anatomy atlases- anatomy of first aid, a case study approach

8/2/2019 Anatomy Atlases- Anatomy of First Aid, A Case Study Approach

1/67

Anatomy Atlases: Anatomy of First Aid: A Case Study Approach: Drawing Blood and Transfusion

natom y of First Aid: A Case Study Approach

raw ing Blood and Transfusion

onald Bergm an, Ph.D.

eer Review Status: Internally Peer Reviewed

hospital corpsman consulted her list of blood donor volunteers and asked one to donate a

nt of O+ blood. It was possible that it might be needed for an emergency appendectomyeing undertaken by the ship's surgeon while at sea. The volunteer Sailor was brought tockbay and asked to lie down on the bed. The corpsman determined that the Sailor wasealthy; his pulse, temperature and blood pressure were of normal values. She then tied a

bber band around the Sailor's arm, above the elbow, tight enough to stop superficial venood flow but not enough to prevent arterial blood flow. The cubital fossa (anterior surfacee elbow) was palpated and the median cubital vein was readily located (see illustrations),cilitated by the Sailor repeatedly making a fist. The corpsman knew that there were severrge veins available in the region of the cubital fossa that she could use for venipuncture. Sas aware that there is considerable normal variation in the pattern of veins in the arm andis is usually of no consequence. The corpsman then sponged clean the cubital fossa withcohol and dried it with a sterile gauze pad. She inserted the IV catheter through the skin n angle of about 45 degrees until she felt the needle enter the vein (by a slight decrease o

sistance), then she decreased the angle of the syringe to about 10 to 20 degrees anddvanced it slightly. Blood filled the lower part of the catheter reassuring the corpsman thae was indeed inside the vein. The plastic sleeve of the IV catheter was advanced over thetheter needle into the vein. The pressure band was then released. A blood collection bagas connected to the hypodermic needle and the hypodermic needle was carefully taped toe skin to prevent it from becoming dislodged. The corpsman had several types of cathete

eedles to select from but used the simplest one in this case.

ttp://www.anatomyatlases.org/firstaid/DrawingBlood.shtml(1 of 5) [20/12/2007 19:21:13]


2/67




3/67


he back of the hand (the dorsum of the hand) is also available for venipuncture or IVsertion and here the veins are usually clearly seen. They are not tightly bound torrounding tissues, hence they move and are deceptively easy to penetrate. If they are he

place by a finger, penetration is facilitated. Instead of the rubber band being applied aroe arm when the back of the hand is selected for venipuncture, it is placed around the lowrearm above the wrist.



4/67




5/67




6/67

Anatomy Atlases: Anatomy of First Aid: A Case Study Approach: Closing Cuts of the Skin and Underlying Tissues

losing Cut s of t he Skin and Underlying Tissues

onald Bergm an, Ph.D.eer Review Status: Internally Peer Reviewed

nor or even deep wounds to the skin and underlying tissues can be closed by using Buttepe or by suturing. Taping or suturing should be done when the wound is large, clean andon-jagged. Wounds of the chest and abdomen will be considered later in this booklet.

o not close a wound if the area of the wound is dirty (contaminated), is very deep (into fascia or even deeper, into muscle), or is over 12 hours old. Bleeding is to be controlled, byessure or by tourniquet if necessary. If the wound cannot be closed, tape a sterile or clea

oistened bandage over the entire wound and seek medical assistance immediately.

hings to remember: Skin thickness varies. It is thinnest over the eyelids and face and thickn the palms of the hand and soles of the feet, the back and scalp. It is usually thinner oveentral (anterior) surfaces and in older people.

inging the edges of the skin together by suturing will be shown.

rst review the anatomy of the skin and underlying tissues of the limbs in the following

ustration:

ttp://www.anatomyatlases.org/firstaid/ClosingCutsOfSkin.shtml(1 of 2) [20/12/2007 19:23:26]


