeding may appear more alarming than it re the casualty may also have a skull fracture. Symptoms and Signs + Pain, tenderness and bleeding of the scalp, possible lifted a, scalp : + Swelling around the wound + Possible symptoms and signs of skull fracture + Signs of brain damage may be evident (refer Chapter 6, topic or ‘concussion and compression’) + Unconsciousness may develop. First Aid Measures Aims Control bleeding as soon as possible. Arrange transportation 9 hospital, as all head injuries should be examined by a doctor. Treatment 1. Control the bleeding using direct pressure (refer Chapter 4 topic on ‘controlling blood loss and direct pressure’). Cover the wound with a sterile or clean dressing or a pad of clean materi! (these should be larger than the wound), Retain with a bandas (refer Chapter 9, topic on ‘scalp bandage’). Note: The head bandage does not provide adequate pressute the control of severe bleeding. 2. If the casualty is conscious, carefully and gently lay hi down with head and shoulders slightly raised. 3, Check the casualty’s breathing rate (refer Chapter +, ae ‘preathing’), pulse (refer Chapter 14, topic on pe level of responsiveness (refer Chapter 1, topic on ‘evel responsiveness’) at 10-minute intervals. im/hetChapter 6: Hemorrhage or Bleeding and First Aid 109 4, Ifthe casualty becomes unconscious, open airway and check preathing. Complete the ABC of resuscitation, if required and place him/her in the recovery position with the injured side upper most. 5, Arrange urgent transportation to hospital. Transport the casualty on a stretcher case, maintaining the treatment position. Nose Bleeds (Epistaxis) Nose bleed is a common condition, usually due to bleeding from the plood vessels inside the nostrils. It may occur after a blow to the nose or better result of sneezing, picking or blowing the nose. However, watery-looking, blood-stained fluid discharge from the nose may be asign of a fractured skull (refer Chapter 9, topic on ‘fracture of the skull’). Nose bleeds can cause considerable loss of blood and may also cause the casualty to swallow or inhale a great deal of blood. ‘This may cause vomiting or affect breathing. Symptoms and Signs + Moderate flow of blood from nose « Ifskull fracture is present, there may be a mixture of blood and clear, watery cerebrospinal fluid. First Aid Measures Aims Safeguard the breathing by preventing inhalation of blood and control bleeding. Treatment 1, Make the casualty to sit down with head well forward and ‘of nose (be prepared to takeover, ifitis tiring for him/her). ech, swallowing, coughing, spitting or sniffing. Allow110 Section II: First Aid in Emergen Situations * 5. When the bleeding stops, tell the casualty to avoid exertion, and to blow the nose for at least 4 hours, so as not to disturb the , hy 6. If even after 30 minutes, the bleeding persists or recurs. ‘ medical aid. Bleeding from the Ear the ear canal differs from that found in extern.) ly occurs when an ear drum ruptures or ‘they ‘A perforated eardrum can result fon pushing an object into the ear (refer Chapter 12, topic on ‘foreig, body in the ear’), falling, while waterskiing, diving or being to, near an explosion. Skull fractures are more serious and should be suspected, if blood or clear, watery cerebrospinal fluid mixed wit, plood is issuing from the ear. Bleeding from inside ear wounds. It general a skull fracture is present. Symptoms and Signs If from the eardrum: + Possible pain inside the ear + Deafness «Moderate flow of blood from the ear. If from within the skull: * History indicating possible skull fracture (refer Chapter 9, topic on ‘fracture of the skull’) * Casualty complains of a headache < Small amounts of blood mixed with clear, watery cerebrospinal fluid may be coming from the ear + Possible unconsciousness. or other head injury First Aid Measures Aims Arrange transportation to hospital. If skull fracture is suspected, particular attention to the level of responsiveness. Treatment . Place the conscious casualty in a half-sitting position with head inclined towards the injured side, so that oe or fluid can drait . Cover the ear with a sterile dressing or similar clean, preferably sterile material, Secure it very lightly with a bandage pay112 Section tt Frst Aid in Emergency Situations a Note: This pad must be thick enough to prevent teeth me, when the casualty bites. 3. ‘The casualty should maintain pressure on the dressing o, for 10-20 minutes, supporting the chin on his/her hand, 4. Allow him/her to dribble out any blood in the mouth, w),), maintaining pressure; swallowed blood can cause vomiting . If bleeding persists after 10-20 minutes, carefully re;, De dressing or pad, disturbing the clots as little as possible, Ren, dressing or pad and continue pressure for a further 10 minujo, Note: This is an exception to the rule that one leaves the first dressing in place when applying a further dressing. Do not wash out the mouth, as this may disturb the clot. Advise the casualp, to avoid all hot drinks for 12 hours. 6. Ifthe bleeding persists or recurs, seek medical or dental aid, 7. Ifthe casualty has lost a tooth and it can be found, place it in a clean container. Seek dental aid as soon as possible and send the tooth with the casualty. tin, tf Pad a ) BLEEDING IN VARICOSE VEINS ‘The veins in the legs contain valves to keep the blood flowing back to the heart. When these valves deteriorate, they look backwards and the back pressure of the blood causes the veins to become swollen and ‘knobbly’ or ‘varicose! Such veins can be burst by quite gentle knocks and they bleed severely. If such bleeding is not controlled immediately, the condition can be fatal. Symptoms and Signs Severe external bleeding; blood will be dark red . * Symptoms and signs of shock (refer Chapter 5, topic on ‘shock’) + Unconsciousness may develop . A damaged valve will prevent the correct blood flow. First Aid Measures Aims Control bleeding by elevation and direct pressure. Arrange urgent transportation to hospital, ieTreatment 3. If the pains are severe rst Ald in Emergency Situations ___ 1. Ifpossible, shift the woman toa place, eee pias Some priy, or arrange for screening. Give her sanitary ressing, ff avait oraclean towel to be placed over the entrance of the Vagina 2. Laythe woman down with head and shoulders raised any. bent—supported on a blanket (this will relax the abdoming Se and obviously due to menstruatio, f her own pain-killing tablets, o, me made specifically for the relief of menstrual cramps, if avai, If bleeding continues and is severe, minimize shock by siving treatment for shock. Arrange urgent transportation to hospi, maintaining the treatment position. her take one or two Oo} MISCARRIAGE A miscarriage or ‘spontaneous abortion’ is the loss of the embryo or fetus at any time before the 28th week of pregnancy. It is usually due to abnormality or death of the fetus and is therefore a protective mechanism that avoids the full development and birth of ay abnormal baby. ‘About 20% of all pregnancies end in miscarriage. Although some women may experience a ‘threatened’ miscarriage involving only slight vaginal bleeding. Complete miscarriages always include the very real danger of severe vaginal bleeding. In complete, miscarriage is a serious condition, because the products of conception ate retained in the womb resulting in severe bleeding. Symptoms and Signs Vaginal bleeding; if severe, symptoms and signs of shock ma also be present Cramp-like pains in the lower abdomen or pelvic area; these ™ be severe Passage of the fetus and other products of conception. First Aid Measures Aims Reassure and comfort the se for urge"! transportation to hospital. casualty, and arrange