control of bleeding and first aid

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Control of bleeding and first aid in trauma


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Dr. Lakesh Kumar Anand MD, FIMSA, FCCP, MNAMS Associate Professor Department of Anaesthesia and Intensive Care Government Medical College & Hospital, Chandigarh FIRST AID CONTROL OF BLEEDING

Basic First Aid:

Basic First Aid The immediate care given to an injured or suddenly ill person. DOES NOT take the place of proper medical treatment. Legal consideration Implied Consent involves an unresponsive victim in a life-threatening condition. It is assumed or “ implied ” that an unresponsive victim would consent to lifesaving help. Only perform First Aid assistance for which you have been trained.

Control of bleeding :

Control of bleeding Regardless how severe, all bleeding can be controlled. If left uncontrolled, bleeding may lead to shock or even death. Most bleeding can be stopped before the ambulance arrives at the scene. While you're performing the steps for controlling bleeding, you should also be calling for an ambulance to respond. Bleeding  is the predominant cause of preventable post-injury deaths


Blood Total blood volume= 5-6 LITRES Infants <1 years =80 ml/kg bw Adults (Men)= 75ml/kg bw, Women=65 ml/kg bw Contents =Cells 1/3(RBC,WBC, Platelets) and Plasma (2/3) RBC = 4.5 –5.5 million/cumm blood Hb- 12-14gm% (F), 13-15 gm%(M) Normal life span of RBC =120 days, Anemia = Decrease in Hb or number of RBC


Platelets =1.5 – 4.5 lakhs/cmm bld. Critical Count = 40,000/cmm, Life span=7-14 days Platelets and coagulation factors helps in clotting of blood. Bleeding time= 4-7min. Clotting time= 5-10 min. Function of Blood Transport O 2 and nutrients to the cells Removes CO 2 and other waste products Detoxification and elimination of waste

How does body control bleeding?:

How does body control bleeding? Blood vessels when torn → Constriction of damaged ends Minimize blood loss Blood escapes from damaged vessels Clotting factors (1-13) + Platelets (At site of injury) (Complement system) ↓ CLOT Plugging of wound (10 Minutes) ↓ Finally bleeding is stop

Wound/ ‘GHAAV’:

Wound/ ‘GHAAV’ Any abnormal break in the skin /body surfaces OPEN or CLOSED TYPES Incised Wound - Clean cut from sharp edge Laceration- rough tear by crushing or ripping forces Abrasion- Superficial wound in top layers of skin. Contusion (Bruise) =Rupture of capillaries beneath skin Puncture Wound = Standing on nail, stab wound, etc . Gunshot Wound = Bullet/missile TISSUE DAMAGE→ GERMS, INFECTION

Types of bleeding:

Types of bleeding Arterial Bleed Blood, Richly Oxygenated, Bright Red Under pressure from pumping heart Goes right upwards / empties circulation Venous Bleed Dark red, Less pressure, Normally goes down Major vein gush profusely Capillary Bleed Oozing, All wounds, Negligible blood loss.


Bleeding/haemorrhage External -Revealed outside, e.g. Trauma etc. Internal - Concealed, Bleeding /gastric ulcer, inside the body cavity, Fracture of major bones Primary- At time of injury (Acute tear) Reactionary- Within 24 hours of injury Secondary- Usually after 7-14 days of injury Cause-Clot dislodgement Due to inc. BP, coughing/vomiting Haemorrhoid (piles), Haemetemesis


AIMS Control of bleeding Prevention of shock Minimize infection Take the casualty to hospital Wound care Wash hand Take “Universal precaution “

Control Methods For External Bleeding::

Control Methods For External Bleeding: Direct pressure stops most bleeding Wear gloves (if possible) Place a sterile gauze pad or a clean cloth over wound Elevate injured part to help reduce blood flow. Combine with direct pressure over the wound, will stop the bleeding If bleeding continues, apply pressure at a pressure point to slow blood flow. Pressure point are arteries: can be compressed against bone Brachial (Top of elbow), Femoral (Inside upper thigh) Apply tourniquet if continues to bleed

