Chapter 5.docx

Lf) (]) -f,--J Q_ m u Wounds and Bleeding Chapter 5 Wounds and bleeding Dressings, bandages, and slings Dressings A dressing is a protective covering put on a wound to help control bleeding, absorb blood from the wound, and prevent further contamination. A dressing should be: Sterile, or as clean as...

Lf) (]) -f,--J Q_ m u Wounds and Bleeding Chapter 5 Wounds and bleeding Dressings, bandages, and slings Dressings A dressing is a protective covering put on a wound to help control bleeding, absorb blood from the wound, and prevent further contamination. A dressing should be: Sterile, or as clean as possible Large enough to cover the wound Highly absorbent Compressible, thick and soft Non-stick and lint-free to reduce the possibility of sticking to the wound Dressings are available in a variety of sizes and designs. The dressings used most often in first aid are: Adhesive dressings - prepared sterile gauze dressings with their own adhesive strips Wound closures - adhesive strips that bring the edges of the wound together to assist healing. Gauze dressings - packaged gauze available as sterile single packs or in bulk packaging Pressure dressings - large sterile dressings of gauze and other absorbent material, usually with an attached roller bandage. They are used to apply pressure to a wound with severe bleeding Improvised dressings - prepared from lint-free sterile or clean absorbent material such as a sanitary pad Hemostatic dressings - pressure dressings impregnated with clot promoting agents used to stop serious bleeding. These dressings are not designed for all wound types. Check with your local protocols for more information. Follow the guidelines below for putting on dressings: Prevent further contamination Extend the dressing beyond the edges of the wound If blood soaks through a dressing, leave it in place and cover with more dressings Secure a dressing with tape or bandages Bandages A bandage is any material that is used to hold a dressing in place, maintain pressure over a wound, support a limb or joint, immobilize parts of the body or secure a splint. When using bandages, remember to: Apply firmly to make sure bleeding is controlled or immobilization is achieved Check the circulation below the injury before and after applying a bandage, you may have applied it too tightly or swelling may have made it too tight. The Triangular Bandage A triangular bandage may be used: As a whole cloth-opened to its fullest extent, as a sling or to hold a large dressing in place As a broad bandage-to hold splints in place or to apply pressure evenly over a large area As a narrow bandage-to secure dressings or splints or to immobilize ankles and feet in a figure-8 Broad Bandage To form a broad bandage, fold the point to the centre of the base with the point slightly beyond the base Fold in half again from the top to the base. Narrow Bandage Fold a broad bandage in half again from the top to the base to form a narrow bandage. Reef knot-the knot of choice The reef knot is the best knot for tying bandages and slings: It lies flat, making it more comfortable than other knots It does not slip It is easy to untie in order to adjust the bandage To tie a reef knot: Take one end of a bandage in each hand Lay the end from the right hand over the one from the left hand and pass it under to form a half-knot. This will transfer the ends from one hand to the other The end now in the left hand should be laid over the one from the right and passed under to form another half-knot. The finished knot looks like two intertwined loops Tighten by pulling one loop against the other or by pulling only on the ends Place knots so they do not cause discomfort by pressing on skin or bone, particularly at the site of a fracture or at the neck, when tying a sling. If the knot is uncomfortable, place soft material underneath as padding. Figure-8 A figure-8 tie may be used to tie the ankles and feet, to secure a splint to the ankles/feet, or to support an injured ankle. To tie a figure-8: Position the centre of a narrow or broad triangular bandage under the ankle (or both ankles if tying the feet together). Cross the ends over top the ankles, and bring the ends around the feet and tie off. Roller bandage Roller bandages, usually made of gauze-like elastic material, are used to hold dressings in place or to secure splints. Put on a roller bandage in a simple spiral. Starting at the narrow part of the limb, anchor the bandage with a few turns and continue wrapping the bandage, overlapping each turn by one quarter to one third of the bandage's width. Make full-width overlaps with the final two or three turns and secure with a safety pin, adhesive tape or by cutting and tying the bandage as shown. Always check circulation below the wound before and after applying a bandage, you may have applied it too tightly or swelling may have made it too tight. Slings A sling can be easily improvised with a scarf, belt, necktie or other item that can go around the casualty's neck. You can also support the arm by placing the hand inside a buttoned jacket or by pinning the sleeve of a shirt or jacket to the clothing in the proper position. Arm sling To put on an arm sling: Support the forearm of the injured limb across the body. Place an open triangular bandage between the forearm and the chest so the point extends beyond the elbow and the base is straight up and down. Bring the upper end around the back of the neck to the front of the injured side. While still supporting the forearm, bring the lower end of the bandage over the hand and forearm and tie off on the injured side in the hollow of the collarbone. Place padding under the knot for comfort. Twist the point into a "pigtail" at the elbow and tuck it inside the sling. Adjust the sling so you can see the fingernails-this way you can watch them to check on circulation. St. John tubular sling This sling is used for injuries to the shoulder or collarbone. To put on a St. John tubular sling: Support the forearm of the injured side diagonally across the chest, the fingers pointing toward the opposite shoulder. Place a triangular bandage over the forearm and hand with the point extending beyond the elbow and the upper end over the shoulder on the uninjured side. The base is placed vertically in line with the body on the uninjured side. Ease the base of the bandage under the hand, forearm and elbow. Tuck the base of the bandage under the injured arm to make a pocket that runs the full length of the arm. Gather the bandage at the elbow by twisting it and bring the lower end across the back and over the shoulder on the uninjured side. This closes the pocket at the elbow. Gently adjust the height of the arm as you tie off the ends of the bandage so the knot rests in the natural hollow above the collarbone. Place padding under knot, if available. Tie the sling tightly enough to support the weight of the injured arm. Types of