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Control of External Bleeding
Blood consists of red cells (erythrocytes), which convey oxygen
throughout the body; white cells (leucocytes), which fight
introduced infection; platelets (thrombocytes), which assist in the
clotting process; and plasma, the fluid portion of blood. There are
between five and seven litres of blood in the average adult body.
Blood is moved around the body under pressure by the cardiovascular
system - the heart and blood vessels. Without an adequate blood
volume and pressure, the human body soon collapses. Bleeding, or
haemorrhage, poses a threat by causing both the volume and the
pressure of the blood within the body to decrease through blood
loss.
EXTERNAL BLEEDING
External bleeding is usually associated with wounds, those
injuries that are caused by cutting, perforating or tearing the
skin. Serious wounds involve damage to blood vessels. As
arteries carry oxygenated blood from the heart, damage to a vessel
is characterised by bright red blood which 'spurts' with each
heartbeat. Damage to veins appears as a darker red flow. Capillary
damage is associated with wounds close to the skin and is of a
bright red 'ooze' from below the surface.
TYPES OF WOUNDS
Incision is the type of wound made by 'slicing' with a sharp knife
or sharp piece of metal.
Laceration is a deep wound with associated loss of tissue — the
type of wound barbed wire would cause.
Abrasion is a wound where the skin layers have been scraped off.
Puncture wounds are perforations, and may be due to anything from a
corkscrew to a bullet.
Amputation is the loss of a digit or limb by trauma.
CARE AND TREATMENT
LIFE THREATENING BLEEDING
DRABC
quickly check the wound for foreign matter
immediately apply pressure over the wound to stop any bleeding
call 000 for an ambulance
apply a non-adherent dressing
apply a pad
lay the casualty down
raise and support the injured part above the level of the heart if
possible
apply a firm roller bandage
treat for shock if required
INCISIONS and LACERATIONS.
DRABC
quickly check the wound for foreign matter
immediately apply pressure to stop any bleeding
apply a non-adherent dressing
apply a firm roller bandage
immobilise and elevate the injured limb if injuries permit
ABRASIONS
DRABC
check the wound for foreign matter
swab with a diluted antiseptic solution
apply a non-adherent dressing or a light, dry dressing if necessary
PUNCTURE WOUND
DRABC
check the wound — do not remove any penetrating object
apply pressure to stop any bleeding
stabilise with a ring pad and non-adherent dressing
apply a firm roller bandage
rest and elevate injured limb if injuries permit
  
AMPUTATION
DRABC
apply immediate pressure to stop any bleeding
apply a large pad or dressing to the wound
treat for shock
rest and elevate injured limb if possible
collect amputated part — keep dry, do not wash or clean
seal the amputated part in plastic bag or wrap in similar waterproof
material
place in iced water — do not allow the part to come in direct
contact with ice. Freezing will kill tissue.
ensure the amputated part travels to the hospital with the casualty
Care should be taken to obtain medical advice for prevention
of tetanus.
REMEMBER so as not to disturb clotting on the wound, do not remove
the initial dressing. If bleeding continues and seeps through
the bandage and padding, remove and replace these, leaving the
initial dressing in place.
NOSEBLEED (EPISTAXIS)
have the casualty pinch the fleshy part of the nose
lean slightly forward
advise casualty not to swallow blood
maintain this posture for approximately ten minutes
apply cool compress to neck and forehead
if bleeding persists, obtain medical aid
advise the casualty not to blow or pick nose for several hours
Fractures
There are 206 bones in the human body and they are important,
not just because they hold our skin up, but they act as factories
for the production of blood and essential blood cells through bone
marrow. Bones are also integral to the body's strength. Some bones
have a protective function (skull), some a supporting function
(pelvis), while others are for movement (fingers, jaw).
When a bone is broken, or fractured, it affects not only blood
production and function, but there are also complications associated
with the muscles, tendons, nerves and blood vessels which are
attached, or are close, to the bone.
Fractures are generally classified as:
OPEN — where the bone has fractured and penetrated the skin
leaving a wound
CLOSED — where the bone has fractured but has no obvious
external wound
COMPLICATED — which may involve damage to vital organs and
major blood vessels as a result of the fracture
Treatment for fractures is based on SPLINTING, which endeavours to
replicate the supporting function of the bone. While little
practical splinting can be offered for a fractured skull, a first
aid provider can certainly offer effective and functional support
for fractured limbs. Fractures may be caused by a number of methods:
DIRECT FORCE, where force is applied sufficiently to cause
the bone to fracture at the point of impact.
