Bleeding And Wounds For Clifton Pd

Bleeding and woundsBleeding and wounds

Dan Olesnicky, MDDan Olesnicky, MD

Tactical PhysicianTactical Physician

Basic TraumaBasic Trauma

First thing firstFirst thing first

►Remember ABCRemember ABC►AirwayAirway

If you stop moving air, nothing else matters.If you stop moving air, nothing else matters.

►Breathing Breathing Stop breathing and it does not matter how Stop breathing and it does not matter how

much you bleed. You still die very quickly.much you bleed. You still die very quickly.

►CirculationCirculation You need blood and a functioning heart for You need blood and a functioning heart for

this.this.

Management of bleedingManagement of bleeding

► Stop the bleeding Stop the bleeding and protect the and protect the wound.wound. If you remember this, If you remember this,

that’s pretty much all that’s pretty much all you need to know.you need to know.

► You may be called You may be called upon your skills for upon your skills for yourself or anyone yourself or anyone else.else.

Stop, Think, then Do!Stop, Think, then Do!

► Remember to keep Remember to keep your cool!your cool!

►Medical injuries can Medical injuries can be really ugly looking.be really ugly looking.

► Even the worst Even the worst looking injuries can be looking injuries can be survived.survived.

►Don’t let the patient Don’t let the patient see you lose your see you lose your cool.cool.

Bleeding and shockBleeding and shock

► ShockShock Inadequate perfusion Inadequate perfusion

(blood flow) leading (blood flow) leading to inadequate oxygen to inadequate oxygen delivery to tissuesdelivery to tissues

►Most common Most common cause of shock in cause of shock in the tactical the tactical environment is environment is BLEEDING!BLEEDING!

PerfusionPerfusion

►Basic unit of life = cellBasic unit of life = cell►Cells get energy needed to stay alive Cells get energy needed to stay alive

by reacting oxygen with fuel (usually by reacting oxygen with fuel (usually glucose)glucose)

►No oxygen, no energyNo oxygen, no energy►No energy, no lifeNo energy, no life

PerfusionPerfusion

► Cardiovascular Cardiovascular SystemSystem Transports oxygen, fuel Transports oxygen, fuel

to cellsto cells Removes carbon dioxide, Removes carbon dioxide,

waste products for waste products for elimination from bodyelimination from body

Cardiovascular system must be able to maintain sufficient flow through

capillary beds to meet cell’s oxygen and fuel needs

Flow = Perfusion

Adequate Flow = Adequate Perfusion

Inadequate Flow = Indequate Perfusion

(Hypoperfusion)

Hypoperfusion = Shock

Basic PlumbingBasic Plumbing

► PumpPump► PipesPipes► Fluid Fluid ► Any interruption Any interruption

leads to low blood leads to low blood flow (hypoperfusion) flow (hypoperfusion) and shock.and shock.

Heart

Blood VesselsBlood

BleedingBleeding

► Bleeding (hemorrhage) is the escape of Bleeding (hemorrhage) is the escape of blood from capillaries, veins, and arteries. blood from capillaries, veins, and arteries.

► CapillariesCapillaries are very small blood vessels are very small blood vessels that carry blood to all parts of the body. that carry blood to all parts of the body.

►VeinsVeins are blood vessels that carry blood to are blood vessels that carry blood to the heart. the heart.

►ArteriesArteries are large blood vessels that carry are large blood vessels that carry blood away from the heart. blood away from the heart.

► Bleeding can occur inside the body Bleeding can occur inside the body (internal), outside the body (external) or (internal), outside the body (external) or both. both.

BleedingBleeding

►There are three types of bleeding. There are three types of bleeding. Capillary bleeding is slow, the blood Capillary bleeding is slow, the blood

"oozes" from the (wound) cut. "oozes" from the (wound) cut. Venous bleeding is dark red or maroon, the Venous bleeding is dark red or maroon, the

blood flows in a steady stream. blood flows in a steady stream. Arterial bleeding is bright red, the blood Arterial bleeding is bright red, the blood

"spurts" from the wound. "spurts" from the wound.

►Arterial bleeding is life threatening Arterial bleeding is life threatening and difficult to control.and difficult to control.

