❤️‍🩹First Aid Unit 5 – Wound Care: Bleeding Control & Bandaging

Key Concepts and Terminology

• Hemostasis refers to the body's natural process of stopping bleeding through vasoconstriction, platelet aggregation, and blood clotting
• Primary survey assesses the patient's airway, breathing, and circulation (ABCs) to identify life-threatening conditions
• Arterial bleeding is bright red, spurts with each heartbeat, and is the most severe type of bleeding requiring immediate attention
• Venous bleeding is dark red, flows steadily, and can be serious if not controlled promptly
• Capillary bleeding is oozing from small blood vessels and is usually less severe than arterial or venous bleeding
• Direct pressure involves applying firm, consistent pressure directly on the wound using a clean cloth or dressing to control bleeding
• Elevation involves raising the injured area above the level of the heart to reduce blood flow and aid in bleeding control
• Pressure points are specific locations where major arteries can be compressed against underlying bone to slow blood flow to the wound

Types of Wounds and Bleeding

• Abrasions are superficial wounds caused by friction or scraping of the skin (road rash)
  • Often contain dirt and debris that must be cleaned to prevent infection
• Lacerations are deep, jagged cuts or tears in the skin caused by blunt force trauma or sharp objects
  • May involve damage to underlying tissues, blood vessels, and nerves
• Puncture wounds are caused by pointed objects penetrating the skin (nails, needles)
  • Risk of infection is high due to the depth and difficulty in cleaning the wound
• Avulsions are injuries where a portion of the skin and underlying tissue is partially or completely torn away
  • May result in significant blood loss and require surgical intervention
• Arterial bleeding is the most severe and can lead to rapid blood loss and shock if not controlled immediately
• Venous bleeding is steadier and can still result in significant blood loss over time
• Capillary bleeding is the least severe but may require attention in cases of large abrasions or with patients on blood thinners

Initial Assessment and Safety Precautions

• Ensure the scene is safe before approaching the patient to avoid becoming a victim yourself
• Use personal protective equipment (PPE) such as gloves and eye protection to prevent exposure to blood and bodily fluids
• Assess the patient's level of consciousness and responsiveness using the AVPU scale (Alert, Verbal, Pain, Unresponsive)
• Perform a primary survey to identify and manage any life-threatening conditions (airway, breathing, circulation)
• If the patient is unresponsive and not breathing normally, begin CPR and have someone call for emergency medical services
• Assess the severity and type of bleeding to determine the appropriate course of action
• If possible, gather information about the cause of the injury and any relevant medical history from the patient or bystanders
• Maintain a calm and reassuring demeanor to help keep the patient and any bystanders at ease during the incident

Bleeding Control Techniques

• Direct pressure is the most effective method for controlling external bleeding
  • Use a clean cloth, dressing, or your gloved hand to apply firm, consistent pressure directly on the wound
  • Maintain pressure until the bleeding stops or emergency medical services arrive
• Elevation can be used in conjunction with direct pressure to reduce blood flow to the injured area
  • Raise the wound above the level of the heart if possible, while maintaining direct pressure
• Pressure points can be used when direct pressure and elevation are ineffective or not possible
  • Apply pressure to the brachial artery (upper arm) for wounds on the lower arm or hand
  • Apply pressure to the femoral artery (groin) for wounds on the lower extremities
• Tourniquets should only be used as a last resort when other methods have failed, and the bleeding is life-threatening
  • Place the tourniquet 2-3 inches above the wound, never over a joint
  • Tighten until the bleeding stops, note the time applied, and do not remove once in place
• Hemostatic agents (QuikClot, Celox) can be applied directly to the wound to promote clotting in severe bleeding situations
  • Follow manufacturer instructions and be aware of potential complications such as tissue damage or allergic reactions

