First aid Wounds, bleeding, bandages Jan Hudec, MD Tomáš Korbička, MD KARIM FN Brno •an injury, usually involving division of tissue or rupture of membrane, due to external violence •infected (tetanus, clostridium, rabies…) •bleeding •painfull •top of iceberg… (how deep, nerve, vessel injury, foreign object) Wounds Wounds: •superficial X deep •simple X complicated •penetrating (reaching internal organs/cavities) •cleaned X soiled (mechanically) Types of wounds Abration=graze - caused by transverse action of a foreign object against the skin, and usually does not penetrate below the epidermis Contusion=bruise – vulnus contusum - blunt force trauma damaging tissue under the surface of the skin hand%20contusion Types of wounds Laceration – vulnus lacerum - irregular wound caused by blunt impact to soft tissue overlying hard tissue or tearing such as in childbirth Incised wound - cut into a body tissue or organ, such as by a scalpel, made during surgery Výsledek obrázku pro incised wound Puncture wound - caused by an object that penetrated the skin and underlying layers, such as a nail, needle or knife Gunshot wound - caused by a projectile weapon such as a firearm (entry and exit) puncture-wound Types of wounds wpba4e5e6f Stab wound – caused by long or bladed instrument, penetrating the body Bite wound – human or animal Types of wounds Výsledek obrázku pro stab wound Výsledek obrázku pro bite wound • incised wound (Vulnus scissum) • puncture wound (Vulnus punctum) • gunshot wound (Vulnus sclopetarium) • bite wound (Vulnus morsum) • laceration (Vulnus lacerum) • contusion (Vulnus contusum) Types of wounds Avulsion - In an avulsion, a portion of skin is torn. This can be partial, with a portion of skin remaining as a "flap." In a total avulsion, a body part is completely torn off. Types of wounds Výsledek obrázku pro avulsion Amputation –Do not let the person to eat or drink- GA likely –Shock possible –Wrap the severed part into plastic bag , wrap in gauze and place on ice (into container or another plastic bag) Never place the amputate directly on ice! Výsledek obrázku pro amputation Doplnit obrázek Wounds – first aid •Assess vital functions – pulse, breathing, conscioussness, skin colour •Look for other injuries •Prevent shock •If the wound is bleeding severely, call 112. • •Minor cuts and puncture wounds can be treated at home. Take the following steps. •Wash your hands with soap to avoid infection. •Wash the cut thoroughly with mild soap and water. •Use direct pressure to stop the bleeding. •Apply an antibacterial ointment. •If the cut is likely to get dirty or be re-opened by friction, cover it (once the bleeding has stopped) with a bandage that will not stick to the injury Wounds – first aid Wounds – first aid – punctures and small cuts Wash your hands. Use a stream of water for at least five minutes to rinse the puncture wound. Wash with soap. Look (but DO NOT probe) for objects inside the wound. If found, DO NOT remove - go to the emergency room. If you cannot see anything inside the wound, but a piece of the object that caused the injury is missing, also seek medical attention. Apply antibacterial ointment and a clean bandage. Wounds – first aid – DO NOT DO NOT assume that a minor wound is clean because you can't see dirt or debris inside. Wash it. DO NOT breathe on an open wound. DO NOT try to clean a major wound, especially after the bleeding is under control. DO NOT remove a long or deeply embedded object. Seek medical attention. DO NOT probe or pick debris from a wound. Seek medical attention. DO NOT push exposed body parts back in. Cover them with clean material until medical help arrives. Wounds – call emergency The bleeding is severe, spurting, or cannot be stopped (for example, after 15 minutes of pressure). The person is seriously injured. The wound is large or deep, even if the bleeding is not severe. You think the wound might benefit from stitches (the cut is more than a quarter inch deep, on the face, or reaches bone). The person has been bitten by a human or animal. Wounds – call emergency A cut or puncture is caused by a fishhook or rusty object. You step on a nail or other similar object An object or debris is embedded -- DO NOT remove yourself. The wound shows signs of infection warmth, redness in the area, a painful or throbbing sensation, fever, swelling, or pus-like drainage You have not had a tetanus shot within the last 10 years. Burns A burn can be caused by heat (flames, hot grease, or boiling water), the sun (solar radiation), chemicals or electricity. Size – rule of 9 3 degree burns Location – complicated – perineum, hands, face, joints, airways Age – less then 2 years and elderly person(over 60) Výsledek obrázku pro burns rule of 9 Burns – first aid •General assessment – vital signs •Cooling – at least 10 min running water –tepid, not ice cold - no more then 5 % BSA - not in schocked patients •Cover the burn – sterile dressing or cling film •Do not rupture blisters KARIM FN BRNO Dr. Malý 2005 External bleeding – first aid •direct pressure on the wound •elevation •pressure points •immobilize affected part Using Direct Pressure to Control Bleeding 1.Clean dressing over the wound and press firmly. 