Bleeding from special sites:

Bleeding from special sites Scalp, Rich blood supply, profuse bleeding Ear Allow blood to drain away, No plugging of ear Nose Pinch just below nasal bridge for 10 min Mouth and tooth socket. Pad of gauze between the teeth ---prevents meeting of jaws and bite

Bleeding from special sites:

Bleeding from special sites Penetrating/ blunt chest injuries Injury to lungs/pleura/ Heart Check for breathing and consciousness Seal the wound from three sides and maintain breathing Penetrating/ blunt Abdominal injuries Large wound, External bleeding/Internal Protruding / Puncturing abdominal contents Injury by Stab/Gunshot/ Blunt trauma/Punches

Abdominal and pelvic trauma:

Abdominal and pelvic trauma

Crush injuries of the limbs and fractures :

Crush injuries of the limbs and fractures Closed (Simple) fracture The skin is intact and no wound exists anywhere near the fracture site. Open (Compound) fracture Skin over the fracture has been damaged or broken. Wound may result from bone protruding through the skin. Bone may not always be visible in the wound. Tenderness , pain, swelling, deformity, loss of use. Do not move the injured limb

Immobilized the extremity with body, other limb, or splint :

Immobilized the extremity with body, other limb, or splint

Shock :

Shock Inadequate tissue perfusion, as the result of: Loss of blood due to uncontrolled bleeding or other circulatory system problem. Trauma (injury) Loss of fluid due to dehydration or excessive sweating. Occurrence of an extreme emotional event. What to Look For Altered mental status, Anxiety and restlessness Pale, cold, and clammy skin, lips, and nail beds Nausea and vomiting Rapid breathing and pulse Unresponsiveness when shock is severe

SHOCK cont.:

SHOCK cont. Class % Blood Loss Clinical Signs I Up to 750 ml (15%) Slight increase in HR; no change in BP or respirations II 750-1500 ml (15-30%) Increased HR and respirations; increased diastolic BP; anxiety, fright or hostility III 1500-2000 ml (30-40%) Increased HR and respirations; fall in systolic BP; significant AMS IV >2000 (>40%) Severe tachycardia; severe lowering of BP; cold, pale skin; severe AMS

Control Methods For Internal Bleeding::

Control Methods For Internal Bleeding : Signs of internal bleeding: Bruises or contusions of the skin Painful, tender, rigid, bruised abdomen Vomiting or coughing up blood Stools that are black or contain bright red blood What to Do: (For severe internal bleeding) Monitor ABC’s (Airway Breathing Circulation) Keep the victim lying on his/her left side. Treat for shock by raising the victim’s legs 8” – 12” Seek immediate medical attention

Dressings and Bandages:

Dressings and Bandages The purpose of a dressing is to: Control bleeding Prevent infection and contamination Absorb blood and fluid drainage Protect the wound from further injury What to Do: Always wear gloves (if possible) Use a dressing large enough to extend beyond the wound’s edges. Cover the dressing with bandages.

Dressings and Bandages cont.:

Dressings and Bandages cont. Bandage can be used to: Hold a dressing in place over an open wound Apply direct pressure over a dressing to control bleeding Prevent or reduce swelling Provide support and stability for an extremity or joint Bandage should be clean but need not be sterile.

Eye injury:

Eye injury Injury -Cut/bruise/direct blow by sharp /chipped fragments of metal /grit/glass Potentially serious, Rupture of eyeball AIM - Prevent further damage, DO NOT ATTEMPT TO REMOVE FOREIGN BODY Lay the casualty on his back Avoid eye movements /No rubbing/ Bandage both eyes Take to hospital

Burn (Thermal):

Burn (Thermal) Flames, Hot objects, Flammable vapor, Steam or hot liquid First-degree burns (Superficial) Second-degree burns (Partial Thickness) Stop the burning, Remove victim from burn source Immerse in cold water immediately 10 to 45 minutes or use cold, wet cloths. Cold stops burn progression Decreased the severity of injury Do not break blisters

