First Aid Course-PHTX 944 Lecture 3 Bleeding and Amputation PDF

First Aid Course-PHTX 944 Lecture 3 Bleeding and Amputation Dr. Noha El Hadary MD, PhD Molecular Physiology  ILOs a. Knowledge & Understanding a.1.Recognize the principles for basic life support measures a.2.Recogniz...

First Aid Course-PHTX 944 Lecture 3 Bleeding and Amputation Dr. Noha El Hadary MD, PhD Molecular Physiology  ILOs a. Knowledge & Understanding a.1.Recognize the principles for basic life support measures a.2.Recognize important signs of bleeding a.4.Recognize important and common medical measures taken in shock a.5.Recall the first aid measures in case of bleeding and shock b. Professional and practical skills b.2. Demonstrate the ability to perform technical procedures for bleeding b.3. Perform the appropriate first aid measures in case bronchial asthma attack c. Intellectual skills c.1. Demonstrate the rapid and correct assessment of the situation and casualty at the scene of an incident. c.2. Analyze the common conditions of medical emergencies. d. General and transferable skills d.1. Work effectively in a team d.2. Communicate effectively with emergency care providers d.3. Act in a reliable and responsible manner  What is bleeding? Bleeding, also known as a hemorrhage, simply blood loss, it is blood escaping from the circulatory system from damaged blood vessels. Types of bleeding: can be external or internal bleeding I-External bleeding I- External bleeding: Bleeding that can be seen The most common cause of external bleeding is any trauma that damages the blood vessels. This includes cuts, abrasions, gunshot wounds, crushing wounds, and puncture wounds The seriousness of an external wound doesn't always correspond with the size of the wound or the amount of blood lost. For example, a small superficial scalp wound may bleed heavily because of the rich blood supply to the head. Bleeding from an artery is more serious and will take longer to stop. I-External Bleeding (cont.) Types of Wounds: Sources of Bleeding There are broadly three different types of bleeding according to the source:  arterial  venous  capillary  Arterial bleeding Bleeding from an open artery is bright red in color due to the high oxygen content and spurts (pulsates). The high pressure is the cause of the spurt, it also makes this type of bleeding difficult to control. Venous bleeding Bleeding from an open vein is much darker red color due to the low oxygen content and flows more steadily. As venous blood is under less pressure it does not spurt it flows and is easier to manage. Capillary bleeding Bleeding from damaged capillary vessels is dark red and will ooze from the wound slowly but steadily. This type of bleeding often stops with no medical intervention as the body forms a clot. Sources of Bleeding (Cont.)  Arterial Venous Capillary Cause open artery open vein damaged capillary Blood bright red dark red dark red color The blood is mixed with serous fluid Blood rapid, spurts steady flow slow & oozing flow (pulsate) non pulsating correspond to heart beat Pressure high low low Blood loss rapid and profuse can be controlled stops without difficult to control interference (often clots spontaneously) First Aid of External Bleeding The aim of first aid in bleeding, regardless the type of bleeding or wound is to:  Prevent further loss of blood (stop bleeding)  Prevent shock  Prevent germs entering the wound (infection)  Preserve life  1- Management of Capillary Bleeding Capillaries occurs in all wounds mainly superficial abrasions What to do? Put on gloves if any to prevent blood born infection. Clean the wound with water Dab off the wound to stop the bleeding and remove any excess blood Apply an antibacterial cream to stop any chance of infection. Place a clean and dry bandage, gauze or cloth on the wound Be careful not to apply adhesive to any part of the abrasion. N.B. Dab means press against something lightly several times with a piece of absorbent material (cloth or tissue)  2- Management of Venous Bleeding Venous bleeding is usually less serious than arterial bleeding, it is not under pressure. The blood is dark red in color with steady non spurting flow. What to do? Find the source of the bleeding, you may have to remove or cut away clothing to reveal the wound. Place a sterile bandage or clean cloth on the wound. Apply direct and constant pressure to the wound for 2-5 minutes. If the victim is conscious and can assist, this will help. If bleeding continues, apply a second dressing on top of the first, do not remove the old bandage, as this can strip the wound of blood trying to clot and only delay your ability to control the bleeding. After bleeding is controlled, you can begin to wrap the wound using an roller bandage, beginning at the distal end from the body and wrap over any and all dressing pads you placed over the wound. (If the wound is on the arm, begin wrapping at the end where the fingers are) 3- Management of Arterial Bleeding The blood is bright red in color, spurting and the pressure is higher than other types of bleeding. What to do? Find the source of the bleeding, you may have to remove or cut away clothing to reveal the wound. Cover the wound as long as no pierced objects are protruding from it. Ideally, a sterile pad or bandage would work best, but use whatever you have available, so long as it's clean.  