Download File - your own free website

Wounds and Circulation
Chapter 6
• To assess the victim’s condition quickly and calmly
• To control blood loss by applying pressure and elevating the injured part
• To minimize the risk of shock
• To comfort and reassure the victim
• To call 911 for emergency help if you suspect a serious injury or illness
• To be aware of your own needs, including the need to protect yourself against BBP
The Heart & Blood Vessels
• Circulatory system:
• Heart
• Blood vessels
• Three functions
1.
2.
3.
Supply body with constant flow of blood
Brings oxygen and nutrients to the tissues
Carries waste away
• Three types of vessels
1. Arteries
2. Veins
3. Capillaries
• Blood pressure: force that is exerted by the blood flow through the main
arteries
•THE CIRCULATORY SYSTEM
How the Heart Functions
• The heart pumps blood by muscular contractions called heartbeats
• Each beat has three phases:
• Diastole- blood enters the heart
• Atrial systole- squeezed out of the atria
• Ventricular systole- blood leaves the heart
Diastole
• The heart relaxes
• Oxygenated blood from the lungs--- pulmonary veins--- left atrium
• Deoxygenated blood flows from venae cavae ( large veins that enter
the heart) into right atrium
Atrial Systole
• Two atria contract and the valves between the ventricles (pumping
chambers) open so that blood flows into ventricles.
Ventricular Systole
• Ventricles contract
• The left ventricle forces blood into the aorta----the rest of the body
• The right ventricle pumps blood into pulmonary arteries----lungs to
collect more oxygen
• NOTE:
• THE HEART’S RIGHT SIDE PUMPS DEOXYGENATED BLOOD FROM THE
BODY TO THE LUNGS.
• THE LEFT SIDE PUMPS OXYGENATED BLOOD TO THE BODY VIA THE
AORTA
Composition of Blood
• 10 pints (5 liters)
• 1 pint per 14 pounds of body weight
• 55% is clear yellow fluid (plasma)
• Red blood cells
• Contain hemoglobin (enables cells to carry oxygen)
• White blood cells
• Defend body against infection
• Platelets
• Help blood clot
45%
Bleeding & Types of Wound
• Bleeding (hemorrhage) is characterized by the type of blood vessel that is
damaged:
1. Arteries
1. Bleeding is profuse
2. Blood will spurt out in time with the heartbeat
2. Veins
1. Darker red
3. Capillaries
1. Occurs with any wound
2. Brisk, but slight
3. Bruising
How Wounds Heal
• When a blood vessel is severed/ damaged= constricts/ narrows
• Injured tissue cells and platelets begin to form a mesh
• This mesh traps blood cells= make a clot
• Clot releases fluid (serum) that contains antibodies and begins to
repair area
• Fibroblasts form a plug within the clot--- scab
Types of Wounds
• Simple laceration
• Clean surface cut from a sharp object (razor)
• Blood vessels cut straight across; bleeding may be profuse
• Tendons/ nerves may be damaged
• Complex laceration
• Crushing/ ripping forces
• Wounds may bleed less; may be deep tissue damage
• Often contaminated with germs; infection risk is high
• Abrasion (scrape)
•
•
•
•
Superficial wound
Raw/ tender area
Sliding fall/ friction burn
May contain embedded foreign particles that may cause infection
Types of Wounds
• Contusion (Bruise)
• Blunt blow-rupture capillaries beneath skin
• Skin may split
• Puncture wound
• Standing on a nail/ pricked by a needle
• Small entry site; deep track of internal damage
• Infection risk
• Stab wound
• Long/ bladed instrument (knife)
• Penetrating the body
• Must be treated seriously
• Gunshot wound
• Bullet/ missile
• Serious internal injury
• High risk of infection
Heart Attack (myocardial infarction)
• Most commonly caused by a sudden obstruction of the blood supply
to part of the heart muscle
• Main risk= heart will stop beating
• Effects of a heart attack depend largely on how much of the heart
muscle is affected
• Video
Heart Attack
• Recognition:
• Persistent, central chest pain which may spread to the jaw & down one/ both
arms
• Breathlessness
• Discomfort occurring high in the abdomen
• Collapse
• Fainting/ dizziness
• “Ashen” skin and blueness in the lips
• Rapid, weak or irregular pulse
• Profuse sweating
Heart Attack
• Your aims:
• To ease the strain on the victim’s heart by ensuring that he rests
• Call for emergency medical help
1. Make the victim as comfortable as possible; half sitting position with head
and shoulders supported & knees bent-place cushions behind and under
knees
2. Call 911
3. Give aspirin tablet (if not allergic)
4. Monitor/ record vital signs
5. Stay calm
Angina
• Constriction of the chest
• Coronary arteries become narrowed & can’t carry sufficient blood
• Once victim rests- pain should ease soon
• Recognition:
•
•
•
•
Central chest pain
Shortness of breath
Fatigue
Anxiety
Angina
1.