Wounds A wound is any damage to the soft tissues of the body. It usually results in the escape of blood from the blood vessels into surrounding tissues, body cavities or out of the body. A wound can be either open or closed: Open wound-a break in the outer layer of the skin Closed wound-no break in the outer layer of skin but there is internal bleeding The aim in the care of wounds is to stop the bleeding and prevent infection. Although some bleeding may help to wash contamination from the wound, excessive blood flow must be stopped quickly to minimize shock. Contusions or bruises Contusions or bruises are closed wounds. The tissues under the skin are damaged and bleed into surrounding tissues, causing discolouration. A bruise may be a sign of a deeper, more serious injury or illness. Abrasions or scrapes Abrasions or scrapes are open wounds where the outer protective layer of skin and the tiny underlying blood vessels are damaged. The deeper layer of the skin is still intact. Incisions Incisions are clean cuts caused by something sharp such as a knife. Lacerations Lacerations are tears in the skin and underlying tissue with jagged and irregular edges. Puncture wounds Puncture wounds are open wounds caused by blunt or pointed instruments that may have a small opening, but often penetrate deep into the tissue. Avulsions and Amputations Avulsions are injuries that leave a piece of skin or other tissue either partially or completely torn away from the body. Amputations involve partial or complete loss of a body part. Bleeding Bleeding is the escape of blood from the blood vessels. In external bleeding, blood escapes the body through a surface wound. In internal bleeding, blood escapes from tissues inside the body. In arterial bleeding, the blood is bright red and spurts with each heartbeat. In venous bleeding, the blood is dark red and flows more steadily. Severe blood loss will result in the following signs and symptoms of shock: Pale, cold and clammy skin Rapid pulse, gradually becoming weaker Faintness, dizziness, thirst and nausea Restlessness and apprehension Shallow breathing, yawning, sighing and gasping for air First aid for severe external bleeding Perform a scene survey, then do a primary survey. To control severe bleeding, apply direct pressure to the wound. Place the casualty at rest. Once bleeding is under control, continue the primary survey, looking for other life-threatening injuries. Before bandaging the wound, check circulation below the injury. Bandage the dressing in place. Check the circulation below the injury and compare it with the other side. If it is worse than it was before the injury was bandaged, loosen the bandage just enough to improve circulation if possible. Give ongoing casualty care. If the dressings become blood-soaked, don't remove them-add more dressings and continue pressure. Removing the blood-soaked dressings may disturb blood clots and expose the wound to further contamination. Tourniquets and hemostatic dressings For catastrophic wounds, where it will be difficult to control bleeding, the use of a tourniquet, a constricting bandage, to stop all blood flow to a limb, or hemostatic dressings to promote blood clotting may be considered. First aid kits for use by the military, law enforcement or wilderness first responders may contain specialized dressings or purpose built tourniquets to control bleeding. Checking circulation below an injury Injuries and first aid procedures may reduce or cut off circulation to the tissue below the injury (called distal circulation): Dislocations and fractures can impinge on an artery. Swelling or bandaging can compress an artery. Blood vessel damage may reduce blood flow through an artery. If oxygenated blood does not reach the tissues below the injury, after several hours there may be tissue damage that could lead to loss of the limb. Check circulation below an injury before tying any bandages, then once again after tying the bandages. You may have applied the bandages too tightly or swelling may have made them too tight. Howto check circulation Check circulation below the injury by comparing the injured limb to the uninjured limb: Check skin colour-if the skin does not have same colour as the uninjured side, circulation may be impaired. Check skin temperature-if the skin temperature feels colder than the uninjured side, circulation may be impaired. Check for a pulse-at the wrist or ankle, and compare to the other limb. Check the nail beds-press on a fingernail or toenail until the nail bed turns white, and then release it. Note how long it takes for normal colour to return, and compare to the uninjured side. Improving impaired circulation To improve impaired circulation: Loosen tight bandages. Reposition the limb to relieve any pressure on blood vessels in a fracture or dislocation. Only move the limb if there is no resistance or increased pain. If circulation cannot be improved, get medical help immediately. Internal bleeding Suspect internal bleeding if: The casualty received a severe blow or a penetrating injury to the chest, neck, abdomen or groin There are major limb fractures such as a fractured upper leg or pelvis Signs of internal bleeding: Bleeding from the ear canal or the nose Bloodshot or black eye (bleeding inside the head) Coughing up blood that looks bright red and frothy (bleeding into the lungs) Vomiting bright red blood, or brown blood that looks like coffee grounds Blood in the stool that looks either red or black and tarry Red or smoky brown-looking blood in the urine Signs of shock with no signs of external injury First aid for internal bleeding Perform a scene survey. Have the casualty lie flat on their back and do a primary survey. Send or go for medical help. Give ongoing casualty care, including laying the casualty in the supine position, and giving first aid for shock. You can do very little to control internal bleeding. Give first aid to minimize shock and get medical help as quickly as you can. Amputations An amputation is when a part of the body has been partly or completely cut off. You must control the bleeding from the wound, care for the amputated tissue and get medical help. First aid for amputations Perform a scene survey, then do a primary survey. Control bleeding-apply direct pressure to the wound. Reposition a partly amputated part to its normal position and bandage. Send for medical help and continue ongoing casualty care to the casualty. Care for the amputated part by wrapping it in a clean, moist dressing (if clean water is available). Put the amputated part in a clean, watertight plastic bag and seal it. Put this bag in a second plastic bag or container partly filled with crushed ice. Attach a record of the date and time this was done and send this package with the casualty to medical help. y If direct pressure fails to control life-threatening external limb bleeding, a tourniquet could be considered by a trained