7/67

Anatomy Atlases: Anatomy of First Aid: A Case Study Approach: Closing Cuts of the Skin and Underlying Tissues

ttp://www.anatomyatlases.org/firstaid/ClosingCutsOfSkin.shtml(2 of 2) [20/12/2007 19:23:26]


8/67

Anatomy Atlases: Anatomy of First Aid: A Case Study Approach: Stitching a Cut

t it ching a Cut


cook on his first deployment, was preparing some meat for a stew when he lost control oe knife and cut his hand. He stemmed the blood flow by placing a clean cloth over the cu

nd applying pressure above the cut. He hurried over to the sickbay to find a hospitalorpsman.

he corpsman cleaned the hand with antiseptic and decided to use sutures to close theound. The size of the cut was too large to use a butterfly tape as a skin closer. The

orpsman had several types of stitching to choose from (see illustrations):

utures A: a lock-stitch

ttp://www.anatomyatlases.org/firstaid/StitchingACut.shtml(1 of 3) [20/12/2007 19:23:03]


9/67


utures B: an interrupted stitch

utures C: a continuous stitch.

n interrupted stitch (B) was thought to be the best to close this cut.

he corpsman used a sterilized needle and suture. A stitch was made through the skinvoiding the superficial fatty fascia as much as possible) at the midpoint of the wound ande edges of the wound drawn closely together. The thread was knotted (square knot) and

ut. The corpsman continued until he completed the closure and covered the wound witherile gauze. The gauze was taped to keep the injured area clean. The corpsman advised t

ook to inspect his hand daily for signs of infection (inflammation, heat, pus and no sign ofealing). A serious infection may require stitches to be removed to drain the infected site.



10/67


utures D: remove stitches

fter 7 days, the corpsman had the cook return to sickbay to remove the stitches using thechnique shown in the last illustration (Sutures D). It is important to cut the sutures as shoreduce the possibility of infection. Before removing the stitches however, the injured han

as again cleaned with antiseptic. Pull up on the knot. Slide scissors under one end with thades parallel to the skin. Cut suture and pull knot and suture out of skin completely.

corpsman may use the following guideline for the number of days for healing to occurefore removing stitches: 5 days for face wounds, 7 days for body wounds and arm and ha

ounds, and 8-10 days for leg and foot wounds.



11/67

natomy Atlases: Anatomy of First Aid: A Case Study Approach: The Eye

he Eye

onald Bergman, Ph.D.er Review Status: Internally Peer Reviewed

Machinist Mate is finishing work on a metal object when he suddenly feels scratchy, sharp pain in hisd hurries to the medical corpsman for help.

e corpsman first, tries to wash out the offending object with lukewarm water by splashing or floodinge eye with water, until blinking is not painful.

this does not succeed in removing the object, blinking alone may flush the object from the eye. This very painful because the conjunctiva is richly supplied with pain nerve receptors.

this simple procedure also fails, the corpsman will examine the eye by lifting the eyelid from the eyebveral methods are shown in the illustrations.

the corpsman cannot find any object on the conjunctiva or cornea that would cause irritation, the objay be embedded in the eye. If this is the diagnosis, both eyes are covered with sterile or clean pads aped in place. Medical advice or assistance will be sought.

ttp://www.anatomyatlases.org/firstaid/Eye.shtml(1 of 5) [20/12/2007 19:24:18]


12/67


e eyelids and eye will be examined and if a foreign object is seen, it will be flushed directly to dislodg with a clean moistened soft swab, the object is loosened and flushed, to remove the offending objee illustrations.



13/67


pain, tearing, or vision defects occur after removal of the foreign object or if the corpsman fails to fine cause of the problem he will seek medical advice and / or assistance.

ote: If any damage occurs to the eyeball, both eyes must be covered by sterile moist pads, and tapedace. Remember that the eyes are extensions of the brain and infections may ultimately involve the brs is to be avoided at all cost. A physician must treat a damaged eye, as soon as possible.



14/67


e anterior eye and eyelids.