2.Use a pressure bandage to maintain pressure on the dressing. 3.Tie the ends of the bandage over the wound with a bow instead of a knot. The bow allows the bandage to be loosened later to reduce the pressure if the extremity becomes numb or turns blue. A bow also allows the wound to be checked for infection. Then, the bandage can be retied, saving time and supplies. Arterial bleed – pressure dressing 17 Sterile cover Thick dressing of gauze Bandage Pressure dressing 3 layers: -cover -pressure -fixation The pressure may be inceresed by twisting the bandage over the pressure layer •In case direct compression is not possible/effective in the wound •Massive bleeding from large vessel-arteria •Amputation •Poisoned wound •Provisional solution in major incidents Severe bleeding – when to apply tourniquet 29 Application of tourniquet Tying of knots •Width at least 5 cm •Do not apply at the joints area •Immobilize (e.g.sling) •Do not remove till definitive treatment •Risk of ischemic injury to the limb – when applyed over 2 hours Application of tourniquet 9 Pressure points - not recommended since 2015 a.temporalis a.facialis a.carotis communis a.subclavia a.brachialis aorta abdominalis a. femoralis a.poplitea Internal bleeding •Difficult to recognize •Often as a result of blunt injury to the chest or abdomen(spleen, liver, kidneys, major vessel injury) Think about when –Pale and clummy, sweatty –Nausea, vomiting –Dizziness, fainty –Rapid shallow breathing –Fast weak pulse –Minimal/no urine production –Thirst Internal bleeding Internal bleeding – first aid •Keep calm •Treat any obvious cause of shock •Anti shock position – improves backflow of blood to vital organs •Loosen tight clothing, insulate from cold surface, keep in warm •Do not let eat or drink •Monitor and record vital signs till the EMS arrives •Anti shock position – improves backflow of blood to vital organs • • • •volat ZZS Výsledek obrázku pro anti shock position Trendelenburg position Nosebleed Rupture of blood vessels (sneezing, picking, blowing the nose) High blood pressure Till head forward – allow the blood to drain Breath through mouth Pinch the soft part of the nose, keep pinching (10 min) After 10 min. release the pressure Nosebleed Bleeding from the ear Connected with trauma Half sitting position Head tilted to the injured side – allow blood to drain away Sterile dressing or a clean pad in place on the ear Send to hospital Bleeding from the mouth Cuts the tongue, lips Dental extraction Blood may be inhaled into the lungs! Sitting position, head forward Allow blood to drain from the mouth Place a gauze pad over the wound, hold the pad and press on the wound for 10 min. Knocked out adult tooth – place into sterile gauze moistened by water Eye wound Potentially serious Pain and spasm of the eyelid Visible leakage of blood or clear fluid First aid Sterile cover Keep both eyes still Send to hospital •Calm and reasuring approach •Facing the casualty •Keep the bandaged part of the body all the time in the same position – if possible •Width of the bandage – same or larger than the diameter of the bandaged part •Start from the narrowest part Bandages techniques Gauze bandage Compression bandage Triangular Tube bandage Types of bandages 1. Triangular bandage Výsledek obrázku pro folding the triangular bandage Head bandage using triangular bandage Bandage of the eye Bandage of the ear Triangular bandage of the hand Triangular bandage of the palm Bandage of the shoulder Fakultativně – nemusí zkoušet, umět Sling Foot bandage Heel bandage Ankle bandage Knee bandage Hip bandage Fakultativně – nemusí zkoušet, umět 2. Work with roller bandages Hold the tightly rolled bandage with the ‘head’ of the bandage on top and wrap the ‘tail’ around the body part without unrolling more than a few centimetres at a time. Locking turn to hold the start of the bandage securely under each following turn •Work from the middle of the body or limb in an outwards direction. •Work from the narrowest part below the dressing and work upwards. •Ensure that each turn covers two-thirds of the previous turn. •Cover totally any dressing and padding used. •Finish with a straight turn at the end of the bandage. •Secure the bandage with a safety pin or adhesive tape. Metal clips are possible to use as well. 2. Work with roller bandages Ending without tearing… Diagonal bandaging of the thumb Fakultativně Diagonal bandaging of the foot Výsledek obrázku pro recurrent fold head bandage Recurrent fold head bandage Head bandage using two roller bandages Thank you for your attention 