first aider (in special circumstances, such as mass casualty management, a disaster, remote locations). Minor Wound Care Preventing Contamination All open wounds are contaminated to some degree. Tell the casualty to seek medical help if signs of infection appear later. Wash your hands with soap and water and put on gloves if available. Do not cough or breathe directly over the wound. Fully expose the wound but don't touch it. Gently wash loose material from the surface of the wound. Wash and dry the surrounding skin with clean dressings, wiping away from the wound. An antibiotic cream can be used on superficial wounds and abrasions. Cover the wound with a sterile dressing. Wound infection The acronym SHARP identifies signs and symptoms of infection. S- Swollen H - Hot, feels warmer than the surrounding area A-Aches, a dull pain R-Red P - Pus may leak from the wound Tetanus infection Any wound may be contaminated by spores that cause tetanus, a potentially fatal bacterial disease characterized by muscle spasms. Tetanus is commonly referred to as "lockjaw." Deep wounds are at especially high risk of tetanus infection. Advise a casualty with this type of wound to get medical help as soon as they can. Symptoms may not arrive immediately. First aid for hand and foot injuries Hand and foot injuries are common. If the injury seems minor and the casualty chooses not to get medical help, instruct them to get medical help within 48 hours if there is still pain, loss of function, or an infection. First aid for bleeding from the palm of the hand Start ESM. Perform a scene survey. Perform a primary survey and expose the wound. Control the bleeding with direct pressure with a bulky pad over sterile dressings. Check the circulation in the fingers and compare it with the other hand. Bend the fingers over the pad to make a fist and bandage the hand so the fist is held firmly closed: Place the middle of a narrow triangular bandage on the inside of the wrist and bring the ends around the back of the hand, or start wrapping with a roller bandage at the wrist, and continue wrapping around the back of the hand. Wrap the tightly bandage over the fingers and then down around the wrist. Leave the thumb exposed, if possible, to check circulation. Tie the bandage off at the wrist and tuck in the ends. Give ongoing casualty care, recheck the circulation below the injury, and get medical help. Use a sling to support the arm and hand if transporting. First aid for pinched fingernail When a finger or toe nail has been pinched, sometimes called a nail bruise, the pressure from the blood under the nail can cause great pain. You can relieve this pain as follows: Place the injured part under cool running water to reduce pain and swelling. If the pain is severe, and you can see pooled blood under the nail, release the pressure under the nail as follows: Straighten a paper clip or blunt wire and heat one end to red hot, using a stove element or the flame from a lighter. Don't use a needle, the hole it makes is too small to release the pooled blood effectively. Place the heated end of the paper clip on top of the nail and let it melt a hole just deep enough to release the pooled blood. Once the pressure has been released, wash the area with water and put on an adhesive dressing. Advise the casualty to seek medical help if signs and symptoms of an infection develop. First aid for slivers and splinters Slivers are small embedded objects - wood, thorns, glass or metal. This type of injury is common in the hands and feet. Although slivers may cause discomfort and pain, in most cases they can be removed easily without complications. In serious cases, slivers can be disabling and cause infection. Do not remove a sliver if it: Lies over a joint Is deeply embedded into the flesh Is in or close to the eye Has a barb (e.g. metal slivers and fishhooks) Cannot be removed easily In these cases, give first aid for an embedded object. Removing a sliver Clean the area with water. With sterile tweezers, grip the sliver as close to the skin as possible. Pull the sliver in a straight line in the opposite direction to the angle of entry. Get medical help if some of the sliver was not removed, there is more tissue damage than a simple, small puncture wound or if an infection develops. First aid for contusion (bruise) With a contusion or bruise, blood escapes into the surrounding tissue. Relieve the pain and reduce the swelling by using the acronym RICE: R- Rest I - Immobilize C-Cold E - Elevate First aid for puncture wounds Puncture wounds are serious because of the possibility of serious internal damage and contamination carried deep inside the wound. Perform a scene survey. The mechanism of injury is important. Then perform a primary survey. Expose the wound. Although there may not be much external bleeding, you should suspect internal bleeding, especially if the wound is in the chest or abdomen. Control bleeding with direct pressure on the wound, and get medical help. Give ongoing casualty care until handover. First aid for gunshot wound A gunshot wound is a serious type of puncture wound. The entry wound is often small, but the bullet may have travelled deep into or through the body and there may be an exit wound as well, which is often larger than the entry wound. The exit wound may not be directly across from the entry wound. Perform a scene survey and ensure the area is safe for yourself and the casualty. Then perform a primary survey. Expose the wound and check carefully for an exit wound; it may not be where you expect it. Control bleeding with direct pressure on the wound, and get medical help. Place the casualty at rest and give first aid for shock. Give ongoing casualty care. First aid for wounds with embedded objects Do not remove an object embedded in a wound if possible. Removing the object will probably result in heavier bleeding; the object can help stop bleeding. Removing it could cause further tissue damage too, for example a barb on a fish hook. Expose the injured area and assess the wound. Check the circulation below the injury. To stop the bleeding, put pressure around the embedded object. If the embedded object is short, "tent" a clean dressing loosely over the object to keep the wound clean, then place bulky dressings around the object to keep it from moving. This will apply pressure around the wound Secure the bulky material (dressings) in place with a narrow bandage, taking care that pressure is not exerted on the embedded object. Check the circulation below the injury again. Give ongoing casualty care and get medical help. Chest injuries Wounds to the chest can cause breathing problems and require immediate medical help. Pneumothorax A pneumothorax is caused by air in the chest between the lung and the chest wall. Air can enter from the outside, an open pneumothorax, or penetrating chest wound. Air can also enter from the lung, a closed (or