E A. The eyeball is covered and protected anteriorly by two thin , movable eyelids (or palpebrae). Theball is also covered by a transparent mucous membrane (the conjunctiva), which is continuous alone inner surface of both eyelids (the palpebral conjunctiva).

the medial angle of the eye a small piece of skin (the caruncula lacrimalis) is located that containsbaceous and sweat glands.

e pupil is the circular opening in the iris. The size of the opening is controlled by the nervous systemst, the parasympathetic nervous system constricts the pupil and in danger, the sympathetic nervousstem supplies the pupillary dilator muscle to enlarge the pupil.



15/67


e low er eyelid and medial angle

E B. The lower eye lid has been pulled downward in order to expose its inner surface (i.e., the palpenjunctiva), as well as the medial angle (or medial canthus). The gaze is upward (superiorly) and outw

terally).

e conjunctiva is very vascular and very sensitive. The inferior palpebral part and the bulbar part arentinuous along a line of reflection (inferior conjunctival fornix). The line of reflection is also foundtween the eyeball and the upper eyelid (superior conjunctival fornix).

hen the medial angle is enlarged, a pair of small openings (punctae lacrimali) are visible, located abod below the caruncula lacrimalis. These openings enter the lacrimal canals leading to the nasolacrimact and further, to the nose.



16/67

natomy Atlases: Anatomy of First Aid: A Case Study Approach: Fracture of the Jaw

racture of the Jaw


petty officer was carrying an iron rod on his shoulder. He heard his name being called and swung aroundn rod accidentally hit a Sailor in the face with great force. He fell to the floor and broken teeth and bloodiva came from his mouth; he was unconscious. The face of the Sailor began to swell and extensive bruisicame evident. A corpsman was called immediately.

is important for the person providing first-aid to know the anatomical basis of the injured region beforeatment starts. This information is provided in the first illustration).

ttp://www.anatomyatlases.org/firstaid/JawFracture.shtml(1 of 3) [20/12/2007 19:25:00]


17/67


e Sailor was coughing and choking and it was not certain if there was any neck damage. The corpsman, ditional aid from other Sailors, carefully rolled the patient to his side. Particular attention was paid to thesition of the head and neck so that it remained facing forward in its usual position with the body lying on e. The Sailor's mouth was inspected and cleared of broken teeth and foreign bodies; the choking ceased.

hole teeth were wrapped in a sterile or clean cloth. The patient gradually became conscious but was in gr

in, which the corpsman medicated. A neck brace was applied until the extent of the injuries could becurately determined. The patient was turned on his side so that blood and saliva could drain from his moueeding from a small cut on the Sailor's face was cleaned with a moist sterile cloth and controlled by gentleessure. A cold bandage or package was applied to help reduce swelling of the tissues associated with the

e following clues were sufficient for the corpsman to diagnose a broken jaw: facial tenderness, swelling,



18/67


ange in symmetry of the face, pain on moving the jaw, inability to speak and open or close the jaw. Thessibility of other damage, e.g., to the zygomatic arch, the orbit and eye must also be carefully consideredecond illustration).

e corpsman also determined that the airway was clear, controlled bleeding and supervised the transfer ofilor to sickbay for definitive medical attention.



19/67

Anatomy Atlases: Anatomy of First Aid: A Case Study Approach: The External Ear

he External Ear

onald Bergm an, Ph.D.er Review Status: Internally Peer Reviewed

petty officer second class took a boat full of supplies to a Marine base located on an islande South China Sea. While waiting for his boat to be unloaded he found an isolated place toke a nap. When he awakened he heard a buzzing in his ear and became panicked and triedmove the insect with his little finger to no avail - but the buzzing stopped. A corpsman,signed to the Marines and who was on the island at the time, told the Sailor the following

