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- Nov 14, 2005
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Ok, at request I have decided to do a few differant first aid write ups. This is one that is important to all outdoorsmen, and a esential part of wilderness/survival medicine. The treatment of wounds and fractures.:thumbup:
WOUND MANAGEMENT
First it is important to look at the differant types of bleeding.
Arterial- This is the least common and most dangerous type of bleeding. It involves bright red blood that comes out in large volume, and in spurts that correspond with each beat of your heart.
Venous-A cut vein typically results in a steady but relatively slow flow of dark red blood.
capillary-Capillaries are the smallest blood vessels in your body; they are about as thin as the hairs on your head.
When a minor scrape or cut opens some capillaries, the bleeding is almost always very slow and small in quantity. Your body's natural clotting mechanism is able to stop most cases of capillary bleeding within seconds to minutes.
So the first step in treating wounds is to look at what kind of wound you have, and if it is impeading breathing(will go into later) Then you must try to be as sterile as possible when preparing for treatment. Glove-up, sterilize tools etc. Also be concerned about blood-borne pathogens. You dont want to catch something by being unprepared. Remember- your safety is priority one!!!!!!!
Now we will look at treatment of differant kinds of bleeds. For every type of wound, the things you NEED to do is
1)stop bleeding
2)stop bleeding
3)stop bleeding
4) minimize infection risk
The number one way to stop bleeding in all types is direct pressure. Place dressing over wound and apply pressure, adding more dressings as they become soaked. Never remove the first ones, you will disturb the clot and be back to square one. Just apply new ones over the top of the old ones. This is not for changing bandages, just for the initial stoping of bleedng. If that doesnt work, apply pressure, and elevate extremity, If that doesnt work, apply pressure, and pinch off pressure point above site. Next, if the wound will not quit bleeding through direct pressure you need to get aggressive. This is where tournaquets and quick-clot come into play. Touniquets once fell out of favor. It is my opinion b/c they were not being used right. A tournequet is applied to essentially cut off bloodflow to extremity therefore stopping bleeding, often in the case of arterial bleeding. They need to be monitored, and loosened over time. Artirial bleeds and serious ones will need advanced medical care, in the form of clips on the vessel, Cauterization, which is the process of burning to seal it, all surgical in nature. Do not attempt this. You need lots more training then I have, and feel comfortable giving. Stick to applying a tournaquet, releasing slightly over time to avoid necrosis, and keeping the extremity with blood supply. Apply it above the wound.:thumbup:
All wounds are contanamated, and need to be treated as such.So this is where cleaning the wound is important. Us a syrynge(w/o needle) with sterile water, either bottled or boiled and cooled. Irrigate the wound washing out the contanaments., and then dress it sterilly. Mix up an iodine solution with water and clean around the site gently. Do not rub, as you do not want to dislodge a clot and be back to square one. Allow to dry for 30 seconds w/o blowing or fanning it. Apply a antibiotic ointment(externally!) and dress with sterile dressings then bandage the wound.
A dressing goes on the wound, a bandage keeps it in place.:thumbup:
After bandaging the wound, you need to check for distal pulses in the extremity, to make sure your bandage isnt too tight. Unless you have a tournaquet applied, in which case the pulses will be absent.
SUTURES
To tell if a laceration needs stitches, you will have to look at the depth of the wound. If you can see yellow sub q fatty tissue, or bone, then you will need sutures. Sutureing is the process of closing a wound by stitching it up with a needle(sterile) and suture material. The purpose is to close up the wound to aid in healing, and prevent infection. A suture knot is a square knot. If you can tie a knot, you can tie a suture knot.
here is some things I found in research to consider when stitchin up a wound.....I dont suggest doing this unless you are 100% confident.....
The completed knot must be firm, and so tied that slipping is virtually impossible. The simplest knot for the material is the most desirable.
The knot must be as small as possible to prevent an excessive amount of tissue reaction when absorbable sutures are used, or to minimize foreign body reaction to nonabsorbable sutures. Ends should be cut as short as possible.