spontaneous) pneumothorax. Breathing with a pneumothorax becomes impaired as the lungs begin to collapse. Medical help is required immediately. First aid for a penetrating chest wound Perform a scene survey and primary survey. If the open chest wound has significant bleeding, cover it by pressing the casualty's hand, a bystander's hand or your own hand over the wound (preferably a gloved hand). If there is no significant bleeding, the first aider may leave the wound exposed, or use a non-occlusive dressing. If the dressing becomes saturated, it must be changed. Place the casualty in the position that makes breathing easiest-this is usually semi-sitting, leaning slightly towards the injured side. This position keeps the uninjured side of the chest upward so it can be used most effectively for breathing. Do not seal the wound with an airtight dressing, but cover the wound to prevent further contamination. If the dressing becomes wet, replace it with a dry dressing. Give ongoing casualty care, monitoring breathing often. There is not always an open wound with a pneumothorax. A pneumothorax always has the potential to be a life-threatening breathing emergency and medical help is needed as quickly as possible. First aid for a blast injury that affects breathing For Canadians working in the mining and construction industries, explosives are a workplace hazard. There are three mechanisms of injury from an explosion: Injuries from being struck by material thrown by the blast Injuries from being thrown by the blast Injuries to hollow organs, including the lungs, caused by the shock wave from the blast The casualty may complain of chest pain and cough up frothy blood. Perform a scene survey. If the casualty was thrown by the blast, suspect a head or spinal injury and prevent any unnecessary movement. Perform a primary survey. Place the casualty in a semi sitting position if there is no suspected head or spinal injury. Send for medical help. Monitor breathing closely. Give ongoing casualty care. Abdominal injuries Abdominal wounds may be closed or open. Closed wounds occur when internal abdominal tissues are damaged but the skin is intact. An open abdominal wound has a break in the skin where internal organs may protrude. Complications from abdominal wounds may include severe bleeding (either internal or external) and contamination from the contents of ruptured abdominal organs. To assess an abdominal injury expose the injured area and look for open wounds. Consider the history of the incident, especially the mechanism of injury. Observe the casualty's position; are they 'guarding' their abdomen? Gently feel for swelling, rigidity, and pain. If you suspect an abdominal injury, you should also suspect internal bleeding that may be severe. Give first aid for severe internal bleeding. First aid for open abdominal wounds Perform a scene survey and a primary survey. If you find an open abdominal wound you must be prevent it from opening wider. The internal organs may be displaced. Position the casualty in the semi-sitting position with the knees raised and supported. Dress the wound. The method of dressing a wound of the abdominal wall depends on whether or not internal organs are protruding: If the organs are not protruding, apply a dry dressing to the wound and bandage firmly. If the organs are protruding, do not try to put them back into the abdomen. Put on a moist dressing to stop the organs from drying out and bandage loosely with two broad bandages. Give ongoing casualty care. Crush injuries A crushing force can cause extensive bruising of the area, and there may be complications including fractures or ruptured organs. When the crushed area is limited, such as a hand or foot, the injury is considered serious, but is not usually life-threatening. However, a major crush injury may cause compartment syndrome, and needs medical help immediately. This occurs when excessive pressure builds up inside the body, usually from bleeding or swelling after an injury. The dangerously high pressure in compartment syndrome can cut off the flow of blood through the affected area. Severe shock can develop after a casualty is released from the weight that caused the crush injury. When the crushing force is removed, fluids from the crushed tissues leak into surrounding tissues-this causes shock. When muscle is crushed, it releases the contents of muscle cells into the blood. If the injury is large, it can cause kidney failure. This is crush syndrome, also called post-traumatic acute renal (kidney) failure. First aid for crush injuries Perform a scene survey and a primary survey. Give first aid for shock right away-even if there are no signs, shock will probably develop. Call for medical help and give ongoing casualty care Scalp and facial injuries First aid for bleeding from the scalp Bleeding from the scalp is often severe and may be complicated by a fracture of the skull or an embedded object. Avoid direct pressure, probing and contaminating the wound. Perform a scene survey and a primary survey. Apply a thick, sterile dressing and bandage it firmly in place with a head bandage. If there is suspected underlying skull fracture, give first aid for a fracture of the skull. If there is an embedded object, apply dressings around the object to maintain pressure around but away from the wound. Give ongoing casualty care. First aid for bleeding from inside the ear Don't try to stop the bleeding from the ear canal by putting pressure on the ear or by packing it with dressings. To reduce the risk of infection inside the ear, it is best to let the blood drain away. Perform a scene survey and assess the mechanism of injury. If you suspect a head or spinal injury, tell the casualty not to move. Do a primary survey. Assess the bleeding from the ear. If the blood from the ear is mixed with straw-coloured fluid, suspect a skull fracture­ steady and support the head and neck. Place a dressing lightly over the ear and give first aid for a skull fracture. The dressing will absorb the blood and protect the wound. If a head or spinal injury is not suspected, lightly tape a dressing over the ear. Position the casualty to allow the blood to drain from the ear if injuries permit. If the casualty is unconscious and injuries permit, put dressings over the ear and place them in the recovery position with the injured side down. Give ongoing casualty care. First aid for a nosebleed A nosebleed may start for no obvious reason, or may be caused by blowing the nose, an injury to the nose, or by an indirect injury, such as a fractured skull. Perform a scene survey and assess the mechanism of injury. If you suspect a head or spinal injury, tell the casualty not to move. Do a primary survey. Assess the bleeding from the nose. If the blood from the nose is mixed with straw-coloured fluid, suspect a skull fracture. Allow the nose to bleed and give first aid for a skull fracture. If a head or spinal