L3 Wounds and Bleeding v3 April 2021.pdf

Support the emergency care of wounds, bleeding and burns Component 7 Wounds and Bleeding © Department of Clinical Education & 1 Standards  Wounds & Bleeding - Component 7 Objectives  Be able to iden...

Support the emergency care of wounds, bleeding and burns Component 7 Wounds and Bleeding © Department of Clinical Education & 1 Standards  Wounds & Bleeding - Component 7 Objectives  Be able to identify different types of wounds, how they are caused and what underlying structures may be affected.  Be able to manage each type of wound and bleeding in line with current standards.  Be able to identify the different types of bleeding and how to manage them. © Department of Clinical Education & 2 Standards  Wounds & Bleeding - Component 7 A wound is the break in the continuity of a body tissue due to an external action. A closed wound causes soft tissues beneath the surface of the skin to be damaged. There is no break in the surface of the skin - Bruise An open wound is a break in the surface of the skin or mucous membrane making it exposed to infection - Cut © Department of Clinical Education & 3 Standards Wounds & Bleeding - Component 7 © Department of Clinical Education & 4 Standards  Wounds & Bleeding - Component 7 Categories Contusion (Bruises) Abrasion (grazes) Lacerations (tear) Incision (cut) Puncture (stab) Burn Gunshot © Department of Clinical Education & 5 Standards  Wounds & Bleeding - Component 7 Complications Haemorrhage (external and internal) Damage to underlying structures (bones, organs, blood vessels) Infection Foreign body © Department of Clinical Education & 6 Standards  Wounds & Bleeding - Component 7 Treatment DABCDE History Clean and dress the wound if able © Department of Clinical Education & 7 Standards  Wounds & Bleeding - Component 7 Management Foreign object in wound. If possible, wash out small objects with water Larger object not easily removed, should be left in situ and a non adhesive sterile dressing applied Larger objects i.e. knives etc. should be left in place and secured as best as possible to avoid movement. © Department of Clinical Education & 8 Standards Wounds & Bleeding - Component 7 Bleeding © Department of Clinical Education & 9 Standards  Wounds & Bleeding - Component 7 Bleeding is the loss of blood from a damaged blood vessel. It is also called haemorrhage. It is classified by whether it is internal or external , or by the type of vessel involved. © Department of Clinical Education & 10 Standards  Wounds & Bleeding - Component 7 Types: External Internal Arterial Venous Capillary © Department of Clinical Education & 11 Standards  Wounds & Bleeding - Component 7 Management Appropriate PPE Infection control procedures Follow primary survey algorithm Arrest catastrophic haemorrhage using field dressings and direct pressure Once Airway and breathing have been assessed and any life threatening issues corrected Re assess for catastrophic bleeding © Department of Clinical Education & 12 Standards  Wounds & Bleeding - Component 7 Management Assess for pulses – noting rate, rhythm and volume Assess capillary refill time and skin colour, texture and temperature Remain alert for potential of internal bleeding Blood on the floor and four more © Department of Clinical Education & 13 Standards  Wounds & Bleeding - Component 7 Management 1. External ‘on the floor’ plus 2. Chest 3. Abdomen– palpation and looking for bruising 4. Pelvis – do not manipulate – by MOI only 5. Long bones – assess but do not distracted by them © Department of Clinical Education & 14 Standards  Wounds & Bleeding - Component 7 Management Recognise the need for advanced clinical Interventions early Re Assess the patient at all times to detect any changes. © Department of Clinical Education & 15 Standards  Wounds & Bleeding - Component 7 Dressings Plasters Sterile Adherent Dressing Pads Low Adherent Dressing Pads No2 Ambulance Dressing Conforming Retention Bandages Elastic Adhesive Bandage Olaes Modular Dressing Blast Dressing © Department of Clinical Education & 16 Standards  Wounds & Bleeding - Component 7 Combat Application Tourniquet Introduced for use as during the London bombings, staff used improvised tourniquets. Kept in the primary response bag and triage kits. To be placed as low as possible proximal to the bleeding point Can be placed over two bones, i.e tibula and fibula © Department of Clinical Education & 17 Standards  Wounds & Bleeding - Component 7 Assessing Blood Loss Blood loss is very difficult to ascertain and is often under or over estimated by medical staff Always assess for signs and symptoms of shock Continually re-assess © Department of Clinical Education & 18 Standards  Wounds & Bleeding - Component 7 To Assess, Consider Blood Lost: In body tissues (swelling) On floor (absorption into surface?) In patient`s clothing In wound dressing © Department of Clinical Education & 19 Standards  Wounds & Bleeding - Component 7 Blood Loss 30 ml 60ml © Department of Clinical Education & 20 Standards  Wounds & Bleeding - Component 7 Blood Loss 100 ml 250ml © Department of Clinical Education & 21 Standards  Wounds & Bleeding - Component 7 Blood Loss 500 ml 1000ml © Department of Clinical Education & 22 Standards  Wounds & Bleeding - Component 7 Blood Loss 1500ml © Department of Clinical Education & 23 Standards  Wounds & Bleeding - Component 7 Internal blood Loss due to fractures (#) © Department of Clinical Education & 24 Standards Wounds & Bleeding - Component 7 Blood Loss in an open fracture Open fractures can = TWICE the loss of closed fractures!! © Department of Clinical Education & 25 Standards  Wounds & Bleeding - Component 7 Factors affecting blood loss Depth, type, size and position of the wound Size and type of blood vessel Duration of bleeding Age and size of patient Underlying injuries © Department of Clinical Education & 26 Standards  Wounds & Bleeding - Component 7 Indications of severity of blood loss Pulse rate increases - weakens with deterioration Respiration rate increases - air hunger develops Pupils become dilated with deterioration Skin pallor, ashen, cold extremities, cyanosis develops B.P. least sensitive - a very late but dramatic sign © Department of Clinical Education & 27 Standards  Wounds & Bleeding - Component 7 Any Questions? © Department of Clinical Education & 28 Standards