mportant things to remember when there are problems with the ears. If there are foreignbjects in the ear do not use any liquid to flush the offending object from the ear. Do not plany instrument or tool in the ear canal. Do not hit or thump the head to free and dislodge thfending object. The corpsman suspected that an insect became trapped in the ear. Therpsman had an otoscope in his medical kit and was able see, and to remove, the crushedsect. The corpsman suggested several things that could be done in the absence of immediaedical care. If a live insect is in the external auditory canal one can safely kill the insect witw drops of alcohol. However, seek medical assistance as soon as possible to remove thesect. The rationale for not putting water in the ear is that some objects swell in water, lead

ttp://www.anatomyatlases.org/firstaid/Otoscopy.shtml(1 of 3) [20/12/2007 19:25:39]


20/67


significant pain and greater difficulty in removal of object.

bjects that are clearly visible and easily accessible at the entrance of the canal may bemoved with a tweezers. A physician should be consulted to confirm the removal of the obje). To the inexperienced, trying to remove objects with a tweezers can result in damage to t

ardrum. One additional method, short of medical treatment, is for the individual to turn hisead, with the affected ear down, and to shake his head. Do not try any other procedure -- n, water or hitting the head. The corpsman will safely remove the object.

rainage from the ear is another serious event. If there is bleeding from the ears consider aull fracture; immediate medical attention is essential. If bleeding is from the external ear, iay be controlled by direct pressure with a sterile or clean cloth. Do not try to stop drainageeeding from inside the ear. Do not allow the patient to thump his head to restore lost hearave the patient lie on the side of the head that is affected to promote drainage.

ar dr um



21/67


ar emergencies requiring medical care may include the following: swimmer's ear usuallyused by bacteria; varieties of ear pain from middle ear infections, toothache, and mandibuint pain; excess wax in the ear and perforation of the ear drum resulting in a loss of hearinoking irritating hard objects into the ear and the introduction of foreign objects.

wimmer's ear may result in disturbing sensations from retention of water in the ear. This cae avoided by placing a few drops of a solution containing 20% white vinegar or dilute 20%bbing alcohol in the external acoustic canal.



22/67

natomy Atlases: Anatomy of First Aid: A Case Study Approach: Bladder Catheterization

adder Catheter izat ion

nald Bergm an, Ph.D.r Review Status: Internally Peer Reviewed

ailor aboard a supply ship in the Red Sea reported to sickbay and told the hospital corpsman on duty that

was having great difficulty urinating and that his bladder was full and he could not adequately relievemself. His distress was obvious. The corpsman donned sterile gloves and then tapped the Sailor's lowerdomen verifying the full bladder. He told the Sailor that he would empty his bladder by catheterizatione accompanying illustrations). Hearing this, the Sailor became very anxious. His anxiety was greatlysened when the corpsman explained to him that the procedure might look painful but actually was not.addition, the relief he would feel would worth any discomfort he might feel.

ttp://www.anatomyatlases.org/firstaid/BladderCatheterization.shtml(1 of 5) [20/12/2007 19:27:10]


23/67


aseptic wash of urethral opening of penis.

ertion of catheter.

order to catheterize the Sailor the corpsman swabbed the urethral opening of his penis with a non-tating antiseptic. Taking a sterile catheter lubricated for about two inches he inserted it slowly into thethral meatus (opening), he encountered a slight resistance at the sphincter located in the urogenitalphragm, then it moved easily through the prostatic urethra into the bladder. A flood of urine enteredcollection bag. The corpsman taped the catheter tube to the Sailor's abdomen to secure the collection bag.

e corpsman told the Sailor that a physician would take over his case and prescribe a course of treatment forproblem.



24/67


covery of urine.

heterization is essentially the same in both male and female; the catheter, by traversing the urethra, entersd drains the bladder. The anatomical route is shorter in the female patient but must be understood in ordereffectively perform the catheterization procedure.