injury is not suspected, place the casualty in a sitting position with the head slightly forward. Leaning forward allows blood to drain from the nose and mouth instead of back into the throat and stomach where it will cause vomiting. Tell the casualty to compress the entire fleshy part below the bridge of the nose firmly with the thumb and index finger for about 10 minutes or until bleeding stops. Tell the casualty to breathe through the mouth and not blow their nose for a few hours, so that blood clots will not be disturbed. If bleeding does not stop with this first aid, or if it starts again, get medical help. First aid for a knocked-out tooth A knocked-out tooth can be re-implanted if the casualty receives medical/dental help quickly. Perform a scene survey and assess the mechanism of injury. If you suspect a head or spinal injury, tell the casualty not to move. Do a primary survey. Apply direct pressure to stop the bleeding from the socket of the tooth. Seat the casualty with the head forward so blood can drain out of the mouth. Place the knocked-out tooth in a balanced salt solution, or coconut milk. If none of these are available, the casualties own saliva will do. Handle the tooth by the top-don't touch the root. Give ongoing casualty care. Bleeding from the cheek, gums or tongue When there is bleeding from the gums or mouth, first assess the mechanism of injury to determine if there is a chance of a serious head and/or spinal injury. Make sure the bleeding in the mouth doesn't block the airway. Control the bleeding in the mouth using direct pressure over a clean, preferably sterile, dressing. Do not wash out the mouth after bleeding has stopped, this may dislodge clots and cause bleeding to start again. Eye injuries The eye can be injured very easily; proper first aid given right away may prevent partial or complete loss of eyesight. Tears may not be enough to loosen and wash away irritating particles on the eye. Signs and Symptoms of an Eye Injury Some signs and symptoms that will indicate an injury to the eye include: Pain Blurred or double vision Excessive tearing Feelings of grit or a partidle under the lid Broken blood vessels or red spots Bleeding or other fluids from the eye Deformity Loss of vision First aid for a loose foreign particle in the eye Begin by asking the casualty where they feel the particle is located. If it feels like the particle is under the upper lid, instruct the casualty to grasp the upper eyelashes and pull the lid straight out and then down over the lower eyelashes to try to sweep the particle away. Try this several times. Remember to remove excess eye make-up before attempting this procedure. If the particle is still in the eye, try flushing it out using clean running water from a tap, an eye cup or eye wash bottle. If the above methods have not been successful, you will need to examine the surface of the eye and under the lids. Examining the eye Seat the casualty facing a good light and steady the head. Instruct the casualty to look to the left, right, up and down. A penlight directed across the eye will cause a shadow to appear if the particle is in the path of the light, making it easier to see. To examine under the upper and lower lids, gently pull down on the lower lid and ask the casualty to look up. To examine under the upper lid, gently pull up on the lashes and ask the casualty to look down. Use your penlight to check under the lids. If you locate the particle, remove it gently using the moist corner of a facial tissue, clean cloth or cotton-tipped applicator. Do not try to remove a particle that is stuck Do not attempt to examine the eye if there are burns or injuries to the eyelid. to the eye, or is located on the coloured part of the eye. If the casualty is wearing contact lenses, have them remove the lens before trying to remove a particle from the eye. First aid when you cannot safely remove a particle from the eye If removing the particle is unsuccessful, warn the casualty not to rub the eye because this may cause pain and tissue damage. Close the casualty's eye and cover the affected eye with an eye or gauze pad. Extend the covering to the forehead and cheek to avoid pressure on the eye. Secure lightly in position with a bandage or adhesive strips. Make sure there is no pressure on the eyeball. Give ongoing casualty care and get medical help. Wounds in the soft tissue around the eye Wounds to the eyelid and soft tissue around the eye are serious because there may be injury to the eyeball. Blows from blunt objects may cause bruises and damage the bones that surround and protect the eyes. Cover only the most seriously injured eye to avoid the psychological stress that the casualty may suffer when both eyes are covered. This leaves the casualty able to walk on their own. If both eyes must be covered due to serious injury, (e.g. intense light burn from arc welding), reassure the casualty often by explaining what is being done and why. This casualty must be carried. First aid for lacerations and bruises around the eye Lacerated eyelids usually bleed profusely because of their rich blood supply. A dressing on the area will usually control bleeding. Never apply pressure to the eyeball-this mayforce fluid out of the eyeball and cause permanent damage to the eye. First aid for an embedded object in or near the eyeball Give first aid for an embedded object in or near the eyeball. As for any embedded object, prevent the embedded object from moving since movement could cause further damage to the eyeball. Perform a scene survey and primary survey. Have a bystander support the head. Place dressings, preferably sterile, around the embedded object. Place padding or dressings around the object in a "log cabin" fashion, to stabilize the object. Make sure there is no pressure on the eyeball. Arrange transportation of the casualty on a stretcher to medical help as soon as possible. First aid for an extruded eyeball "Extruded" means the eyeball has been thrust out of its socket. Do not try to put the eye back into position. 1. Perform a scene survey and primary survey. Have a bystander support the head. 1. Gently cover the eyeball and socket with a moist dressing. Hold this in place with tape and more { dressings. 