Wounds and Bleeding

1. Wounds and Bleeding

2. classification • Wounds are classified into two large groups • - open wound • - closed wound

3. More about wounds? • An injury, especially one in which the skin or another external surface is torn, pierced, cut, or otherwise broken. www.thefreedictionary.com • Types of wounds • Abrasion (graze) • Contusion (bruise) • Laceration • Incised • Puncture • Gunshot • Stab • Avulsion

4. Abrasion (Graze) • Superficial wound • Caused by friction burns • Top layer of skin scraped off • Minimal Bleeding • Moderate risk of infection

5. Contusion (bruise) • Closed wound (internal damage) • Caused by blunt blow/trauma • Severe contusion may contain hidden damage • Very low risk of infection

6. Laceration • Irregular, rough tearing of the skin • Caused by crushing/ripping forces • Moderate bleeding • Usually involves more tissue damage • High risk of infection

7. Incised • Clean cut through skin and into blood vessels • Caused by sharp edge • May result in profuse bleeding • Possible severing of underlying structures • Moderate risk of infection

8. Puncture wound • Caused by sharp point • Minimal (if any) bleeding • Small entry site • Deep track of internal damage • High risk of infection

9. Gunshot wound • Bullet wound • Profuse bleeding • Smaller entry site, with larger, messy exit (if any) • High risk of infection

10. Stab wound • Caused by long/bladed instrument • High risk of infection

11. Avulsion • Tear resulting in loose flap of skin • Usually profuse bleeding

12. Bleeding • To emit or lose blood. www.thefreedictionary.com • Three types of bleeding • Arterial • Venous • Capillary

13. Arterial bleeding • Bleeding from the arteries • Blood spurts in time to the heartbeat • Bright red (oxygenated blood) • Severe arterial bleeding can lead to death if not stopped promptly

14. Venous bleeding • Bleeding from the veins • Blood flows out • Dark red (deoxygenated blood) • May bleed profusely if blood is pooled within veins

15. Capillary bleeding • Bleeding from the capillaries • Blood oozes out • Contains both oxygenated blood and deoxygenated blood • Minimal bleeding • Most common form of bleeding

16. Treatment for external bleeding • Remove/ Cut clothing to expose the wound (unless clothing is stuck to the wound) • Apply direct pressure to control bleeding by pressing over wound with a clean pad for at least 10 minutes • If and object is protruding from the wound, the press down on both sides of the wound and squeeze the edges together • Raise and support casualties injured limb above casualty’s heart level if no fracture is suspected

17. Treatment for external bleeding • Lay casualty down to reduce blood flow • If bleeding is still not controlled, apply another dressing over the first • In the event that the 2nd dressing is soaked through, remove ALL layers of dressing and reapply the dressing before bandaging tightly • If direct pressure is ineffective in arresting bleeding at the limbs, apply indirect pressure for not more than 10 minutes. • Prevent/Treat for shock (covered at a latter date) • Monitor LOC and vital signs at least every 5 minutes

18. Nose bleed • What about a nose bleed? • Lean forward and pinch the soft part of the nose • Breathe through the mouth • Do not sneeze, cough, talk and spit • Could be sign of more serious underlying injury • Pinch for at least 10 minutes

19. Amputation • Stop bleeding using direct pressure. • Elevate injured limb above heart level • Care of amputated part • Wrap the amputated limb in kitchen film and put it into a plastic bag. • Place the plastic bag into a box of ice and label on the box with… … • the name of the casualty • What time it was amputated (if possible)

20. Bites and stings • Animal and human bites • Snake bites • Insect sting • Sting from sea creatures • Marine puncture wound

21. Animal and human bites • Stop Bleeding by applying direct pressure • Gently clean with soap and warm water. Rinse for several minutes after cleaning. • Apply antibiotic cream to reduce risk of infection, and cover with a sterile bandage. (If available) • Get medical help immediately for any animal bite that is more than a superficial scratch or if the animal was a wild animal or stray, regardless of the severity of the injury. • If the animal's owner is available, find out if the animal's rabies shots are up-to-date. Give this information to your health care provider. •  If the animal was a stray or wild animal, call the local health department or animal control immediately.