Bandaging Materials and Methods

• Sterile gauze pads are used to cover wounds and absorb blood
  • Apply directly to the wound and secure with medical tape or a wrap
• Roller bandages (Kling, Kerlix) are used to hold dressings in place and provide compression
  • Start at the distal end of the limb and wrap towards the body, overlapping each layer by 50%
• Elastic bandages (Ace wraps) provide compression and support for sprains and strains
  • Start at the distal end of the limb and wrap towards the body, using even pressure throughout
• Triangular bandages can be used as a sling for arm injuries or to secure splints
  • Fold the bandage into a triangle, place the arm in the center, and tie the ends around the neck
• Adhesive bandages (Band-Aids) are suitable for minor cuts and scrapes
  • Ensure the wound is clean and dry before applying the bandage
• Occlusive dressings are used for open chest wounds to prevent air from entering the chest cavity
  • Place the dressing over the wound, tape on three sides, and monitor for signs of a tension pneumothorax

Special Considerations for Different Body Parts

• Head wounds may bleed profusely due to the rich blood supply
  • Apply direct pressure with a clean dressing, avoid applying pressure to the skull if a fracture is suspected
• Facial wounds may compromise the airway or cause significant bleeding
  • Monitor the airway, suction if necessary, and apply direct pressure with caution to avoid further injury
• Neck wounds can involve critical structures such as the carotid artery, jugular vein, or trachea
  • Apply direct pressure with caution to avoid compressing the airway, monitor for signs of airway compromise
• Chest wounds may result in a sucking chest wound or tension pneumothorax
  • Apply an occlusive dressing, monitor for signs of respiratory distress, and prepare for needle decompression if needed
• Abdominal wounds can cause evisceration (organs protruding from the wound)
  • Cover the organs with a moist, sterile dressing, do not attempt to reinsert them, and seek immediate medical attention
• Extremity wounds may involve damage to bones, joints, or major blood vessels
  • Control bleeding with direct pressure, elevation, or pressure points; immobilize fractures and dislocations

Complications and When to Seek Professional Help

• Shock can develop due to significant blood loss, leading to organ dysfunction and death if not treated promptly
  • Monitor for signs of shock (pale, cool, clammy skin; rapid pulse; altered mental status) and treat accordingly
• Infection can occur if wounds are not properly cleaned and dressed
  • Watch for signs of infection (redness, swelling, warmth, discharge) and seek medical attention if present
• Compartment syndrome can develop in extremities due to prolonged compression or injury
  • Monitor for signs (severe pain, pallor, paresthesia, pulselessness) and seek immediate medical attention
• Tetanus is a serious bacterial infection that can occur with puncture wounds or wounds contaminated with soil
  • Ensure the patient's tetanus vaccination is up to date and seek medical attention for high-risk wounds
• Scarring and disfigurement may result from severe wounds or improper treatment
  • Seek professional medical care for wounds that are deep, extensive, or involve cosmetically sensitive areas
• Delayed bleeding or re-bleeding can occur if the initial bleeding control measures fail or the patient has an underlying bleeding disorder
  • Monitor wounds closely, reinforce dressings as needed, and seek medical attention if bleeding persists or recurs

Practical Skills and Hands-On Practice

• Proper glove removal technique to avoid contaminating yourself or others
  • Grasp the outside of one glove near the wrist, peel it off inside-out, hold the removed glove in your gloved hand, slide your ungloved finger inside the wrist of the remaining glove, peel it off inside-out over the first glove, dispose of gloves properly
• Applying direct pressure to a wound using a clean dressing or gloved hand
  • Place the dressing directly on the wound, apply firm, consistent pressure, maintain pressure until bleeding stops or help arrives
• Elevating an injured extremity while maintaining direct pressure
  • Support the limb, raise it above the level of the heart, continue applying direct pressure
• Locating and applying pressure to the brachial and femoral arteries
  • Brachial artery: locate the medial side of the upper arm, apply pressure against the humerus
  • Femoral artery: locate the crease between the thigh and groin, apply pressure against the pelvic bone
• Properly applying a tourniquet to an extremity
  • Place the tourniquet 2-3 inches above the wound, tighten until bleeding stops, note the time applied, do not remove once in place
• Demonstrating the correct application of various bandaging techniques (roller, elastic, triangular)
  • Roller bandage: start at the distal end, wrap towards the body, overlap each layer by 50%
  • Elastic bandage: start at the distal end, wrap towards the body, use even pressure throughout
  • Triangular bandage: fold into a triangle, place the arm in the center, tie the ends around the neck