1. Give ongoing casualty care until handover. First aid for chemical burns to the eye The eyes can be permanently injured by corrosive chemicals in either solid or liquid form. Casualties normally suffer intense pain and are very sensitive to light. Give first aid as follows: Perform a scene survey and primary survey. Have a bystander support the head. Sit or lay the casualty down. If only one eye is injured, protect the uninjured eye. When working with Chemicals, know where to find Safety Data Sheets (SDS) and refer to them for guidance with first aid. If the chemical is a dry powder, brush away whatever is on the skin. Do not use your bare hands. Flush the injured eye with cool water. Since pain may make it hard for the casualty to keep the eye open, gently open the eye with your fingers. Flush the eye for at least 15 minutes. Cover the injured eye with dressings. If both eyes are injured, cover the more seriously injured eye. Only cover both eyes if the casualty is more comfortable that way. Covering both eyes blinds the casualty and adds to the stress of the scene. If you do cover both eyes, keep the casualty lying down. Give ongoing casualty care. If the casualty is wearing contact lenses Don't waste time trying to remove contact lenses. Flush the eyes for 15 minutes-this maywash the lenses out. If not, have the casualty remove them. Lenses exposed to chemicals should be thrown away (so it doesn't matter if they are washed away during flushing). When there is a risk of eye injury from chemicals, proper eye-wash equipment should be kept nearby. First aid for intense light burns to the eye Burns to the eyes may be caused by prolonged exposure to intense light such as direct or reflected sunlight or a short duration event like the flash from an arc welder. Snow blindness is a common injury of this kind. As with a sunburn, the casualty may not feel the tissue damage happening but will develop symptoms several hours after exposure. Signs and symptoms include: Sensitivity to light Pain A gritty feeling in the eyes Give first aid as follows: Perform a scene survey and primary survey. Cover the eyes to cool them and keep the light out. The casualty will be temporarily blinded, so reassure them often. Give ongoing casualty care. Burns Burns are injuries to the skin and other tissues caused by heat, radiation or chemicals. They are a leading cause of injury in the home. Young children and elderly people are especially at risk of being burned, and at these ages, burn injuries can be serious. Types of burns Heat burns (also called "thermal" burns) Burns from heat applied to the body are the most common of burns. A scald is a heat burn caused by hot liquid or steam. Heat burns can also be caused by friction. Chemical burns Chemical burns are often serious because the chemicals continue to burn as long as they remain on the skin. Examples of chemicals that can burn include acids or alkali metals. Electrical burns Electrical burns result from contact with an electric current. Although it is heat that causes these burns, electrical burns are considered separately because of the complications caused by the electricity. Radiation burns Most people have experienced a radiation burn in the form of sunburn, where the sun is the source of radiant energy. Other types of radiant energy that can cause burns include X-rays, arc welder's flash and radiation from radioactive material. Severity of a burn Burns are classified as critical, moderate or mild depending on: The depth of the burn The amount of body surface that is burned The part(s) of the body that is burned The age and physical condition of the casualty Burn depth The skin protects the body from bacteria, helps control body temperature and keeps body fluid in the body. When the skin is damaged by a burn, it cannot do these functions properly, or at all. The severity of a burn depends on the depth of the tissue damage. The deeper the burn, the more serious it is. In first aid, burns are described as superficial, partial thickness or full thickness burns depending on how deep into the skin they extend. Estimating the burned area-the rule of nines A first aider can quickly estimate how much body surface area has been burned using the rule of nines. The body is divided up into areas of either nine or eighteen per cent of total body area. Add these areas to quickly calculate the percentage of the body that is affected. The percentages change slightly for a child's body. Rule of nines for an adult 9%-head andneck together 9%-each arm 18%-front surfaces of the trunk 18%-rear surfaces of the trunk 1%-genitalia 18%-each leg Rule of nines for a child 18%-head and neck together 9%-each arm 18%-front surfaces of the trunk 18%-rear surfaces of the trunk 14%-each leg Another way to estimate burned area The area of the casualty's palm equals one per cent of the casualty's body surface area. With this information, you can estimate the percentage of the body that is burned. Critical burns The burns that are critical, that may be life-threatening or can cause life-long disability or disfigurement include: Any burn that interferes with breathing, inhalation injuries Any burn where there is also a serious soft tissue injury or fracture Any burn where the skin bends, including the hands, elbows, knees, etc. All electrical burns, because of internal injuries or cardiac compromise Most chemical burns Burns to casualties under two or over fifty years old-they do nottolerate burns well Burns to casualties who have serious underlying medical conditions including diabetes, seizure disorders, hypertension, respiratory difficulties, or mental illness Complications of burns Common complications of burns include: Shock caused by the loss of blood or blood plasma to the surrounding tissues is the immediate danger Infection, because burned skin isn't a good barrier to bacteria Breathing problems if the face or throat is burned, or the casualty has inhaled smoke, fumes or steam Swelling, as clothing and jewellery will cut off circulation when the area swells Inhalation injuries Inhalation injuries occur when the casualty inhales hot steam or hot (superheated) air, smoke or poisonous chemicals. Signs and symptoms of inhalation injuries include signs of shock: Dizziness, restlessness, confusion, Pallor or cyanosis Abnormal breathing rate or depth Along with a history of exposure to heat and: Noisy breathing Pain during breathing Burns on the face, especially the mouth and nose Singed hair on the face or head Sooty or smoky smell on breath Sore throat, hoarseness, barking cough, difficulty swallowing The only first aid for someone with suspected inhalation injuries is to get to medical aid quickly. Place a conscious casualty in the semi­ sitting position if possible and combat shock. Recognizing burns Superficial burn-only the top layer of the skin is damaged Skin colour is pink to red Slight swelling Skin is dry Tenderness to severe pain in the injured area Partial Thickness burn-the top two layers of the skin are damaged Skin looks raw and is mottled red in colour Skin is moist and ranges in colour from white to cherry red Blisters that contain clear fluid Extreme pain Full Thickness burn-the full thickness of the skin, including tissues under the skin are damaged Skin is pearly-white, tan-coloured or charred black Skin is dry and leathery You may see blood vessels and bones under the skin Little or no pain (nerves are destroyed) First aid for heat burns Do a scene survey and a primary survey. Cool the burn right away: Immerse it in cool water if possible. If you can't do this, pour cool water on