INDIRECT FORCE, where force or kinetic energy, applied to a
large, strong bone, is transmitted up the limb, causing the weakest
bones to fracture.
SPONTANEOUS OR SPASM-INDUCED fractures are associated with
disease and/or muscular spasms. These are usually associated with
the elderly, and people with specific diseases affecting the bones.
Care should always be exercised when assessing an elderly casualty
as the condition known as OSTEOPOROSIS or 'Chalky Bones' causes
bones to fracture easily, often in several places. Always suspect a
fracture if an elderly person complains of pain or loss of power to
a limb. Be especially aware of fractures at the neck of the femur
(near the hip), a very common fracture in the elderly.
Young children are also prone to fractures, and the common fractures
suffered by children tend to be associated with the arms and wrists.
As young bones do not harden for some years, children's fractures
tend to 'bend and splinter', similar to a broken branch on a tree
— hence the common name 'greenstick fracture'.
SIGNS AND SYMPTOMS OF FRACTURES
Some, or all, of the following:
pale, cool, clammy skin
rapid, weak pulse
pain at the site
tenderness
loss of power to limb
associated wound and blood loss
associated organ damage
nausea
deformity
crepitus
CARE AND TREATMENT OF FRACTURES
Care and treatment of fractures relies on immobilisation and
adequate splinting of the injury. However, if the fracture is
particularly complex, the wound associated with an open fracture is
difficult to control. If the pulse to the distal part of the limb
cannot be restored by gentle traction, then the limb should be
stabilised in its current position. Urgent ambulance transport
should be obtained. Do not waste time with splinting.
Generally, fractured limbs should be made immobile and left for
medical aid. However, in remote areas or some time from medical aid,
you may be required to treat as follows:
CARE AND TREATMENT OF A FRACTURED FOREARM
check for distal pulse, if none — gentle traction until pulse
returns
treat any wounds
pad bony prominences
apply adequate splint
secure above and below fracture, secure wrist
reassess pulse or capillary return
elevate injury with arm sling
call 000 for an ambulance
CARE AND TREATMENT OF A FRACTURED UPPER ARM
check for distal pulse, if none — gentle traction until pulse
returns
treat any wounds
pad between arm and chest
apply 'collar and cuff' sling, secure above and below fracture
firmly against chest with triangular bandages
reassess pulse or capillary return
call 000 for an ambulance
CARE AND TREATMENT OF A FRACTURED LEG
check for distal pulse, if none — gentle traction until pulse
returns
call 000 for an ambulance
treat any wounds
immobilise the limb
pad bony prominences
reassess pulse or capillary return
CARE AND TREATMENT OF A FRACTURED PELVIS
call 000 for an ambulance
check for distal pulse both legs
bend legs at knees, elevate lower legs slightly and support on
pillows or similar
support both hips with folded blankets either side
discourage attempts to urinate
Care must be exercised with a suspected fractured pelvis. This
injury may have serious complications, especially with regard to
female casualties. The casualty should always be transported by
ambulance and not by alternative means unless absolutely essential.
Burns and Scalds
BURNS are caused by contact with flame, hot objects, chemicals,
electrocution, radiated heat, frozen surfaces, friction or
radiation.
SCALDS are caused by contact with boiling fluids or steam.
The results of either injury are disfigurement, scarring and severe
pain. As with most potentially serious injuries, prevention is
better than cure.
Burns are classified as either:
SUPERFICIAL - reddening (like sunburn), outer layer of skin
only
PARTIAL THICKNESS - blistering, damage to deeper layers of
skin
FULL THICKNESS - whitish or blackened areas, damage to all
layers of skin, plus underlying structures and tissues
The severity of burns is dependent on certain factors such as; the
age of the casualty, the depth of the burns, the part of the body
burnt, and the area affected.
The burnt body area of a casualty is assessed as a 'percentage', and
is arrived at by reference to 'THE RULE OF NINES'. Eleven areas of
the body are designated each worth 9%, eg. arm = 9%, etc. The
percentages are added, and the total given as the percentage of the
total body area burnt.
SIGNS AND SYMPTOMS:
red, blistered, white or blackened skin
pain in superficial and partial thickness burns
shock
breathing difficulties
hoarse voice and/or snoring sound when breathing
CARE AND TREATMENT
DRABC
cool only with clean water if possible, and resist using other
substances
up to 20 minutes for thermal or radiation burns
20-30 minutes for chemical burns
30 minutes for bitumen burns
consider scoring or cracking bitumen if it is encircling a limb
cover with a clean, non-adherent burn dressing (or plastic wrap
etc.)
remove tight clothing and objects, eg. jewellery
call 000 for an ambulance
treat for shock if the burn is severe.
ensure that contaminated clothing is removed unless it is adhering
to the burn
flush chemicals from the skin, pay special attention to eyes
DO NOT break blisters
Ensure that the cooling process does not become excessive and cause
shivering.