Burn :

Burn Third-degree burns (Full Thickness) Usually not necessary to apply cold to areas of third degree Do not apply ointments Apply sterile, non-stick dressings Get medical help Chemical burns Acids (batteries), Alkalis (drain cleaners- often more extensive), Organic compounds (oil products) Remove the chemical by flushing the area with water Electrical burn A mild electrical shock can cause serious internal injuries

Bites and Stings:

Bites and Stings Insect stings and bites Check the sting site to see if a stinger and venom sac Bees are the only insects that leave their stingers and venom sacs Scrape the stinger and venom sac away with a hard object such as a long fingernail, credit card, scissor edge, or knife blade. Reactions generally localized pain, itching, and swelling. Wash the sting site with soap and water to prevent infection. Apply an ice pack over the sting site to slow absorption of the venom and relieve pain. Because bee venom is acidic, a paste made of baking soda and water can help.

Snake bite :

Snake bite Cobras, common krait, Russell's viper, E. carinatus and sea snakes, are common species of snake in India A. General guideline Minimize movement, especially affected part. Keep the affected area below heart level. Wash the area with soap and water. Seek immediate medical assistance. Don't apply a tourniquet or ice. Don't make any local cut around the bite. Don't suck out the venom by mouth. B. Specific management by ASV in hospital

Blood groups (ABO Rh system):

Blood groups (ABO Rh system) Blood Group Antigen on RBC Antibody in plasma A A Anti-B B B Anti-A AB A&B Nil (o) O Nil Anti-A& Anti-B Blood group O = universal donor Blood group AB =universal recipient

Donor who can donate blood:

Donor who can donate blood Good health Age = 18-60 years Weight >35 kg Sex -- male/female Light meals before donation Hb/haematocrit >12 .5gm%/>38% BP systolic-100-160 mmhg/diastolic 60-100 mmhg Pulse rate- 60-90 beats/min. Temperature not more than 37.0 o c/98.6 o f Rule out chest, CVS, and abdominal abnormalities 3 months after Ist transfusion

Blood donation criteria for donor selection:

Blood donation criteria for donor selection Donor deferral— permanent deferral History of AIDS, IV drug addiction, STD, H/o prolong fever, unexplained wt. Loss, severe allergy, bleeding disorder, HTN, MI, Angina, Chr.Liver disease, Malignancy, Diabetes, Epilepsy, Kidney diseases, active TB

Donor deferral—temporary period of deferral:

Donor deferral — temporary period of deferral Accident 6 months Abortion 6 months Alcoholism 24 hours after intake Allergy till symptoms disappear Anaemia till treated Blood donation 3months Blood transfusion 6 months Common cold till symptom free Drug intake 1 week after stoppage

Donor deferral—temporary period of deferral cont.:

Donor deferral — temporary period of deferral cont. Fracture 6 months Hepatitis 12 months after recovery Lactation 6 months Malaria 3 months Pregnancy 12 months Surgery-major 6 months Minor 3 months Tuberculosis(TB) 2 yr after full treatment

First aid kit bag (Components ):

First aid kit bag (Components ) Blood bank phone no. Cotton roll Savlon Betadine cream/powder Tourniquet I.V. Cannula Bandage Antibiotic spray/cream Pain killer spray Bandaid Haemaccel, ringer lactate Microtape, scissors Washed cloth Blood transfusion set Air splints, Medical antishock trousers



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Slide 37:

Everybody must see this

Slide 38:

38 Right Ventricle Left Ventricle Right Atrium Left Atrium

Determining the need for transfer:

Determining the need for transfer

Calling the EMS :

Calling the EMS Dial the correct number Following information must be provided Location of place with land mark Scenario with brief history Specific brief information Number of causalities Do not cut the call / put the phone off until the responder understood the massage

SHOCK Inadequate tissue perfusion:

SHOCK Inadequate tissue perfusion

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