the area or cover it with a clean, wet cloth. Cool the burn until the pain has lessened. This will reduce the temperature of the burned area, and reduce tissue damage, swelling, blistering and relieve the pain. Remove jewellery and tight clothing before the injury swells. Don't remove anything that is stuck. When the pain has lessened, loosely cover the burn with a clean, lint-free dressing. If the area is large, use a sheet. Give ongoing casualty care. Precautions for first aid for burns Do not breathe on, cough over or touch the burned area. Do not break blisters. Do not remove clothing that is stuck to the burned area. Do not use butter, lotions*, ointments* or oily dressings on a burn. Do not cover a burn with cotton wool or other fluffy material. Do not use adhesive dressings. Do not cool the casualty too much. Once the area is cooled, take action to keep the casualty warm. *Sunburn lotions and ointments can be used on minor sunburn. Burn dressings A good burn dressing is sterile, lint-free and won't stick to the injury when it is removed. If you don't have something like this, use something clean and lint-free, like a linen sheet. Another type of burn dressing is the "gelled water" burn dressing, e.g. Water-Jel®. These sterile dressings are coated with a jelly-like substance that is mostly water. As such, the dressings are effective in cooling the burn, keeping it clean and providing pain relief. Use these dressings according to the instructions on the package. First aid for chemical burns A corrosive chemical will keep burning as long as it is on the skin. The faster you get the chemical off the skin, the less tissue damage there will be. Do a scene survey and a primary survey. Flush the area with large amounts of cool water. Remove contaminated clothing while flushing. If the chemical is a dry powder, quickly brush off any loose chemical with a cloth before flushing. Continue flushing the area with water for 15 to 20 minutes. When the pain has lessened, loosely cover the burn with a clean, lint-free dressing. Give ongoing casualty care. If you work with chemicals, make sure you know the specific first aid for the chemicals in your workplace. The safety data sheet (SDS}, for each chemical contains this information. Send the SOS to the hospital with the injured worker if possible. If you work with chemicals at your place of employment, you are required to be certified in WHMIS/GHS. First aid for electrical burns Electrical burns can be either flash burns or contact burns. A flash burn results when high voltage electricity arcs (jumps) from the electric source to the casualty. When the electricity arcs, it produces intense heat for a very short time and this heat causes burns, which can be a very deep. The force can throw the casualty as well. Head/spinal injuries, fractures or dislocations may be present. In a contact burn, electricity travels through the body. The body may be burned at both the point where the electricity entered the body and where it exited. There may also be severe tissue damage inside the body, along the path the electricity followed. An electrical current going through the body can cause breathing to stop and/or the heart to stop. There is also the danger of electrical injury to the first aider. Do a scene survey, then a primary survey. Make sure there is no further danger from electricity; call the power company or other officials to make the scene safe. If high voltages are involved, all you can do is keep others out of the area until the power is shut off. Does it look like the casualty was thrown? If so, suspect a head or spinal injury. Do a secondary survey to locate burns and any fractures, dislocations, etc. Look for both entry and exit burns. Give first aid for the burns by covering them with clean, dry dressings. Give first aid for any fractures or dislocations. Give ongoing casualty care. When power lines are down If there is a possibility of a downed power line or a weakened pole, do not leave your vehicle until you have inspected the surrounding area, looking for downed power lines. Stay inside your vehicle if it is touching power lines. Wait for authorities to arrive, then follow their instructions. If you suspect or see any downed power lines, don't let anyone enter the area. When you are sure no one will enter the area, notify the power company. With high voltages, electricity can travel through the ground, energizing the area around the power lines. If the soles of your feet tingle as you enter an area, you've gone too far-get back. Assume all downed power lines are live. A high voltage wire may be unpredictable-it may jump to an object for a better ground. Stay well away from any wires. Remember that vehicles, guardrails, metal fences, etc., conduct electricity. First aid for sunburn Sunburns can range in severity from those that are mildly uncomfortable to those that are serious because they cover a large area of the body, and can be complicated by heatstroke. For minor sunburn, give first aid as follows: Get out of the sun, and do a scene survey and primary survey. Gently sponge the area with cool water or cover with a wet towel, to relieve the pain. Repeat this step as needed to relieve pain. Pat the skin dry and put on a medicated sunburn ointment if available. Apply the lotion according to directions on the package. Protect burned areas from further exposure to the sun. Don't break any blisters-doing so may promote infection. If large areas of the skin begin to blister, get medical help. If the casualty begins to vomit, or develops a fever, give first aid for heat injuries and get medical help. First aid for burns from X-rays and nuclear radiation There is no specific first aid for radiation burns from X-rays or radioactive material. Give first aid following the guidelines for first aid for heat burns. In an environment where there is radioactive material, protect yourself accordingly. How to put out a fire on your clothes If your clothing catches fire: Stop - moving Drop - to the ground Roll - several times to put flames out Don't run - this only fans the flames. How to exit a smoke-filled room If you can, cover your mouth and nose with a wet cloth Hot smoke rises-keep your head low as you crawl under the smoke Bites and stings Animal and human bites Animal and human bites that cause puncture wounds or lacerations may carry contaminated saliva into the body and are dangerous because of the risk of infection. The most common human bites in adults are to the hand. All animal and human bites that break the skin should be seen by a doctor. Rabies is an acute viral disease of the nervous system that is always fatal if not treated. Rabies should be suspected in domestic animals if they behave in an unusual way, and in all attacks by wild animals (bats, foxes, skunks, raccoons, and more). The rabies virus can be transmitted to anyone who handles a diseased animal or who touches