Unit 3 Lesson 2 Soft-Tissue Injuries and Bleeding PDF

Unit 3 Trauma-Related Medical Issues Lesson 2 Soft-Tissue Injuries and Bleeding Lesson Goal At the end of this lesson, you will learn about soft-tissue injuries and be able to provide emergency first aid for a patient with major or minor bleeding using basic tools such as dressings, bandag...

Unit 3 Trauma-Related Medical Issues Lesson 2 Soft-Tissue Injuries and Bleeding Lesson Goal At the end of this lesson, you will learn about soft-tissue injuries and be able to provide emergency first aid for a patient with major or minor bleeding using basic tools such as dressings, bandages, and tourniquets. Closed Soft-Tissue Injuries A closed soft-tissue injury is any injury that is bleeding internally or has pooling blood under the skin. There are two types of closed soft-tissue injuries: bruising—a closed, discolored injury that is somewhat flat, tender to the touch, and has an obvious discoloration (black and blue) at the injury site. Bruising occurs from leakage of blood under the skin from small blood vessels. swelling—a closed, discolored injury that is a raised, firm, and painful lump. Swelling occurs from larger leakage of blood under the skin from larger blood vessels. Closed soft-tissue injuries can be life threatening even though they may be lacking the obvious signs of open soft-tissue injuries, such as bleeding outside of the skin. Treatment for Closed Soft-Tissue Injuries ✅ HL232.1. Describe how to provide treatment for a closed soft-tissue injury To treat a patient for a closed soft-tissue injury: 1. Treat large bruising and swelling by applying a cold pack to the injury site. Minimal swell- ing normally does not require treatment but applying cold pack to the injury site helps reduce pain and swelling. 2. If you cannot assess the seriousness of a closed soft-tissue injury, treat the patient as if they have internal bleeding, and monitor for shock. Open Soft-Tissue Injuries An open soft-tissue injury is any injury where the skin is open, which may lead to external bleeding. 94 / Florida Basic Recruit Training Program (HL): Volume 2 ✅ HL232.2. Describe the different types of open soft-tissue injuries Types of open soft-tissue injuries include: amputation—removal or loss of a limb evisceration—a wound where the organs protrude outside the body puncture wound—wound caused by a sharp object that penetrates skin laceration—a cut in the skin abrasion—injury to the outer layer of skin from rubbing or scraping The most important first-aid responsibilities to a patient with an open soft-tissue injury are to control bleeding and prevent further contamination of the area. Bleeding In a previous lesson, the circulatory or cardiovascular system was mentioned as being responsible for delivering oxygen to the body’s tissues, among other functions. If the patient has severe bleeding or massive hemorrhage, their body tissues may not be receiving adequate oxygen exchange even if the patient is breathing. Therefore, it is important to identify and stop life-threatening bleeding as quickly as possible. ✅ HL232.3. Describe the three types of bleeding Understanding what type of bleeding the patient has will tell you how you can best stop the bleed- ing and keep the patient alive. arterial bleeding—bright red blood spurting or flowing from a wound, indicating a severed or damaged artery venous bleeding—dark red blood flowing steadily from a wound, indicating a severed or damaged vein capillary bleeding—dark red blood oozing slowly from a wound, indicating damaged capillaries Tools to Stop Bleeding No matter what tools you use, stopping bleeding involves applying some type of pressure to the injury site to stop or slow the flow of blood out of the body. ✅ HL232.4. Describe the main tools to stop bleeding of an open wound Use the following tools to control bleeding: tourniquet—a device that restricts the flow of blood to an extremity. Unlike the more common venous tourniquets used during blood collection, arterial tourniquets used to Chapter 2 First Aid for Criminal Justice Officers / 95  control life-threatening bleeding stop arterial flow. It works by creating a circumferential force around the limb which compresses the bleeding blood vessel against underlying bone. It works much the same way as simply holding direct pressure with fingers, but is more consistent in the force applied. dressings—(preferably) sterile pads applied directly to a wound to promote healing and protect the wound from further harm. Avoid touching or contaminating the side of the dressing that will come in direct contact with the wound. hemostatic gauze or dressing—a wound dressing containing an agent that promotes blood clotting. It encourages clotting at the injury site. bandages—coverings that hold dressings in place and do not touch the wound, usually made of gauze or other absorbent material. They can create pressure to help stop bleed- ing, support an injured extremity, and prevent the wound from further contamination and damage. Major, Life-Threatening Bleeding ✅ HL232.5. Describe the common signs of major, life-threatening external bleeding Some common signs of major, life-threatening external bleeding include: blood spurting out of the wound (arterial) volumes of blood that will not stop or is pooling on the ground clothing soaked with blood loss of all or part of an arm or leg (amputation) a patient who is bleeding and has an altered level of consciousness Determine if the bleeding is coming from an extremity (like an arm or leg), or from a junction (such as the