Download Unit 5 Wounds and Bleeding

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Occupational First Aid. Fetac Level 5
Unit 5 Wounds and Bleeding
Learners should be able to:
5.1 List the components of the circulatory system
In its most basic form, the circulatory system is a simple loop which starts, and ends, at the
heart. It is also a closed system in the sense that blood does not enter or leave the system
during its journey from the heart, to the body, and back again. In such a system, a continuous
flow of the same liquid can be pumped through the loop again and again.
The circulatory system is comprised of five main parts:
1.
2.
3.
4.
5.
The Heart
Arteries
Arterioles
Capillaries
Veins
Each of the components has a specific job to do in order for the circulatory system to function
properly.
Circulation Begins in the Heart:
By convention, the circulatory system can be thought of as beginning in the right atrium, this
is the upper right-hand chamber. As blood moves through the heart, it passes through each of
the four chambers (upper right, lower right, upper left, lower left), takes a quick detour to the
lungs (to get rid of carbon dioxide and pick up oxygen) and ends up in the lower left-hand
chamber, called the left ventricle.
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Left Ventricle:
In the context of pushing blood out to the body and through the circulatory system, the left
ventricle is the most important chamber in the heart. It is the largest of the four chambers, and
is responsible for generating the force necessary to propel the blood out into the aorta, which
is the first artery that blood enters as it leaves the heart.
Regulation:
Blood travels from the aorta through a series of smaller and smaller blood vessels until it
reaches the capillaries. Before reaching the capillaries, however, blood must travel through
the arterioles, where its speed and pressure are constantly adjusted as different segments of
the arterioles change diameter in response to pressure and chemical sensors positioned
nearby. These sensors adjust blood flow via the arterioles in response to changing conditions
in the body.
Capillary Flow:
Because of arteriole action, by the time blood reaches the capillaries it is no longer travelling
in a pulsing fashion - blood actually flows continuously through the capillaries, it does not
"squirt" and "pause" along with the beating of the heart. This continuous flow is necessary
because there is a constant exchange of oxygen and nutrients happening through the walls of
the capillaries. No cell in the body is very far away from a capillary.
Closed Loop:
As blood travels through the capillaries, its supply of oxygen is reduced and it acquires waste
products. From the capillaries, blood enters the venules and then veins, and travels back to
the heart to be refreshed and sent out once again
5.2 List the functions of blood
 Transport: to and from tissue cells
• Nutrients to cells: amino acids, glucose, vitamins, minerals, lipids (as
lipoproteins).
• Oxygen: by red blood corpuscles (oxyhaemoglobin - 4 x O2
molecules/haemoglobin).
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•
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Wastes from cells: urea, CO2 (mainly as HCO3 in solution in the plasma).
Temperature Regulation: by altering the blood flow through the skin.
Immunity: protection against pathogens — blood clotting; phagocytes, lymphocytes and
antibodies distributed in blood.
Communication: hormones distributed to all parts of the body in the blood.
Defence: clotting following a wound
5.3 Differentiate between arterial, venous and capillary bleeding
Bleeding (haemorrhage) is the escape of blood from capillaries, veins, and arteries.
Capillaries are very small blood vessels that carry blood to all parts of the body. Veins are
blood vessels that carry blood to the heart. Arteries are large blood vessels that carry blood
away from the heart. Bleeding can occur inside the body (internal), outside the body
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(external) or both. Blood is a fluid that consists of a pale yellow liquid (plasma), red blood
cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes). Plasma is
the fluid portion of the blood that carries nutrients. Red blood cells give color to the blood
and carry oxygen. White blood cells defend the body against infection and attack foreign
particles. Platelets are disk shaped and assist in clotting the blood, the mechanism that stops
bleeding. There are three types of bleeding. Capillary bleeding is slow, the blood "oozes"
from the (wound) cut. Venous bleeding is dark red or maroon, the blood flows in a
steady stream. Arterial bleeding is bright red, the blood "spurts" from the wound.
Arterial bleeding is life threatening and difficult to control.
5.4 State the effects of severe bleeding
Bleeding, technically known as haemorrhaging is the loss of blood or blood escape from the
circulatory system. Bleeding can occur internally, where blood leaks from blood vessels
inside the body or externally, either through a natural opening or through a break in the skin.