25/67




26/67




27/67

natomy Atlases: Anatomy of First Aid: A Case Study Approach: Choking

hoking


squad of Marines was celebrating the end of prolonged and strenuous maneuvers with a steak dinner. Du

e meal, one of the Marines stood up clutching his throat, his face turning red. The choking sign was clearderstood; he was unable to speak and he had severe difficulty breathing. The treatment to follow will bensidered in 5 scenarios:

mediately the Marine began coughing. A piece of meat flew out of his mouth and the Marine began toeathe normally. This ends the 1st scenario.

ttp://www.anatomyatlases.org/firstaid/Choking.shtml(1 of 7) [20/12/2007 19:28:42]


28/67


mediately the Marine thrust his abdomen on the top of a chair back. A piece of meat flew out of his moutd the Marine began to breathe normally. This ends the 2nd scenario.

Standing thumper

mediately a corpsman assigned to the squad asked, "Are you choking?" The Marine nodded. The corpsmve 3 backblows between the shoulder blades to the Marine with the man in a bent over position. A piece eat flew out of his mouth and the Marine began to breathe normally. This ends the 3rd scenario.



29/67


Standing Hemilich If pregnant

mediately a corpsman assigned to the squad grabbed the Marine from behind, between the ribs and thembilicus (belly button), and gave several strong thrusts or squeezes to the Marine's abdomen (Heimlichaneuver). A piece of meat flew out of his mouth and the Marine began to breathe normally, the red skin ccreased, the heart rate decreased and the panic subsided. If pregnant, the corpsman would give the thrud-sternum. This ends the 4th scenario.

e methods outlined above, coughing, backblows, and abdominal thrusts (Heimlich maneuver) have a verygh rate of success. In the event, however, that these methods fail to dislodge the obstructing material froe air pipe (trachea), a tracheotomy must be considered.



30/67




31/67


the choking victim is without oxygen for 4 to 5 minutes he may die or have severe brain damage, if hervives. Tracheotomy is the last resort - the very last resort - a matter of life or death. In order to beccessful, several common sense things must be kept in mind.



32/67


mediately a corpsman that was present for dinner asked one of the Marines to keep time for him and cal

e time by the minute. He tried the Heimlich maneuver several times and after this failed to dislodge thestruction the choking victim became unconscious. The corpsman then palpated the thyroid cartilage andund the "Adam's apple" or laryngeal prominence. The corpsman then traced the cartilage distally in thedline straight down until it ended (about 2.5 cm. or 1 inch). The hard cartilage gave way to a membrane ot), the cricothyroid membrane. It is this membrane that must be opened (see diagrams). (Elapsed time e minute) The skin was opened with a sharp knife in the sagittal plane (up/down). Pulling the cut surfaceart (right/left) he quickly examined the exposed area for blood vessels and parts of the thyroid gland.apsed time - two minutes) Avoiding blood vessels and glandular tissue he punctured the cricothyroid

embrane with a knife (very carefully and never transversely) (or he could have used a sharp pencil or ballint pen), to enter the trachea. The depth of the puncture should be just sufficient to gain access to the

way. No more than a half-inch or about 1.25 cm. To maintain the opening to facilitate breathing, a sodaaw or tube was placed in the opening. (Elapsed time - three minutes) The duty corpsman said he was tophysician about "the rule of three" - something easy to remember and to be on the safe side - three weekthout food and you die; three days without water and you die; but only three minutes without air and youe. The Marine was then taken to sickbay for further treatment. The entire procedure took less than 4 minue opening of the airway allowed the Marine to get the oxygen needed to survive. This ends the 5th scenamember that tracheotomy is the last resort to restore respiration but; the alternative is death.

Dangers of anatomic variat ions covering t he cricothyroid ligam ent



33/67


owledge, and confidence in that knowledge, makes this procedure as safe as is possible in an emergencyuation.



