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Bleeding And Wounds

Bleeding And Wounds. Sources of External Bleeding. Arteries Veins Capillaries. Arterial Bleeding. Most serious / arteries are usually deep in the body Rapid and profuse blood loss Bright red / spurts Less likely to clot Must use external means to stop blood flow. Venous Bleeding.

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Bleeding And Wounds

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  1. Bleeding And Wounds

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

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

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

  5. Capillary Bleeding • Easily controlled • Blood oozes • Road rash

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

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

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

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

  10. Dressings • 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 • Removal of Dressings • Soak “stuck” dressing in warm water

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

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

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

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

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

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

  17. Problem Bleeders • Hemophiliacs • Aspirin

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

  19. Types of Open Wounds • Abrasion – scrape • Incision – smooth edged cut (not in text) • Laceration – jagged irregular edges • 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 • Avulsion – flap of skin torn loose • Amputation – cutting off a body part

  20. Minor Open Wounds: What To Do • Wear gloves and expose wound • Control bleeding • 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 • Severe wound? Control bleeding and get help

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

  22. Wound Care #2 • 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 • Swelling, redness, pain, warmth • Fever / chills • Swollen lymph nodes • Red streaks • Tetanus (lock jaw) • Receive injection in first 72 hours • Throbbing • Pus

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

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

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

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

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

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

  30. Open or Painful Blister • Clean blister site – treat as a minor wound • 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 • Do not remove • Control bleeding • Stabilize object • Shorten object only if necessary • One exception: • If impaled in cheek and > l hour from help • Control bleeding • Dressings inside and outside of cheek • (frog gig) • Houston, TX, Dec. 2000 • Child with pencil

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

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

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

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

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

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

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

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

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

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

  42. Nosebleeds: First Aid • Sitting position • Tilt head slightly forward • Pinch nose 10 minutes • Bleeding persists? • 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 • Second attempt to control bleeding fails • Bleeding keeps reappearing • Posterior bleeding • Weakness or faintness • Taking anticoagulants / aspirin • Other health problems (son)

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

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

  46. Dental Injuries • Knocked out tooth • Broken tooth

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

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

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

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

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