2.
3.
4.
Help the victim stop what they are doing and sit them down
Help administer angina medication (nitroglycerin) if they have it
Encourage the victim to rest
If the pain persists, call 911
Fainting
• Brief loss of consciousness
• Temporary reduction of the blood flow to the brain
• May be caused by:
•
•
•
•
Reaction to pain
Lack of food
Emotional stress
After long periods of physical inactivity
• Pulse rate becomes very slow
• Pale, cold skin and sweating
• DO NOT advise a person to sit on a chair with her head between her knees
because if she faints she may fall
Fainting
1. Advise to lie down. Raise her legs, supporting her ankles on your
shoulders to improve blood flow to the brain
2. Make sure victim has plenty of fresh air
3. Reassure the victim & help her sit up gradually
Internal Bleeding
• Bleeding inside body cavities may follow an injury
• Fracture
• Blow from a blunt object
• May occur spontaneously (stomach ulcer)
•
•
•
•
•
•
•
•
•
Main risk= shock
Initially pale, cold clammy skin
Rapid, weak pulse
Thirst
Rapid, shallow breathing
Confusion
“Pattern bruising”
Pain
Check for bleeding from orifices
Severe External Bleeding
• Your aims:
•
•
•
•
•
Control bleeding
Prevent & minimize the effects of shock
Minimize infection
Arrange urgent removal to hospital
Caution: do not allow victim to eat/ drink anything because an anesthetic
may be needed
Severe External Bleeding
1. Remove/ cut clothing if necessary
2. Apply direct pressure over the wound using a sterile dressing (if you do
not have, ask victim to apply direct pressure)
1.
If there is an object in the would apply pressure on either side of the object
3. Maintain direct pressure on the wound to control bleeding. Raise and
support injured limb above level of heart
4. Help victim lie down; raise and support legs above heart
5. Secure dressing with a bandage
6. Support injured part in a raised position; check circulation beyond the
bandage every 10 minutes
7. Call 911
Shock
• Life-threatening condition occurs when circulatory system fails & vital organs are deprived of
oxygen
• Most common cause = severe blood loss (exceeds 2 pints)
• Loss of other body fluids:
• Diarrhea
• Vomiting
• Bowel obstruction
•
•
•
•
•
•
•
•
•
•
Serious burns
Blood infection
Severe heart disease
Heart attack
Acute heart failure
Hypoglycemia
Hypothermia
Anaphylactic shock
Drug overdose
Spinal cord injury
Shock: Recognition
Initially:
As shock develops:
• Rapid pulse
• Pale, cold, clammy skin
• Sweating
• Rapid, shallow breathing
• Weak “thread” pulse
• Cyanosis
• Weakness & dizziness
• Nausea; possibly vomiting
• Thirst
As the brain’s oxygen supply weakens:
Restlessness, confusion, aggressiveness; yawning & gasping for air; unconsciousness…. Finally the heart will
stop
Shock: Caution
• Do not allow victim to eat/ drink
• Thirsty- moisten lips with water
• Do not leave unattended
• Unless you call for emergency help
• Do not warm the victim with a hot-water bottle/ direct sources of
heat
• DO cover him with a blanket
• Pregnancy: lay down leaning toward left side
• Prevents baby from restricting blood flow
Shock: Treatment
1. Treat any possible cause of shock that you can detect
1. Severe bleeding
2. Serious burns
2. Help victim lie down on a rug/ blanket; raise & support legs above
heart level
3. Loosen tight clothing at the neck, chest & waist
4. Keep victim warm by covering body and legs with coats/ blankets
5. Monitor/ record vital signs
Impalement
• Never attempt to left victim off the object
1. Call 911
2. Support victim’s body weight; reassure victim
Crush Injury
• May include a fracture, swelling & internal bleeding
• May cause impaired circulation
• Numbness at or below site of injury
1. Under 15 minutes- try to release
1.
2.
Control external bleeding
Treat for shock
2. More than 15 minutes- leave in position found
1.