22. Animal and human bites • If you suspect rabies, • -Wash the wound using soap and water (put gloves or plastic bags on if you can). • -Pat dry and cover with a clean dressing. Tell the casualty to go to a clinic or doctor and check whether anti-tetanus and rabies injections are needed. • -For more serious wounds, control the bleeding with direct pressure. • -Cover with a sterile dressing and take or send the casualty to medical help. • -Remember to keep checking the casualty’s vital signs and writing down (or remembering) what you found and what you did, so that you can report this to any health worker who takes over from you.

23. Snake bites • Signs and Symptoms of a snake bite • - puncture marks (like holes) in the skin severe (very bad) pain, redness in a light-skinned person, and • -swelling nausea and vomiting • -visual disturbances (i.e. he or she cannot see properly) • -difficulty breathing, and in bad cases, the casualty may stop breathing.

24. Snake bites • Your aims: • -Reassure the casualty. • -Prevent the spread of poison. • -Try to get urgent medical help. • -Prevent infection.

25. Snake bites • Your actions: • -Help the casualty lie down, with the affected part lower than the heart. It is very, very important to keep the casualty as still as possible – any movement will make the poison spread more quickly. • -Reassure the casualty to make the chance of shock less and slow down the heart rate. If necessary, treat for shock. • -Bandage the wound • --Wrap a second bandage over the wound, starting from near the wound and bandaging up the limb, so that the bandage is pressing gently on the whole limb above the wound. Be careful not to rub the wound.

26. Snake bites • -Use triangular or broad-fold bandages, and splints if available, to stop the casualty from moving the limb. • -Get medical help as soon as possible. • -Remember to keep checking the casualty’s vital signs and writing down (or remembering) what you found and what you did, so that you can report this to any health worker who takes over from you.

27. Snake Bites • DO NOT: • -cut the wound • -suck the wound • -use a tourniquet or tight bandage to stop the poison from spreading • -shock the person with electricity • -apply (put) or inject chemicals or medicines to the wound • -use ice on the wound.

28. Insect sting (commonly bee sting) • Signs and symptoms • -pain, redness in a light-skinned person or • -swelling • -itching • -signs of an allergic reaction

29. Insect sting (commonly bee sting) • Your actions • -If you can see the sting, brush or scrape it off with your fingernails or the edge of a blunt (not sharp) knife or other suitable object. • -Do not remove the sting with tweezers, since you might squeeze more poison into the wound. • -Raise the affected part, if possible, and apply a cold compress (something cold which you can use to apply pressure to the wound – like a cloth with ice wrapped in it) to relieve pain and swelling for at least 10 minutes.

30. Insect sting (commonly bee sting) • Your actions • -Tell the casualty to go to a doctor or clinic if the pain and swelling do not get better over the next day or so. • -If the sting occurs in the mouth, there is a risk of swelling which may affect breathing. • -Encourage the casualty to suck ice or drink cold water to reduce the swelling. If swelling starts, try to arrange transport for medical help urgently

31. Insect sting (commonly bee sting) • Your actions • -If the casualty is a victim of a swarm attack (e.g. a lot of bees), causing many stings, do not go near until it is safe to do so. • -Place the casualty in the most comfortable position. • -Keep the casualty quiet, and reassure him or her. • -Try to get the person to a clinic or hospital as soon as possible. • -Remember to keep checking the casualty’s LOC and vital signs

32. Sting from sea creatures • Sea creatures cause injury in two ways:• Stinging cells from creatures such as jelly fish • • Poisonous spines from sea urchins, for example. These wounds can be deep, and can become infected if the spines are not removed.

33. Sting from sea creatures • Your actions-If the casualty is showing signs of shock, or is having trouble breathing, he or she may be having a massive allergic reaction. • -Reassure the casualty, and encourage him or her to sit or lie down. • -If possible, raise the affected part and • -Apply a cold compress (something cold which you can use to apply pressure to the wound – like a towel with ice wrapped in it) to relieve pain and swelling for at least 10 minutes.

34. Marine Puncture wound • May lead to • - Serious or life-threatening infections • - Tissue destruction and loss of joint mobility • Treatment • - Place the injury into water as hot as the casualty can bear without scalding (burning) him or her. The injury will need to stay in hot water for at least 30 minutes. • -Keep adding hot water but be careful not to scald the casualty.

35. Marine Puncture wound • -Try to arrange transport for the casualty to a clinic or hospital to have the spines removed. • Do not: bandage the wound

36. Clarification?

37. Thank you