CH04_Bleeding

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Chapter 4
Care of Bleeding, Wounds, and Burns
Lesson Objectives (1 of 2)
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List the steps to control bleeding.
Identify the different types of open wounds.
Describe the procedure for cleaning a wound.
Explain the procedure for wound irrigation.
Evaluate movement and sensation beyond the
wound.
• Recognize the signs and symptoms for an
infected wound.
• Know how to close a wound.
Lesson Objectives (2 of 2)
• Identify risks for infection and know how to
recognize an infected wound.
• Know how to care for special wounds, such as
amputations, blisters, and bruises, and know
when to consider evacuation because of a wound.
• Recognize burns by classification and severity.
• Know how to manage electrical burns.
• Know how to manage sunburn.
Bleeding (1 of 2)
• Controlling bleeding
– First priority is to control bleeding
– Major bleeding can lead to cardiovascular
shock.
– Shock occurs when tissues do not get enough
oxygenated blood.
Bleeding (2 of 2)
• Steps to control bleeding:
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Use a barrier device.
Apply direct pressure.
Use elevation.
Use a pressure
bandage.
– Add more dressings.
Wounds (1 of 14)
• Types of wounds
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Abrasions
Lacerations
Incisions
Puncture wounds
Avulsions
Amputations
© E. M. Singletary, M.D. Used with permission.
Wounds (2 of 14)
• Cleaning a wound
– Wash the wound.
– Use soap and clean water for shallow wounds.
– Cover with a sterile or clean dressing.
Wounds (3 of 14)
• Wound irrigation
– Clean with a large syringe, bulb syringe, or
plastic bag with a small hole in the corner.
– Remove remaining fragments.
– Do not use disinfectant in the wound.
– Clean only the surface of puncture wounds.
Wounds (4 of 14)
• Evaluating function
– Check movement
and sensation
beyond the wound.
© Howard Backer, M.D.
Wounds (5 of 14)
• Wound closure
– Close small wounds with tape or
“butterfly” strips.
– Pack large wounds with sterile dressings.
– Cover all wounds with sterile or clean
dressings.
– Change dressings every 24 to 48 hours.
Wounds (6 of 14)
• Wound infection
– Deep, dirty wounds, punctures, and bites
are at high risk for infection.
– Animal and human bites have high risk of
infection.
Wounds (7 of 14)
• Wound infection
– What to look for
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Redness
Warmth
Swelling
Pain
Tenderness
Pus
© Shout/Alamy Images
Wounds (8 of 14)
• Wound infection
– What to do
• Clean the area.
• Allow pus to escape.
• Soak in warm water.
• Change dressings often.
Wounds (9 of 14)
• Amputations
– Attempt to preserve part.
– Control breathing and treat victim for shock.
– If amputated part is found:
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Rinse with clean water.
Wrap part in sterile gauze.
Place in waterproof container.
Place on ice or in snow.
Take part to hospital with victim.
Wounds (10 of 14)
• Blisters
– A collection of fluid underneath the skin
caused by friction.
– Prevent by taping susceptible areas with
duct tape or adhesive or cover with
adhesive felt.
Wounds (11 of 14)
• Blisters
– What to do
• Unbroken blisters: Clean with soap and water,
puncture edges with sterile needle, cover with
nonstick dressing.
• Broken blisters: Wash; cover with tape or a
nonstick pad; If infected, cut away skin and
begin warm soaks.
Wounds (12 of 14)
• Bruises
– A collection of blood within or under the skin
– What to look for
• Pain and discoloration
• Possible fraction
Wounds (13 of 14)
• Bruises
– What to do
• Apply a cold pack for 20 minutes, four
times a day.
• If cold pack is not available, wrap firmly
with an elastic bandage.
• Do not cut off circulation.
Wounds (14 of 14)
• Wounds requiring evacuation
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Uncontrolled or severe bleeding
Deep wounds
Severe wounds of hands or feet
Large or deep puncture wounds or embedded objects
Human or animal bites
Serious eyelid injuries
Infected wounds
Amputations
Open fractures
Burns (1 of 9)
• Caused by:
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Thermal energy
Electrical energy
Radiant energy
Chemicals
Burns (2 of 9)
• Burn classification
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Depth
Extent
Location
Severity
Other considerations
Burns (3 of 9)
• Immediate action
– Stop the burning!
– Remove victim from flame or smoke-filled area.
– Cut off smoldering clothing or soak it with
water.
Burns (4 of 9)
• What to do at first
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Check breathing.
Care for burns.
Check for additional injuries.
Remove jewelry and watches.
Remove belts and clothing from burned area.
Keep burn clean and prevent blisters from breaking.
Evacuate.
Give large amounts of fluids.
Relieve pain and inflammation.
Burns (5 of 9)
• What to do later
– First-degree burns: Apply ointment or cream to
soothe.
– Second- and third-degree burns: Wash gently,
apply antibiotic ointments, cover with nonstick
dressing and bandage.
Burns (6 of 9)
• Electrical burns
– Caused by lighting strikes, in remote
households, or job sites.
– Can produce entrance and exit wounds.
– Can penetrate nerves and blood vessels,
causing extensive damage.
Burns (7 of 9)
• Electrical burns: What to do
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Unplug or disconnect power.
Check breathing.
Check for fractures.
Monitor for shock.
Perform CPR if necessary.
Treat entrance and exit wounds.
Evacuate if necessary.
Burns (8 of 9)
• Sunburn
– Caused by ultraviolet rays from the sun.
– Sun reflects strongly of water, sand, and snow.
– Prevent by wearing sun-protective clothing and
sunscreen.
Burns (9 of 9)
• Sunburn
– What to look for
• Red skin
• Blisters
– What to do
• Soothe burned skin with cool compresses,
baking soda, or calamine lotion.
• Give antihistamine pills for itching and
ibuprofen for pain and inflammation.
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