Typically, a healthy person can endure a loss of 10-15% of the total blood volume without
serious medical difficulties, and blood donation typically takes 8-10% of the donor's blood
volume.
Bleeding generally becomes dangerous, or even fatal, when it causes hypovolemia (low blood
volume) or hypotension (low blood pressure).
Certain diseases or medical conditions, such as haemophilia and low platelet count
(thrombocytopenia), may increase the risk of bleeding or may allow otherwise minor bleeds
to become health or life threatening.
Death from bleeding can generally occur surprisingly quickly. This is because of 'positive
feedback'. Positive feedback, sometimes referred to as "cumulative causation", refers to a
situation where some effect causes more of itself. A system undergoing positive feedback is
unstable, that is, it will tend to spiral out of control as the effect amplifies itself.
An example of this is 'cardiac repression', when poor heart contraction depletes blood flow to
the heart, causing even poorer heart contraction. This kind of effect causes death to occur
more quickly than expected.
5.5 List wound types
See AAOS 2009: pages 45 & 46 for further wound types
Traumatic bleeding is caused by some type of injury. There are different types of wounds
which may cause traumatic bleeding. These include:
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Abrasion - Also called a graze, this is caused by transverse action of a foreign object
against the skin, and usually does not penetrate below the epidermis
Hematoma - Caused by damage to a blood vessel that in turn causes blood to collect
under the skin.
Laceration - Irregular wound caused by blunt impact to soft tissue overlying hard
tissue or tearing such as in childbirth. In some instances, this can also be used to
describe an incision.
Incision - A cut into a body tissue or organ, such as by a scalpel, made during
surgery.
Puncture Wound - Caused by an object that penetrated the skin and underlying
layers, such as a nail, needle or knife
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Occupational First Aid. Fetac Level 5
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Contusion - Also known as a bruise, this is a blunt trauma damaging tissue under the
surface of the skin
Crushing Injuries - Caused by a great or extreme amount of force applied over a
period of time. The extent of a crushing injury may not immediately present itself.
Ballistic Trauma - Caused by a projectile weapon, this may include two external
wounds (entry and exit) and a contiguous wound between the two
5.6 Demonstrate the control of bleeding using posture, expose/examination and elevation,
pressure and shock (PEEPS)
http://www.brooksidepress.org
AAOS 2009: pages 47- 48
Pressure: Direct pressure is the first and most effective method to control bleeding. In many
cases, bleeding can be controlled by applying pressure directly to the wound. Place a sterile
dressing or clean cloth on the wound, tie a knot or adhere tape directly over the wound, only
tight enough to control bleeding. If bleeding is not controlled, apply another dressing over the
first or apply direct pressure with your hand or fingers over the wound. Direct pressure can be
applied by the casualty or a bystander. Under no circumstances is a dressing removed once
it has been applied.
Elevation: Raising (elevation) of an injured arm or leg (extremity) above the level of the
heart will help control bleeding.
Pressure Points for Control of Bleeding
Elevation should be used together with direct pressure. Do not elevate an extremity if you
suspect a broken bone (fracture) until it has been properly splinted and you are certain that
elevation will not cause further injury. Use a stable object to maintain elevation. Placing an
extremity on an unstable object may cause further injury.
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Indirect Pressure
In cases of severe bleeding when direct pressure and elevation are not controlling the
bleeding, indirect pressure must be used. Bleeding from an artery can be controlled by
applying pressure to the appropriate pressure point. Pressure points are areas of the body
where the blood flow can be controlled by pressing the artery against an underlying bone.
Pressure is applied with the fingers, thumb, or heel of the hand.
Pressure points should be used with caution. Indirect pressure can cause damage to the
extremity due to inadequate blood flow. Do not apply pressure to the neck (carotid)
pressure points, it can cause cardiac arrest.
Indirect pressure is used in addition to direct pressure and elevation. Pressure points in the
arm (brachial) and in the groin (femoral) are most often used, and should be thoroughly
understood. The brachial artery is used to control severe bleeding of the lower part of the
upper arm and elbow. It is located above the elbow on the inside of the arm in the groove
between the muscles. Using your fingers or thumb, apply pressure to the inside of the arm
over the bone. The femoral artery is used to control severe bleeding of the thigh and lower
leg. It is located on the front, centre part of the crease in the groin. Position the casualty on
his or her back, kneel on the opposite side from the wounded leg, place the heel of your hand
directly on the pressure point, and lean forward to apply pressure. If the bleeding is not
controlled, it may be necessary to press directly over the artery with the flat surface of the
fingertips and to apply additional pressure on the fingertips with the heel of your other hand.