In tying any knot, friction between strands ("sawing") must be avoided as this can weaken the integrity of the suture.
Care should be taken to avoid damage to the suture material when handling. Avoid the crushing or crimping application of surgical instruments, such as needleholders and forceps, to the strand except when grasping the free end of the suture during an instrument tie.
Excessive tension applied by the surgeon will cause breaking of the suture and may cut tissue. Practice in avoiding excessive tension leads to successful use of finer gauge materials.
Sutures used for approximation should not be tied too tightly, because this may contribute to tissue strangulation.
After the first loop is tied, it is necessary to maintain traction on one end of the strand to avoid loosening of the throw if being tied under nay tension.
Final tension of final throw should be as nearly horizontal as possible.
The surgeon should not hesitate to change stance or position in relation to the patient in order to place a knot securely and flat.
Extra ties do not add to the strength of a properly tied knot. They only contribute to its bulk. With some synthetic materials, knot security requires the standard surgical technique of flat and square ties with the additional throws if indicated by surgical circumstances and the experience of the surgeon.
Pretty advanced, and dont attempt this if you do not feel comfortable, or have had training.
------------------------------------------------------------
As far as long term care of wounds, bandages need to be changed daily, and the wound needs to be kept clean. Monitor vital signs, skin tempature, and any changes in mental status. This will tell you if your patient is turning downhill, and infection is present. Examine the wound for swelling, redness, or discharge.
Pain controll is something else to consider.
Ok, now this is a pretty in depth subject. We could get into wound vacs, and other stuff, but I feel it will confuse more then help, for what we are trying to accomplish as far as first aid. I went a litte into sutures etc, but thats as far as I care to go into with advanced treatment of wounds.:thumbup:
Lets touch a little on sucking chest wounds and bubbling neck wounds. You dress them differantly then others They need to be sealed with an occlusive dressing. Which can be an asherman chest seal, or as simple as a credit card.
This will prevent air from entering or exiting the wound and developing a pneumothorax. Often these types of wounds are a result from gunshot wounds.
Next how about bowel eviseration. Irrigate, and dress with saline soaked dressings, and bandage with saran wrap or alluminum foil.
Shock- Look for changes in vitals, and treating for shock is never a bad idea when dealing with injury. Elevate feet above heart. Approx 25cm.:thumbup:
There is more, but this is basics.
Ok, in summary, If you can stop bleeding, and prevent infection, you are golden. Remember-----DIRECT PRESSURE FIRST, TOURNEQUET LAST.:thumbup:
++++++++++++++++++++++++++++++++++++++++++++++++++
FRACTURES
Fractures, they can happen easily. There are many types, open, closed, resulting from crush injury, twisting forces, bending forces etc.....Lots of times the result of Falls, or blunt force.
With closed fractures, as far as basic first aid. Stabilize the fracture check for distal pulses. If you have distal pulses splint the fracture. Secure splint above and below the site, imobilizing the joints above and below. Ater splint is applied, check for distal pulses again to make sure that your splint is not too tight.:thumbup:
A fx can present some problems. If the bone cut off a vessel when it broke, the fx will have to be set, to return bloodflow. Use manual traction to acheive this. Manual traction is achieved by gripping the extremity, and pulling untill the PT expresses relief, and pulses return. I have seen docs do about everthing but hook a pt up to a truck bumper to acheive setting a fx. It s insane to watch!!!!!!
Open fxs need to be kept sterile, and watched close for infection. Treat like a wound. Do not apply traction to an open Fx.
Ok, this is basically as deep as I think we need to go into these things. Like I said, I am not a doctor, I think this will give you at the least, an understanding and a thought process when dealing with wounds and FXs. I am just sharing my limited knowlage, and experiane with you guys. Of course there is more, and of course here may be differant ways of treating this. Thats why its called practicing.
WOUND MANAGEMENT
First it is important to look at the differant types of bleeding.