Management of Arterial Bleeding (Cont.) Apply direct and constant pressure with a sterile or clean dressing. make sure you are pressing on a point closer to the heart than the wound. Press down firmly on the artery between the bleeding site and the heart for 5 to 10 minutes. Elevate the wound above the heart Wrap ice in a clean, dry cloth and place it on the wound. Once bleeding is under control, use roller gauze to secure the dressing, beginning at the distal end and working towards the heart. You can twist the gauze to apply more pressure. If bleeding doesn’t stop with direct pressure or pressure dressings, call EMS and apply a tourniquet Management of Arterial Bleeding (Cont.) How to apply a tourniquet? 1. Place a pad on site of injury over the artery 2. Place the tourniquet between the injured vessel and the heart. 3. The tourniquet should be at least 5 cm (2 inches) above the wound. 4. Place windlass (stick, pen or a rod), then twist the elongated object until the tourniquet is tight around the injured limb and the bleeding stops. 5. Secure the windlass by tying one or both of its ends to the injured person's arm or leg. 6. Once tightened, don't loosen the tourniquet 7. You need to note what time you put the tourniquet on. Tourniquets cannot be applied for longer than 2 hours.  Management of Arterial Bleeding (Cont.) How to apply a tourniquet? What is a dressing? A dressing is a protective covering applied to a wound to: 1- Prevent infection 2- Absorb wound discharge 3- Control bleeding 4- Avoid further injury 5- Reduce pain A dressing should be large enough to totally cover the wound, with a safety margin of about 2.5 cm on all sides beyond the wound. Use a sterile low-adherent pad, which will not stick to the wound, but will absorb the blood coming from it What is a bandage and what are uses? A bandage is used in combination with a dressing where a wound is present. Bandages are used for: Hold a dressing in place over a wound Support a splint Immobilize a wounded body part Compress a soft tissue injury Management of Piercing Foreign Object in a Wound Apply a bandage around the wound and apply pressure around the foreign object and control bleeding by placing bulky dressings around the object Don't try to remove the object to avoid further harm. removal of the object may result in massive blood loss from an injured blood vessel. Seek prompt medical help for a foreign object that seems to be deeply embedded in the skin, muscle or pinch off a blood vessel. II- Internal Bleeding Bleeding inside the body that is not seen from the outside it may go unnoticed initially. (blood loss within the body) Although the blood is not lost from the body, it is lost from the circulatory system and vital organs will be deprived of oxygen. Internal bleeding might be mild or severe II- Internal Bleeding (Cont.) Internal bleeding might be : Mild like a bruises (or contusions) that are blue patches that appear on the skin when capillaries and the small veins break or burst underneath. Severe and not evident for many hours after it begins. Symptoms occur when there is significant blood loss or if a blood clot is large enough to compress an organ and prevent it from functioning properly.  II- Internal Bleeding (Cont.) Causes of internal bleeding: Trauma: including car accidents, falls, and dropping a heavy object on the person can damage any organ, blood vessels causing internal bleeding. Chronic high blood pressure: high BP weakens blood vessel walls. Inherited bleeding disorders: hemophilia and absence of any clotting factors. Certain medications: like blood thinners, can prevent clotting and lead to severe bleeding in mild injury or accident. Some over-the-counter medications, including aspirin, can damage the lining of your stomach. Weak blood vessel walls: can form aneurysm that can rupture and bleed. Lifestyle factors: like consuming alcohol and smoking Broken bones: breaking larger bones, such as the femur, can cause significant internal bleeding. Ectopic pregnancy: a condition that can be life-threatening. Surgery: before a surgeon completes an operation, he make sure all the bleeding has stopped. If he misses something, bleeding may continue even after the incision is closed. Internal Bleeding (cont.) Symptoms of Internal Bleeding:  pale, cool, clammy (sweaty moist) skin  chest pain and shortness of breath  severe pain at the injured site (abdomen)  swollen, tight abdomen  nausea and vomiting  extreme thirst  severe weakness  acute visual problems  severe headache  unconsciousness Internal Bleeding (cont.) First Aid of Internal Bleeding There is little a first aider can do for internal bleeding other than seek medical attention. Call for emergency medical help Whilst waiting for the ambulance to arrive, follow the general guidelines Let the person to lay down Raise the legs of the victim above the level of the heart and not giving them anything to eat or drink Maintain normal body temperature Monitor the vital signs Treat any injuries found Provide reassurance to the victim Nosebleeds (Epistaxis) Is bleeding from the nose, it is usually not severe First aid suggestions include: Sit the person upright and ask him to tilt his head forward. Using the thumb and forefinger, to squeeze the nostrils shut. Hold for at least 10 minutes (10 to 20 minutes). Release the hold gently and check for bleeding. If the bleeding has stopped, advise the subject to avoid blowing his nose or picking at it for the rest of the day. If the bleeding continues beyond 20 minutes, seek medical aid. If the nose bleed occurs again, seek medical aid.  