Reassure victim
3. Call 911
4. Monitor/ record vital signs
Cuts & Scrapes (Abrasions)
• Easily controlled by pressure & elevation
• Adhesive bandage
• Seek medical help:
•
•
•
•
Bleeding does not stop
Foreign object embedded in the cut
Risk of infection
Human/ animal bite
1. Clean wound by rinsing under water/ alcohol- free wipes; pat
wound dry- cover with sterile gauze
2. Raise & support injured part above heart level
3. Clean area around wound with soap & water
Bruising
• Caused by bleeding into skin/ tissue beneath skin
• Can indicate deep injury
1. Elderly/ anticlotting medications= bruise easily
2. Raise & support injured part
3. Apply firm pressure to the bruise using cold compress
Blisters
• Skin is repeatedly rubbed against another surface or it is exposed to heat
• Damaged area of skin leaks fluid that collects under the top layer of skin=
blister
1. Wash area with clean water & rinse; Gently pat area around skin & dry
with a sterile gauze pad
2. Cover the blister with an adhesive dressing with a pad larger than the
blister
• CAUTION: do not burst a blister because it increases the risk of infection
Infected Wound
• Any open wound can become contaminated with bacteria
• Any wound that does not begin to heal within 48 hours is likely to
become infected
• Antibiotics
• Recognition:
• Increasing pain & soreness
• Swelling, redness, & heat around the injury
• Pus/ oozing from the wound
• Advanced= signs of fever: sweating, thirst, shivering
Infected Wound
1. Cover wound with a sterile dressing/ nonstick pad
2. Raise & support injured part
1. Helps reduce swelling
3. Advise the victim to seek medical advice; if advanced take/ send to
hospital
Foreign Object in a Wound
• If left in the wound may cause infection/ delay healing
• Superficial pieces of glass/ grit from skin= tweezers
• Rinse loose pieces off with running water
• Firmly embedded= do not remove
1. Apply pressure on either side of object & raise area above heart level
2. Build up padding on either side of object until high enough for you to
bandage over object
1.
Rolled bandages
3. Arrange to take/ send to hospital
Scalp & Head Wounds
• Scalp has many small blood vessels running close to skin
surface
• Cut= profuse bleeding
• Appears worse
1. Carefully replace any displaced area of skin over the
wound
2. Cover with sterile dressing & apply firm, direct pressure
3. Keep pad in place with a roller bandage
4. Help victim lie down with head and shoulders raised
slightly; call 911 if there are any signs of shock
Eye Wound
• Potentially serious because of risk to victim’s vision
1. Help victim lie on his back; hold head still
2. Give victim a sterile dressing to hold over affected eye
3. Arrange to take/ send to hospital
• CAUTION: do not touch/ attempt to remove anything that is sticking
to/ embedded in the eyeball or on the colored part (iris) of the eye.
• Place a paper cup over eye & bandage in place
Bleeding from the Ear
• Perforated eardrum
• Ear infection
• Blow to the side of the head
• Explosion
• Skull fracture
• Symptoms:
•
•
•
•
Sharp pain
Earache
Deafness
Dizziness
1. Help victim into half sitting
position with head tilted
to the injured side to allow
blood to drain away
2. Hold sterile dressing lightly
in place on the ear. DO
NOT plug ear
3. Send/ take to hospital
• Clear fluid= more serious
injury
Nosebleed (Epistaxis)
• Blood vessels inside nostrils= ruptured
• Blow to the nose
• Sneezing
• Picking/ blowing nose
• High blood pressure
• Anticlotting medication
1. Sit victim down & tilt head slightly forward; tell them to breathe through
their mouth & pinch soft part of his nose
2. Advise not to speak, cough, spit, or sniff
3. Once bleeding has stopped, clean around nose with lukewarm water
4. Longer than 30 minutes= hospital
Knocked- Out Adult Tooth
• Options:
• Replant in socket ASAP
• Gently rinse off any dirt
• Ask victim to keep tooth inside his cheek/ under tongue
• Place in small container of milk
1. Gently push tooth into socket; place gauze pad between bottom & top
teeth
2. Ask victim to hold tooth in place
3. Send to hospital/ dentist
• DO NOT rinse off fleshy debris= reduce chance of reimplantation
Wound to the Palm
• Palm has good blood supply= profuse bleeding
• Deep wound may sever tendons & nerves
• Bandaging fist is effective as long as there are no foreign objects
embedded in the wound
1. Press sterile dressing firmly into palm & ask victim to clench fist
over it
2. Raise & support the hand; bandage fingers so they are clenched
over the dressing; leave thumb free (check circulation)
3. Support arm in elevation sling
Bleeding Varicose Vein
• Veins contain one-way valves
• Fail= blood collects (pools) behind them & swells (varicose vein)
•
•
•
•
Usually develops in legs
Taught, thin walls
Often raised
Knobbly skin
• If injured, shock will develop if not controlled
1. Help victim lie down; raise & support leg
2. Rest leg on shoulder/ chair & apply direct pressure
3. Call 911 for emergency help