Small woundsSmall wounds

► In small wounds, only the capillaries are In small wounds, only the capillaries are damaged. damaged.

►Deeper wounds result in damage to the Deeper wounds result in damage to the veins and arteries. veins and arteries.

►Damage to the capillaries is usually not Damage to the capillaries is usually not serious and can easily be controlled serious and can easily be controlled with a Band-Aid. with a Band-Aid.

►Damage to the veins and arteries are Damage to the veins and arteries are more serious and can be life more serious and can be life threatening. threatening.

Larger WoundsLarger Wounds

► The adult body contains approximately 5 to 6 The adult body contains approximately 5 to 6 quarts of blood (10 to 12 pints). quarts of blood (10 to 12 pints).

► The body can normally lose 1 pint of blood The body can normally lose 1 pint of blood (usual amount given by donors) without (usual amount given by donors) without harmful effects. harmful effects.

► A loss of 2 pints may cause shock, a loss of 5 to A loss of 2 pints may cause shock, a loss of 5 to 6 pints usually results in death. 6 pints usually results in death.

►During certain situations it will be difficult to During certain situations it will be difficult to decide whether the bleeding is arterial or decide whether the bleeding is arterial or venous. The distinction is not important. venous. The distinction is not important.

► The most important thing to remember is that The most important thing to remember is that all bleeding must be controlled as soon as all bleeding must be controlled as soon as possible. possible.

External WoundsExternal Wounds

►While administering first aid to a casualty While administering first aid to a casualty who is bleeding, you must remain calm. who is bleeding, you must remain calm.

► The sight of blood is an emotional event for The sight of blood is an emotional event for many, and it often appears severe. many, and it often appears severe.

►However, most bleeding is less severe than However, most bleeding is less severe than it appears. it appears.

►Most of the major arteries are deep and well Most of the major arteries are deep and well protected by tissue and bone. protected by tissue and bone.

► Although bleeding can be fatal, you will Although bleeding can be fatal, you will usually have enough time to think and act usually have enough time to think and act calmly. calmly.

Take ControlTake Control

►There are four methods to control There are four methods to control bleeding:bleeding: Direct pressureDirect pressure ElevationElevation Indirect pressureIndirect pressure Use of a tourniquet.Use of a tourniquet.

Direct pressureDirect pressure

►Direct pressure is the first and most Direct pressure is the first and most effective method to control bleeding. effective method to control bleeding.

► In many cases, bleeding can be controlled In many cases, bleeding can be controlled by applying pressure directly to the by applying pressure directly to the wound. wound.

►Direct pressure can be applied by the Direct pressure can be applied by the casualty or a bystander. casualty or a bystander.

►Under no circumstances is a dressing Under no circumstances is a dressing removed once it has been applied.removed once it has been applied.

Indirect pressureIndirect pressure

► In cases of severe bleeding when direct In cases of severe bleeding when direct pressure and elevation are not controlling pressure and elevation are not controlling the bleeding, indirect pressure must be the bleeding, indirect pressure must be used. used.

► Bleeding from an artery can be controlled by Bleeding from an artery can be controlled by applying pressure to the appropriate applying pressure to the appropriate pressure point. pressure point.

► Pressure points are areas of the body where Pressure points are areas of the body where the blood flow can be controlled by pressing the blood flow can be controlled by pressing the artery against an underlying bone. the artery against an underlying bone.

► Pressure is applied with the fingers, thumb, Pressure is applied with the fingers, thumb, or heel of the hand. or heel of the hand.

Signs of internal bleedingSigns of internal bleeding

► 1. Anxiety and restlessness. 1. Anxiety and restlessness. ► 2. Excessive thirst (polydipsia). 2. Excessive thirst (polydipsia). ► 3. Nausea and vomiting. 3. Nausea and vomiting. ► 4. Cool, moist, and pale skin (cold and 4. Cool, moist, and pale skin (cold and

clammy). clammy). ► 5. Rapid breathing (tachypnea). 5. Rapid breathing (tachypnea). ► 6. Rapid, weak pulse (tachycardia). 6. Rapid, weak pulse (tachycardia). ► 7. Bruising or discoloration at site of injury 7. Bruising or discoloration at site of injury

(contusion). (contusion).

Basic wound careBasic wound care

► In evaluating the casualty for location, type, In evaluating the casualty for location, type, and size of the wound or injury, cut or tear his and size of the wound or injury, cut or tear his clothing and carefully expose the entire area clothing and carefully expose the entire area of the wound. of the wound. This procedure is necessary to avoid further This procedure is necessary to avoid further

contamination. contamination. Clothing stuck to the wound should be left in place Clothing stuck to the wound should be left in place

to avoid further injury. to avoid further injury. DO NOTDO NOT touch the wound; keep it as clean as touch the wound; keep it as clean as

possible. possible. ►DO NOT REMOVEDO NOT REMOVE protective clothing in a protective clothing in a

chemical environment. chemical environment. Apply dressings Apply dressings overover the protective clothing. the protective clothing.

Basic Penetrating TraumaBasic Penetrating Trauma► Before applying the Before applying the

dressing, carefully dressing, carefully examine the casualty examine the casualty to determine if there is to determine if there is more than one wound. more than one wound.

► A missile may have A missile may have entered at one point entered at one point and exited at another and exited at another point. point.

► The The EXITEXIT wound is wound is usually usually LARGERLARGER than than the entrance wound. the entrance wound.

Basic Penetrating TraumaBasic Penetrating Trauma

►Casualty should be continually monitored for Casualty should be continually monitored for development of conditions which maydevelopment of conditions which mayrequire the performance of necessary basic require the performance of necessary basic lifesaving measures, such as clearing thelifesaving measures, such as clearing theairway and mouth-to-mouth resuscitation.airway and mouth-to-mouth resuscitation.

►All open (or penetrating) wounds should beAll open (or penetrating) wounds should bechecked for a point of entry and exit and checked for a point of entry and exit and treated accordingly. treated accordingly.

Basic Penetrating TraumaBasic Penetrating Trauma

Basic Penetrating TraumaBasic Penetrating Trauma► If the missile lodges in the body If the missile lodges in the body

(fails to exit), (fails to exit), DO NOTDO NOT attempt attempt to remove it or probeto remove it or probethe wound. the wound.

► Apply a dressing. Apply a dressing. ► If there is an object extending If there is an object extending

from (impaled in) the wound, from (impaled in) the wound, DO NOTDO NOT remove the object. remove the object.

► Apply a dressing around the Apply a dressing around the object and use additional object and use additional improvised bulky improvised bulky materials/dressings (use the materials/dressings (use the cleanest material available) tocleanest material available) tobuild up the area around the build up the area around the object. object.

► Apply a supporting bandage Apply a supporting bandage over the bulky materials to over the bulky materials to hold them in place. hold them in place.

Battlefield dressingBattlefield dressing

►DO NOT touch the DO NOT touch the white (sterile) side white (sterile) side of the dressing, and of the dressing, and DO NOT allow the DO NOT allow the whitewhite(sterile) side of the (sterile) side of the dressing to come in dressing to come in contact with any contact with any surface other than surface other than the wound. the wound.


►Hold the dressing Hold the dressing directly over the directly over the wound with the wound with the white side down. white side down.

► Pull the dressing Pull the dressing open and place it open and place it directly over the directly over the wound wound


► Hold the dressing in Hold the dressing in place with one hand. place with one hand.

► Use the other hand to Use the other hand to wrap one of the tails wrap one of the tails around the injured part, around the injured part, covering about one-half covering about one-half of the dressing. of the dressing.

► Leave enough of the Leave enough of the tail for a knot. tail for a knot.

► If the casualty is able, If the casualty is able, he may assist by he may assist by holding the dressing in holding the dressing in place. place.


► If bleeding continues If bleeding continues after applying the after applying the sterile field dressing, sterile field dressing, direct manual pressure direct manual pressure may be used to help may be used to help control bleeding. control bleeding.

► Apply such pressure by Apply such pressure by placing a hand on the placing a hand on the dressing and exerting dressing and exerting firm pressure for 5 to firm pressure for 5 to 10 minutes. 10 minutes.

► The casualty may be The casualty may be asked to do this himself asked to do this himself if he is conscious and if he is conscious and can follow instructions. can follow instructions.


► Elevate an injured limb Elevate an injured limb slightly above the level slightly above the level of the heart to reduce of the heart to reduce the bleeding.the bleeding.

► DO NOT elevate a DO NOT elevate a suspected fractured limb suspected fractured limb unless it has been unless it has been properly splinted. properly splinted.

► If the bleeding stops, If the bleeding stops, check and treat for check and treat for shock. shock.

► If the bleeding continues, If the bleeding continues, apply a pressure apply a pressure dressing.dressing.

Your Battlefield dressingYour Battlefield dressing

► The Israeli dressingThe Israeli dressing►One dressing does it One dressing does it

allall Simple dressingSimple dressing Pressure dressingPressure dressing TourniquetTourniquet

Your DressingYour Dressing

► The sterile, non-adherent The sterile, non-adherent padpad is placed on the is placed on the wound. wound.

► The application of direct pressure to the wound site The application of direct pressure to the wound site is achieved by wrapping the elasticized woven is achieved by wrapping the elasticized woven leaderleader over the topside of the bandage over the topside of the bandage padpad where where the specially designed the specially designed pressure barpressure bar is situated. is situated. The The pressure barpressure bar is designed to readily accept the is designed to readily accept the wrapping wrapping leaderleader. .

► After engagement of the After engagement of the pressure barpressure bar, wrapping , wrapping the the leaderleader in any direction around the limb or body in any direction around the limb or body part and onto the part and onto the pressure barpressure bar forces the forces the pressure barpressure bar down onto the down onto the padpad creating the creating the direct pressure needed to bring about homeostasis. direct pressure needed to bring about homeostasis.


► The The pressure barpressure bar, in addition to its primary , in addition to its primary function, facilitates bandaging. The elastic function, facilitates bandaging. The elastic bandage uses the rigid shape of the bandage uses the rigid shape of the pressure pressure barbar to change direction while bandaging, thus to change direction while bandaging, thus affording the caregiver more options for affording the caregiver more options for effective dressing of the wound. effective dressing of the wound.

► Subsequent wrappings of the Subsequent wrappings of the leaderleader secures secures and maintains the and maintains the padpad in place over the in place over the wound, and by covering all the edges of the wound, and by covering all the edges of the padpad acts as a sterile secondary dressing. The acts as a sterile secondary dressing. The bandage bandage leaderleader is woven wide and will not is woven wide and will not bunch up or twist itself into a rope. bunch up or twist itself into a rope.


►The closure system of the bandage is The closure system of the bandage is multi-functional yet simple, quick, and multi-functional yet simple, quick, and familiar. Situated at the end of the familiar. Situated at the end of the leaderleader is a closure bar (dowel with is a closure bar (dowel with hooking clips) at each end to secure hooking clips) at each end to secure the wrapping the wrapping leaderleader the same way the same way that a pen is secured in a shirt pocket. that a pen is secured in a shirt pocket. The The closure barclosure bar holds the bandage holds the bandage securely in place over the wound site. securely in place over the wound site.


► If additional pressure is required the If additional pressure is required the closure barclosure bar is easily removed from its is easily removed from its normal closure position and inserted normal closure position and inserted between previous layers of the between previous layers of the leaderleader directly above the protruding directly above the protruding pressure pressure barbar and rotated. This rotation acts to and rotated. This rotation acts to screw down the screw down the pressure barpressure bar onto the onto the wound to exert blood-staunching wound to exert blood-staunching pressure. The pressure. The closure barclosure bar is used as is used as before to secure the dressing before to secure the dressing


► Immediate and Immediate and effective direct effective direct pressure to the pressure to the wound may reduce wound may reduce the need for a the need for a tourniquet tourniquet applicationapplication. This is . This is an important benefit an important benefit as tourniquet as tourniquet applications are to be applications are to be avoided and used avoided and used only as a last resort. only as a last resort.

Thanks for your attention.Thanks for your attention.

Health & Medicine

Bleeding And Wounds For Clifton Pd