Amputation There are 2 types of amputation: - Traumatic - Surgical Traumatic amputation is the loss of a body part, usually a finger, toe, arm, or leg, that occurs as the result of an accident or injury. Aim of prompt first aid: 1. limits blood loss 2. prevents shock 3. increases the victim's chance for a successful reimplantation Recover the amputated body part, if possible, and transport it to the hospital with the injured person.  First Aid Treatment for Traumatic Amputation 1. Control blood loss by applying direct pressure, place a sterile dressing pad on the wound, and secure it with a bandage. 2. Have the injured person lie down, if possible. 3. Elevate the injured area part above his heart 4. Check and treat the patient in case of shock 5. Call local emergency services, tell them amputation is involved. 6. Monitor and record vital signs: level of response, breathing and pulse while waiting for help to arrive. 7. Use a tourniquet or compression bandage only if bleeding is severe and not stopped with direct pressure. 8. Save the amputated part How to save the amputated part? Gently rinse off dirt and debris with clean water, if possible, do not scrub. Wrap the amputated part in a dry, sterile gauze or clean cloth. Place the gauze-wrapped part in a watertight plastic bag and seal the bag, then place it in a container full of crushed ice (no direct contact with ice). Mark the container with the time of injury and the casualty’s name. Give it to the emergency personnel yourself. Amputation (Cont.) Important Notes: DO NOT put the body part directly in water or ice without using a plastic bag. (When skin becomes water logged, this is actually the onset of that tissue breaking down and will make reattachment more difficult). Don't let the body part get wet or freeze from the ice. The goal is to keep the amputated part cool but not to cause more damage from the cold ice. DO NOT allow the casualty to eat or drink because an anesthetic may be needed. Ensure the amputated body part goes to hospital with the casualty. How long can an amputated body part survive? A severed finger can survive for at least 12 hours in a warm environment and up to a couple of days if refrigerated.  Shock Shock is a critical condition brought on by the sudden drop in blood flow through the body Lack of blood flow means the cells and organs do not get enough oxygen and nutrients to function properly. Many organs can be damaged as a result NB: Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 to 6 minutes later. The main types of shock include: Cardiogenic shock due to heart problems Hypovolemic shock severe fluid loss makes it impossible for the heart to pump a sufficient amount of blood, (as in severe bleeding or hemorrhage , burns or vomiting & diarrhea) Anaphylactic shock: caused by allergic reaction ( generalized vasodilation due to histamine release) Septic shock due to infections (hypoxia & vasodilation) Neurogenic shock caused by damage to the nervous system (e.g.: spinal injury, sympathetic NS looses its ability to produce the sympathetic tone severe vasodilation) Poisoning Signs and symptoms of shock According to the cause the signs and symptoms may include: Pale, cool, clammy or sweaty moist skin Bluish lips and fingernails Chest pain Rapid shallow breathing Rapid but weak pulse (tachycardia) Excessive thirst and oliguria (low or no urine output) Anxiety or agitation/restlessness Drowsiness, confusion and irritability Dizziness, lightheadedness, or faintness Being unconscious (unresponsive) First Aid Measure in Shock If you suspect a person is in shock, call (EMS) the local emergency number. Then immediately take the following steps: Lay the person flat on his back with the legs and feet elevated approximately 8–12 inches, unless you think this may cause pain or further injury (shock position). Keep the person still and don't move him or her unless necessary. Begin CPR if the person shows no signs of life, such as not breathing, coughing or moving. Loosen any tight clothing around the neck, chest, and waist to make sure it doesn’t constrict their blood flow. Cover the person with a blanket to prevent chilling. Don't let the person eat or drink anything. If the person vomits or begins bleeding from the mouth, and no spinal injury is suspected, turn him or her onto a side to prevent choking. Treat the cause of shock Shock Position Treatment of shock References https://www.firstaidforfree.com/what-are-the-three- types-of-bleeding/ https://www.medicinenet.com/script/main/art.asp?a rticlekey=101070 https://www.mayoclinic.org/first-aid/first-aid-severe- bleeding/basics/art-20056661 https://www.nursingcenter.com/journalarticle?Article _ID=638064&Journal_ID=54016&Issue_ID=637999 https://stjohnwales.org.uk/first-aid-advice/first-aid- for-amputation/ https://www.mayoclinic.org/first-aid/first-aid- shock/basics/art-20056620#