Arterial- This is the least common and most dangerous type of bleeding. It involves bright red blood that comes out in large volume, and in spurts that correspond with each beat of your heart.
Venous-A cut vein typically results in a steady but relatively slow flow of dark red blood.
capillary-Capillaries are the smallest blood vessels in your body; they are about as thin as the hairs on your head.
When a minor scrape or cut opens some capillaries, the bleeding is almost always very slow and small in quantity. Your body's natural clotting mechanism is able to stop most cases of capillary bleeding within seconds to minutes.
So the first step in treating wounds is to look at what kind of wound you have, and if it is impeading breathing(will go into later) Then you must try to be as sterile as possible when preparing for treatment. Glove-up, sterilize tools etc. Also be concerned about blood-borne pathogens. You dont want to catch something by being unprepared. Remember- your safety is priority one!!!!!!!
Now we will look at treatment of differant kinds of bleeds. For every type of wound, the things you NEED to do is
1)stop bleeding
2)stop bleeding
3)stop bleeding
4) minimize infection risk
The number one way to stop bleeding in all types is direct pressure. Place dressing over wound and apply pressure, adding more dressings as they become soaked. Never remove the first ones, you will disturb the clot and be back to square one. Just apply new ones over the top of the old ones. This is not for changing bandages, just for the initial stoping of bleedng. If that doesnt work, apply pressure, and elevate extremity, If that doesnt work, apply pressure, and pinch off pressure point above site. Next, if the wound will not quit bleeding through direct pressure you need to get aggressive. This is where tournaquets and quick-clot come into play. Touniquets once fell out of favor. It is my opinion b/c they were not being used right. A tournequet is applied to essentially cut off bloodflow to extremity therefore stopping bleeding, often in the case of arterial bleeding. They need to be monitored, and loosened over time. Artirial bleeds and serious ones will need advanced medical care, in the form of clips on the vessel, Cauterization, which is the process of burning to seal it, all surgical in nature. Do not attempt this. You need lots more training then I have, and feel comfortable giving. Stick to applying a tournaquet, releasing slightly over time to avoid necrosis, and keeping the extremity with blood supply. Apply it above the wound.:thumbup:
All wounds are contanamated, and need to be treated as such.So this is where cleaning the wound is important. Us a syrynge(w/o needle) with sterile water, either bottled or boiled and cooled. Irrigate the wound washing out the contanaments., and then dress it sterilly. Mix up an iodine solution with water and clean around the site gently. Do not rub, as you do not want to dislodge a clot and be back to square one. Allow to dry for 30 seconds w/o blowing or fanning it. Apply a antibiotic ointment(externally!) and dress with sterile dressings then bandage the wound.
A dressing goes on the wound, a bandage keeps it in place.:thumbup:
After bandaging the wound, you need to check for distal pulses in the extremity, to make sure your bandage isnt too tight. Unless you have a tournaquet applied, in which case the pulses will be absent.
SUTURES
To tell if a laceration needs stitches, you will have to look at the depth of the wound. If you can see yellow sub q fatty tissue, or bone, then you will need sutures. Sutureing is the process of closing a wound by stitching it up with a needle(sterile) and suture material. The purpose is to close up the wound to aid in healing, and prevent infection. A suture knot is a square knot. If you can tie a knot, you can tie a suture knot.
here is some things I found in research to consider when stitchin up a wound.....I dont suggest doing this unless you are 100% confident.....
The completed knot must be firm, and so tied that slipping is virtually impossible. The simplest knot for the material is the most desirable.
The knot must be as small as possible to prevent an excessive amount of tissue reaction when absorbable sutures are used, or to minimize foreign body reaction to nonabsorbable sutures. Ends should be cut as short as possible.
In tying any knot, friction between strands ("sawing") must be avoided as this can weaken the integrity of the suture.
Care should be taken to avoid damage to the suture material when handling. Avoid the crushing or crimping application of surgical instruments, such as needleholders and forceps, to the strand except when grasping the free end of the suture during an instrument tie.