Burns to the face inevitably have an effect on the casualty's
breathing, and these effects may take some time to appear. It is
important that any casualty who has inhaled smoke, fumes or
superheated air, or has been burnt on the face, should seek medical
aid as soon as possible after the incident. A doctor should
see infants or children who receive any burns.
REMEMBER — Severe burns can lead to shock and massive
infection if not treated properly!
Electric Shock
The human body is an efficient conductor of electricity. When
a casualty receives an electric shock from a household appliance or
a power line, the electricity is conducted through the body. A
casualty may receive significant burns or the electric shock may
interfere with the heart’s electrical system. Burns to the
casualty may be greater than they appear on the surface.
When attending a casualty exposed to electricity, DANGER is the
priority. Be alert for danger to yourself and to other rescuers, and
approach the scene with caution.
DOMESTIC VOLTAGE
Be alert for danger! It is urgent that the casualty be disconnected
from the electrical source, either by:
turning off the power supply and disconnecting any plugs from the
outlet, and isolating the electricity supply at the main powerboard
if possible, or
removing the casualty from the electrical source by separation with
non conducting materials, eg., wooden stick or board, rope, or
blanket.
Be careful not to touch the casualty’s skin before the electrical
source is disconnected, and be alert for the presence of water or
conducting materials which may be in contact.
HIGH VOLTAGE
Damaged high voltage sources can cause the entire scene of an
accident to become ‘live’, especially where water or other
materials are in contact with the electricity. Protect yourself and
others.
When high voltage electricity is involved in an accident, DO NOT
touch the casualty until the scene has been declared safe by the
relevant electrical authorities or workplace supervisor. DO NOT
approach the scene if you feel any unusual sensations, such as
‘tingling’ through your footwear.
The tyres insulate people inside a car with fallen power lines
across them, so tell them to stay inside the car and not to jump
out.
Ensure that all bystanders do not approach the scene and remain at
least six metres away from the nearest suspected energised material.
SIGNS AND SYMPTOMS
difficult, or absent breathing
absent, weak or irregular pulse
evidence of burns
evidence of fractures
entrance and exit wound burns
collapse and unconsciousness
TREATMENT
DRABC
call 000 for an ambulance
inform electrical authorities if high voltage involved
if in respiratory arrest - commence EAR
if in cardiac arrest - commence CPR
cool and cover burns with non-adherent dressings
reassurance
Internal Bleeding
Internal bleeding is classified as either visible, in that the
results of the bleeding can be seen, or concealed, where no direct
evidence of bleeding is obvious. Internal bleeding is always to be
considered as a very serious matter, and urgent medical aid is
necessary.
In most instances, obtaining an adequate history of the incident or
illness will give the first aid provider the necessary clue as to
whether internal bleeding may be present. Remember that current
signs and symptoms, or the lack of them, do not necessarily indicate
the casualty's condition. Certain critical signs and symptoms may
not appear until well after the incident due to the stealth of the
bleed.
VISIBLE INTERNAL BLEEDING
Visible internal bleeding is referred to this way because the
results are visible:
Bleeding in the lungs — frothy, bright red blood coughed up by the
casualty.
Anal or vaginal bleeding — usually red blood, mixed with mucous.
Bleeding in the stomach — dark 'coffee grounds', or red blood, in
vomitus.
Bowel, or intestinal bleeding — dark, loose, foul smelling stools.
Bleeding in the urinary tract - dark or red colured urine
CONCEALED INTERNAL BLEEDING
In these cases, the first aid provider is heavily reliant on
history, signs and symptoms. Judgement and experience play a part,
but it may come down to a first aider's 'gut feeling'. If you are
unsure, assume the worst and treat for internal bleeding.
SIGNS AND SYMPTOMS
pale, cool, clammy skin
thirst
rapid, weak pulse
rapid, shallow breathing
'guarding' of the abdomen, with foetal position if lying down
pain or discomfort
nausea and/or vomiting
visible swelling of the abdomen
gradually lapsing into shock
CARE AND TREATMENT
call 000 for an ambulance
position the casualty supine, with legs elevated and bent at the
knees (only if conscious)
if unconscious, side position with support under the legs to elevate
them
reassurance
treat any injuries
give nothing by mouth
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