Internal Bleeding
Internal bleeding, although not usually visible, can result in serious blood loss. A casualty
with internal bleeding can develop shock before you realize the extent of their injuries.
Bleeding from the mouth, ears, nose, rectum, or other body opening (orifice) is considered
serious and normally indicates internal bleeding.
The most common sign of internal bleeding is a simple bruise (contusion), it indicates
bleeding into the skin (soft tissues). Severe internal bleeding occurs in injuries caused by a
violent force (automobile accident), puncture wounds (knife), and broken bones.
Signs of internal bleeding include:
1. Anxiety and restlessness.
2. Excessive thirst (polydipsia).
3. Nausea and vomiting.
4. Cool, moist, and pale skin (cold and clammy).
5. Rapid breathing (tachypnea).
6. Rapid, weak pulse (tachycardia).
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Occupational First Aid. Fetac Level 5
7. Bruising or discoloration at site of injury (contusion).
If you suspect internal bleeding, do the following:
1. Bruise (contusion) - Apply ice or cold pack, with cloth to prevent damage to the skin, to
reduce pain and (edema) swelling.
2. Severe internal bleeding:
a. Call local emergency number or medical personnel.
b. Monitor airway, breathing, and circulation (ABCs).
c. Treat for shock.
d. Place casualty in most comfortable position.
e. Maintain normal body temperature.
f. Reassure casualty
Nosebleed
Nosebleeds can be caused by an injury, disease, the environment, high blood pressure, and
changes in altitude. They frighten the casualty and may bleed enough to cause shock. If a
fractured skull is suspected as the cause, do not stop the bleeding. Cover the nose with a
loose, dry, sterile dressing and call the local emergency number or medical personnel. If
the casualty has a nosebleed due to other causes, do the following:
1. Keep the casualty quiet, sitting with head tilted forward.
2. Pinch the nose shut (if there is no fracture), place ice or cold packs to the bridge of the
nose, or put pressure on the upper lip just below the nose. Inform the casualty not to rub,
blow, or pick his or her nose. Seek medical assistance if the nosebleed continues, bleeding
starts again, or bleeding is because of high blood pressure. If the casualty loses
consciousness, place them on their side to allow blood to drain from the nose and call
the local emergency number or medical personnel.
Foreign bodies in the nose usually occur among children. First aid consists of seeking
professional medical attention. Nasal damage and the possibility of pushing the object farther
up the nose can result from searching and attempts at removal by unqualified personnel.
Casualties with severe external bleeding and suspected internal bleeding must be seen
by medical personnel as soon as possible. All casualties with external and internal
bleeding should be treated for shock.
5.7 Outline the management of head, eye and facial injuries
AAOS 2009: Chapter 9
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5.8 outline the management of internal bleeding
Pages 48-49
5.9 outline the management of crush injuries
If crushed less than 15 minutes:
Remove the object
Give appropriate treatment
Call for help
If crushed longer than 15 minutes
Send for help immediately
Do not remove the object util the ambulance arrives
5.10 Outline the benefit of tying a reef knot
The Reef knot is a simple first aid knot that is easily loosened when more advanced care
practitioners need to view a wound/fracture/etc.
Take the two bitter ends, cross them over and tie the first half knot (half hitch). Maintain the
same rope on top (red) as you cross them over a second time to tie the second half hitch. Pull
the ends evenly to form a symmetrical reef knot.
5.11 Demonstrate the application of pre-packed sterile dressings to various body sites
page51-52
5.12 Demonstrate the application of bandages to various body sites
5.13 Demonstrate using a triangular bandage the narrow fold, broadfold, arm sling and
elevation sling
5.14 Demonstrate the treatment of a nose bleed
5.15 Demonstrate the procedure to clean a simulated minor wound
5.16 Demonstrate the treatment of surface injuries to the head, ear and face using items from
a first aid kit