Excessive tension applied by the surgeon will cause breaking of the suture and may cut tissue. Practice in avoiding excessive tension leads to successful use of finer gauge materials.
Sutures used for approximation should not be tied too tightly, because this may contribute to tissue strangulation.
After the first loop is tied, it is necessary to maintain traction on one end of the strand to avoid loosening of the throw if being tied under nay tension.
Final tension of final throw should be as nearly horizontal as possible.
The surgeon should not hesitate to change stance or position in relation to the patient in order to place a knot securely and flat.
Extra ties do not add to the strength of a properly tied knot. They only contribute to its bulk. With some synthetic materials, knot security requires the standard surgical technique of flat and square ties with the additional throws if indicated by surgical circumstances and the experience of the surgeon.
Pretty advanced, and dont attempt this if you do not feel comfortable, or have had training.
------------------------------------------------------------
As far as long term care of wounds, bandages need to be changed daily, and the wound needs to be kept clean. Monitor vital signs, skin tempature, and any changes in mental status. This will tell you if your patient is turning downhill, and infection is present. Examine the wound for swelling, redness, or discharge.
Pain controll is something else to consider.
Ok, now this is a pretty in depth subject. We could get into wound vacs, and other stuff, but I feel it will confuse more then help, for what we are trying to accomplish as far as first aid. I went a litte into sutures etc, but thats as far as I care to go into with advanced treatment of wounds.:thumbup:
Lets touch a little on sucking chest wounds and bubbling neck wounds. You dress them differantly then others They need to be sealed with an occlusive dressing. Which can be an asherman chest seal, or as simple as a credit card.
This will prevent air from entering or exiting the wound and developing a pneumothorax. Often these types of wounds are a result from gunshot wounds.
Next how about bowel eviseration. Irrigate, and dress with saline soaked dressings, and bandage with saran wrap or alluminum foil.
Shock- Look for changes in vitals, and treating for shock is never a bad idea when dealing with injury. Elevate feet above heart. Approx 25cm.:thumbup:
There is more, but this is basics.
Ok, in summary, If you can stop bleeding, and prevent infection, you are golden. Remember-----DIRECT PRESSURE FIRST, TOURNEQUET LAST.:thumbup:
++++++++++++++++++++++++++++++++++++++++++++++++++
FRACTURES
Fractures, they can happen easily. There are many types, open, closed, resulting from crush injury, twisting forces, bending forces etc.....Lots of times the result of Falls, or blunt force.
With closed fractures, as far as basic first aid. Stabilize the fracture check for distal pulses. If you have distal pulses splint the fracture. Secure splint above and below the site, imobilizing the joints above and below. Ater splint is applied, check for distal pulses again to make sure that your splint is not too tight.:thumbup:
A fx can present some problems. If the bone cut off a vessel when it broke, the fx will have to be set, to return bloodflow. Use manual traction to acheive this. Manual traction is achieved by gripping the extremity, and pulling untill the PT expresses relief, and pulses return. I have seen docs do about everthing but hook a pt up to a truck bumper to acheive setting a fx. It s insane to watch!!!!!!
Open fxs need to be kept sterile, and watched close for infection. Treat like a wound. Do not apply traction to an open Fx.
Ok, this is basically as deep as I think we need to go into these things. Like I said, I am not a doctor, I think this will give you at the least, an understanding and a thought process when dealing with wounds and FXs. I am just sharing my limited knowlage, and experiane with you guys. Of course there is more, and of course here may be differant ways of treating this. Thats why its called practicing.
Last edited by a moderator:
I grabbed a box of band-aides and went into the bathroom to wash the cut off, but it was bleeding so badly I didn't even try some band-aides I just grabbed a hand towel and rolled in over my finger and applied pressure for half an hour until the bleeding slowed to where i could bandage it up with band-aides. Long story short, thank you for posting this thread im sure it will come in handy :thumbup:
