First aid for gunshot wounds and fractures

8/13/2019 First aid for gunshot wounds and fractures

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MANAGEMENT OF GUNSHOT

INJURIES, BLEEDING & FRACTURES.

BY

Dr Ejidike Amaka


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OUTLINE

Introduction

Gunshot wounds

Fractures Control of bleeding

Shock

CPRCardiopulmonary Resuscitation Conclusion


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INTRODUCTION

As a rule, all gunshot wounds are consideredmedical emergency that requires immediatehospital treatment.

It can vary widely from case to case with widevariations in entry points since the location ofinjury can be in any part of the body.

The immediate damaging effect of the bulletare typically severe bleeding and frequentlyfracture of surrounding bones.


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With the potential of hypovolemic shock in

severe bleeding (a condition characterized by

inadequate delivery of oxygen to vital organs)

as well as the unpredictability of bullet

wounds, it is paramount that immediate aid

be given while awaiting help or transportation

to a hospital.


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GUNSHOT WOUNDS

Unpredictable puncture wounds that causemajor tissue damage

Has entry/exit points

It is difficult to assess the extent of damageand most far exceed what you can reasonablytreat with first aid.

For this reason, the best option for most bulletwounds is to get the victim to a hospital assoon as possible.


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How do you to stabilize the victim in

the meantime?

Make sure you are safe

If shooting was unintentionally (e.g., while

hunting or at the range),secure all firearms If shooting was at a crime, ensure the

shooter is no longer on the scene and that

both you and the victim are safe from

further injury.


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Call for help.

Do not move the victim unless you must doso to keep him safe or to access care.

Assess quickly how deep the gunshot wound

is- a big hole indicates serious injuryAvoid moving the victim as unnecessary

motion worsens the condition

Apply direct pressure to the wound to stopbleeding


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Do NOT attempt to remove the bullet

If victim is not breathing, commence

CPR

Transfer to hospital


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If wound is on the chestApply direct

pressure to control bleeding.

Seal wound with hand or airtight material

(e.g., plastic film) to keep air from being

sucked into the wound

DO NOT elevate the legs to treat for shock in

wounds on the chest or stomach

Victim should NOT eat or drink anything

including water


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If wound is to the arm or legUse direct

pressure to control bleeding.

Elevation of limbs can be employed in

this case to control bleeding and preventshock.


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FRACTURE

A broken or cracked bone

Occurs when pressure is applied to bone

Occurs with / without displacement of bonefragments


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Types of fracture

Open fracture: Skin breaks causing open

wound

Closed fracture: Skin not broken

Commuted fracture: involving 3 or more bone

fragments

Stress fracture: hairline crack due to repeated

stress eg marching (soldiers)


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SYMPTOMSSevere pain

Difficulty in movementSwelling/ bruising /

bleeding

Deformity / abnormaltwist of limb

Tenderness on applying

pressureDiscoloration

+/- signs of shock


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First-aid

Depends on type & location of fracture

For open fractures:

Control bleeding

Rinse and dress the wound


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For open / closed fractures

Check the breathing

Calm the person

Check for other injuries Immobilize the broken wound

Apply ice, if available, to reduce pain /

swelling Consult a doctor


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DO NOT:

Massage the affected area

Straighten the broken bone

Move without support to broken bone Move joints above / below the fracture

Give oral liquids / food


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HOW TO CONTROL BLEEDING

Could be mild, moderate or severe

All bleeding however must be controlled , if

left uncontrolled, severe bleeding may lead to

shock or even death

First step is to plug the hole, blood needs to

clot in order to begin the healing process


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1) Apply

direct

pressure


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2) Elevate above the

heart

Only for wounds outside

the chest or abdomen

This is because gravity

helps blood flow down

easier than it flows up


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3) Use pressure points

Areas of the body where blood vessels

run close to the surface

By pressing on these vessels, bloodflow towards the wound will be slowed

Press on a point above the wound (ie

closer to the heart) than below it


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Common pressure points:

Arm between the shoulder and the

elbow - brachial artery

Groin area along bikini linefemoralartery

Behind the knee popliteal area


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You should almost

never apply tourniquet

to these pressure

points as they have the

potential to damage

the entire limb by

blocking blood flow


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SHOCK

Uncontrolled bleeding may lead to a condition

known as shock.

Shock is essentially a decrease in blood flow

to the brain and other important organs.

Untreated, shock from bleeding will almost

always cause death.

Hence,the most important step in treating

shock is to control bleeding.


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WHAT ARE THE SIGNS?

Pallor

Fast tready pulse

Cold clammy extremities (hands and feet) Air hunger

Oliguria (not making urine)


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If the victim is already showing signs of

shock, it's important to take these

necessary steps to stabilize the victim

until help arrives.

As with all emergency treatment, make sureyou remain safe.

Call for help

Make sure the victim is breathing. If not,begin rescue breathing.


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Bleeding must be stopped.

If you do not suspect a neck injury, laythe victim on his or her back (supine)

and elevate the legs.

If you suspect a neck injury, do notmove the victim. Car and other vehicle

accidents often lead to neck injuries as

well as falls from a height taller thanthe victim.


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Keep the victim warm.

Continue to check on the victim. If thevictim stops breathing, begin rescue

breathing.

If the victim vomits, roll the victim to

one side and sweep the vomit from his

or her mouth with your fingers


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CPR- Cardiopulmonary Resuscitation

Life saving technique

Useful in emergencies (heart attack,

drowning) where a persons breathing or

heartbeat has stopped

WHY IS IT NECESSARY?

Without oxygenated blood = brain damage in

a few mins and death in 8-10 mins

Do something!!!


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CAB is the new ABC

C = CIRCULATIONensure blood flow

A = AIRWAYis the airway patent?

B = BREATHINGbreathe for the victim


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AIRWAY

Ensure airway is patent Remove any debris in the

mouth

Head tilt (if no spineinjury) + chin lift = opens

airway

Look out for chest motion,listen for normal breath

sounds


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BREATHING

Breathe for the person

Mouth to mouth (or mouth tonose if the mouth is seriouslyinjured)

Give 2 rescue breathes, look outto see if chest rises

30 compressions to 2 rescuebreathe

If after 5 cycles (about 2 mins) nomovementpatient would needadvanced life support

DO NOT stop CPR until help comes


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IN SUMMARY:


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CONCLUSION

Aim to DO SOMETHING before medical help

arrives

The difference between what you do and not

doing anything could just be SOMEONES LIFE.

Thank you for listening.


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First aid for gunshot wounds and fractures

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