neck, armpit, or groin area where an extremity meets the torso). If the bleeding is coming from a junction, pack the wound (ideally with a hemostatic dressing) and apply steady pressure until the bleeding stops according to manufacturer instructions. If the bleeding is coming from an extremity, use a tourniquet to control or stop the bleeding. Extremity Bleeding When a tourniquet is available, use a tourniquet as the preferred method to stop major, life- threatening bleeding from an extremity. If a tourniquet is not available, apply direct pressure or pack the wound to stop the bleeding. A person who has suffered a complete or partial amputation of a limb may not be bleeding severely when first discovered, but you should still apply a tourniquet. Lack of bleeding is due to the body’s normal defenses of contraction and spasm of the blood vessels. Bleeding will start when the blood vessels relax or if the clot knocks loose when moving the patient. 96 / Florida Basic Recruit Training Program (HL): Volume 2 Figure 2-17 Applying dressings and bandages Chapter 2 First Aid for Criminal Justice Officers / 97 ✅ HL232.6. Describe how to use a tourniquet to stop major bleeding from an extremity injury Refer to the tourniquet manufacturer for instructions on how to unpackage and prepare the tour- niquet in its recommended quick launch configuration. To apply a tourniquet to an extremity: 1. Recruit someone with a gloved hand, or the patient, to apply pressure while you are prepar- ing to apply the tourniquet. Be sure it is already looped through the tourniquet buckle. 2. Route the looped and preloaded tourniquet band around your non-dominant hand, about your wrist level. Then grasp the injured limb at the hand or foot with your non-dominant hand to off load it onto the injured limb with your dominant hand. 3. Position the tourniquet as high on the extremity as possible, “high and tight,” and at a right angle to the extremity.  Do not apply the tourniquet over a solid object within the clothing, such as a pen, phone, wallet, or set of keys that may be in a pocket.  Do not apply the tourniquet on a joint, such as a knee, ankle, elbow, or wrist, or a junctional site. 4. Pull the band tightly and fasten it back on itself. 5. Twist the windlass until bleeding has stopped. 6. Secure the windlass to lock it in place. 7. Look at the injury site, check for bleeding, and assess for circulation below the tourni- quet of the injured extremity. All bleeding should have stopped and there should not be a pulse below the injury. 8. Secure the TIME strap and record the time of application on the strap, write the time on the patient’s forehead, or radio dispatch to record the time of the tourniquet application. 9. Mark the patient on the forehead by writing a “T” to alert medical personnel that the patient is wearing a tourniquet. 10. If in a warm or cold zone and if time and equipment permit, dress and bandage the wound. Once the tourniquet is in place, do not remove or loosen it. Only medical personnel should remove or loosen a tourniquet. In some cases, you may need to apply a second tourniquet, which you will apply directly adjacent to the first tourniquet. 98 / Florida Basic Recruit Training Program (HL): Volume 2 Figure 2-18 Applying a tourniquet Chapter 2 First Aid for Criminal Justice Officers / 99 Junctional Bleeding Junctional bleeding occurs at a junction of the torso to the extremities, such as neck, armpit, or groin areas. Traditional tourniquets are not effective in stopping bleeding at junctional sites. A later lesson on spinal, head, and neck injuries will discuss controlling bleeding for penetrating neck injuries. ✅ HL232.7. Describe how to stop major bleeding from a junctional injury To stop bleeding at a junctional site: 1. Recruit someone with a gloved hand, or the patient, to apply pressure while you are preparing to provide emergency first aid. 2. Packing the wound with hemostatic gauze is the recommended treatment. If not avail- able, use standard gauze or clean cloth. 3. Place any excess gauze directly over the wound and apply direct pressure according to manufacturer recommendations if using hemostatic gauze, and for three to five minutes if using standard gauze or a clean cloth. Constantly reassess for bleeding.  If bleeding is better controlled but still present, leave old gauze in place and pack new gauze around it. If bleeding is as quick as before, remove and repack.  If you do not have additional hemostatic gauze, do not remove the saturated hemo- static gauze but leave it in place and apply a layer of bulky dressing.  If using standard gauze and the first layer of gauze does not stop the bleeding, do not remove it, but apply additional layers as needed while applying pressure. 4. Once you stop the bleeding, apply a pressure bandage to secure the gauze to the wound. Minor Bleeding ✅ HL232.8. Describe how to treat an injury with minor bleeding Provide emergency first aid to injuries with minor bleeding when the care environment is safe from threats. To treat an injury with minor bleeding: 1. Recruit someone with a gloved hand, or the patient, to apply pressure while you are preparing to provide emergency first aid. 2. Cover the wound with a clean dressing. 3. Apply direct pressure until bleeding stops. If the first layer of dressing (standard gauze) does not stop the bleeding, do not remove it, but apply additional layers as needed while applying pressure. 4. Apply a bandage to secure the dressing once the bleeding stops. 100 / Florida Basic Recruit Training Program (HL): Volume 2