the area of the wound that carries the virus. To be safe, always give first aid for an animal bite as if the animal had rabies, until it is proved otherwise. Be especially careful when giving first aid to anyone you suspect may have been exposed to rabies and in handling the live or dead animal involved. Wear gloves and/or scrub your hands thoroughly after contact to reduce the risk of infection. Even if a person has been exposed to a rabid animal, full-blown rabies can be prevented if immunization against the disease is given quickly. First aid for animal/human bites Perform a scene survey and a primary survey. Examine the wound to see if the skin was broken. If there is bleeding, allow moderate bleeding of the wound-this helps to cleanse the wound. Wash the wound then apply a dressing and bandage. Get medical help. Snakebite Rattlesnakes are the only poisonous snakes found in the wild in Canada. Varieties of this snake can be found in parts of British Columbia, Alberta, Saskatchewan and Ontario. If you are travelling to areas where there are other poisonous snakes, learn the first aid for snakebites in that area. A rattlesnake's bite leaves one or two puncture holes in the skin. Venom may be injected into the casualty. If it is, the casualty will feel a burning sensation. This is followed by swelling and discolouration, severe pain, weakness, sweating, nausea, vomiting and chills. Breathing may be affected. First aid for snakebite Do a scene survey and primary survey. Place the casualty at rest in a semi-sitting position and keep the affected limb below heart level. By placing the casualty at rest, the venom won't spread as quickly. Flush the bite if possible. Wrap a large roller bandage around the entire length of the bitten extremity, just tight enough that you can get your fingers under the bandage. This is an effective and safe way to slow circulation of the venom. Immobilize the limb. Give ongoing casualty care. Precautions when dealing with snakes and snakebite Most snakes will be within 10 metres of the place where the bite took place-be careful Do not let a snakebite casualty walk if there is any other method of transportation to medical help Do not give the casualty alcoholic beverages Do not cut the puncture marks or try to suck poison out with your mouth Do not apply ice-this could cause more damage If the snake is killed, bring it to medical help for identification, but do not touch the snake directly. Avoid the snake's head-a dead snake still may have a bite reflex Insect bites and stings An insect bite or sting causes only a painful swelling with redness and itching at the site for most people. But some people are severely allergic to these stings and being stung may cause a life­ threatening allergic reaction. Signs and symptoms of a localized reaction at the site of a bite or sting: Sudden pain Swelling Heat Redness Itching Signs and symptoms of an anaphylactic reaction to a bite or sting: General itching, rash A bump on the skin that may be white, pink, reddish or blotchy Generalized swelling-especially of the airway Weakness, headache Fever Breathing difficulties that may be severe Anxiety, abdominal cramps, vomiting First aid for an insect bite or sting Do a scene survey, then a primary survey. Are there any signs of an allergic reaction? Looking for a stinger that may still be in the skin. Honey bees leave their stinger and venom sac attached to the skin. Other bees and wasps do not. If it is there, remove it by carefully scraping it and the attached poison sac from the skin. For the irritation at the site of the sting, apply rubbing alcohol or a paste of baking soda and water. Ice can also be used. Don't use alcohol near the eyes. Ticks Ticks are found throughout Canada. They drop from the foliage onto animals and humans, biting through the skin and anchoring themselves to the tissue with barbed mouth parts. A tick will suck the host's (the person or animal) blood for many hours, and may become quite large. Once the tick is done feeding, it detaches itself and drops off. They sometimes carry diseases that can be transmitted to humans. If one tick is found, check your body and clothing thoroughly for others. Keep the tick for identification by a medical professional. First aid for bites from ticks Use a tick removal tool to pull out the tick by sliding the tool along the skin and carefully pulling away from the body If you do not have a tick removal tool, use tweezers by grasping the tick close to the skin and carefully pulling at a slow but steady pace. Do not grasp the tick body, as it will pop, spraying the contents If you don't have tweezers, wear gloves or cover your hand with a plastic bag or tissue paper. If the tick is full of blood, wear eye protection. Keep the dislodged tick and bring it to medical help for identification. Clean the area and apply an antiseptic to prevent infection. Ticks can carry various diseases which may cause symptoms several days after exposure. If the tick is found engorged, or if the site of the bite shows any sign of infection or rash (which may look like a halo), get medical help. Leeches A leech makes a tiny cut in the skin, which may not be felt at the time, and attaches itself to feed on the blood of a human or animal. Once a leech is attached, trying to pull it off often doesn't work-the leech may tear into smaller parts, making it even harder to remove those parts still attached. This may increase the risk of infection. First aid for lesions from leeches Detach the leech by first using a fingernail to push the head end of the leech off of the skin. The head end is the smaller, skinnier part of the leech-not the larger end. After the head is released, use a fingernail to push the larger end off. Once the leech is removed, there may be some bleeding due to the anticoagulant produced by the leech. Wash the area with soap and water, and use a baking soda paste or ammonia solution to relieve irritation. If the site of the bite shows any sign of infection, the casualty should get medical help. Jellyfish Jellyfish can be found in any body of water, whether salt water or fresh, with different varieties being found in Canada. Jellyfish that have been known to cause death live in tropical climates and have not been located near Canada. All jellyfish sting their prey using nematocysts, which in simple terms are "stingers." These stingers may contain venom which can be harmful, but more commonly cause an unpleasant stinging or burning sensation. First aid for jellyfish stings Perform a scene survey and a primary survey. Apply as much vinegar as possible to the affected area. Vinegar will stop the stingers from releasing venom. To help relieve pain, bathe the affected part in warm water, as warm as the casualty can tolerate for about 20 minutes. Do not apply cold water. Cold water helps the stingers to continue releasing venom. If signs of infection occur, seek medical help.