34/67

Anatomy Atlases: Anatomy of First Aid: A Case Study Approach: Sucking Chest Wound

ucking Chest Wound


Marine on patrol in the desert felt a sharp pain in his chest and had difficulty breathing; hlled for a corpsman and then collapsed. He had sustained a penetrating bullet wound to h

hest on the right side. Air had rushed into his chest and his right lung collapsed. Theorpsman recognized the seriousness of this life-threatening wound and knew that the Maras breathing with one lung. He cut away the Marine's shirt and looked for entrance and exounds; he found only an entrance wound. Bleeding was minimal but uncontrollable. Theorpsman recognized that on inspiration air entered the opening in the chest caused by the

ullet and, on expiration, air was forced out of the thoracic cavity (see illustrations). Heepared a sterile occlusive dressing that was taped securely to the chest over the wound odes. One edge was not taped leaving an opening to the dressing. He knew that this wouldct as a "valve" and on inspiration the occlusive dressing would be drawn tightly to the chey the negative pressure (hence the name "sucking wound"). External air is excluded. Onxpiration, the air forced out of the thorax escapes at the unsealed edge of the occlusiveessing. Had the corpsman found an exit wound he would have dressed the wound in theme way. As soon as the corpsman finished with the dressing he covered the Marine with cket to reduce shock. He called for a stretcher and because of the life-threatening nature

e wound, he had the Marine airlifted by helicopter to a hospital ship lying off shore. He wmmediately taken to a navy surgeon for the definitive treatment that is only available in thospital.

ttp://www.anatomyatlases.org/firstaid/ChestWound.shtml(1 of 6) [20/12/2007 19:29:24]


35/67




36/67




37/67




38/67




39/67




40/67

natomy Atlases: Anatomy of First Aid: A Case Study Approach: Injury to Thigh

njury t o Thighompound (Open) Fracture of Femurse of Tourniquet

onald Bergman, Ph.D.

er Review Status: Internally Peer Reviewed

n an aircraft carrier in the Persian Gulf, flight deck personnel were readying fighter aircraft forike at enemy ground forces. One of the Sailors had a problem with ordinance and one rockecidentally discharged. The rocket flew into and past another Sailor causing severe injury to high and fracturing his femur. Ruptured femoral vessels poured forth blood and the injured Sa

l to the deck unconscious. An alert Sailor called for someone to summon the corpsman and te dropped to the deck to close off the blood loss by use of a tourniquet. Very shortly afterware corpsmen arrived. The corpsman checked the tourniquet (see accompanying illustrations), rote on the forehead of the victim the time of application of the tourniquet. The Sailor wasvered with a blanket to reduce the possibility of severe shock and the wound was covered werile, moist gauze. The injured Sailor's vital signs were taken (pulse, blood pressure andspiratory rate) as he was taken rapidly to the sickbay. In the meantime, the naval surgeon wmmoned to sickbay, which was readied for treatment of the injured Sailor. If this accident ha

appened on shore, the corpsman would have followed the same procedures but would have h

ttp://www.anatomyatlases.org/firstaid/ThighInjury.shtml(1 of 15) [20/12/2007 19:30:19]


41/67


immobilize the leg with a splint. The splint, in combat, might include a branch of a tree or anher inflexible object (preferably clean) a pillow, magazine or newspaper as the supportingructure. The two legs can be merely bound together. The rationale is to avoid causing furtheamage by the sharp edges of the fractured bones moving about while the patient is beingvacuated.

he following are useful guidelines when one considers the possibility of broken bones. A

rpsman may use the following signs as indicators of broken bones:

Pain or soreness over a joint or bone.

The victim tells the corpsman that he heard or felt a break.

The victim can't move an injured part or that a move is painful.

The victim tells the corpsman that there is numbness or tingling in the injured limb. This is a

n indicator of possible nerve injury.

An arterial pulse cannot be found in the injured part or limb. This is an indicator of blood vesury.

The corpsman sees swelling or bruising in the injury site. This an indicator of extravasatedood.

The injured part is in an unusual or abnormal position and any possible movement is abnorm

ow to provide first aid to victims with bone or joint injuries? Without x-rays or MR imaging it iot always possible to know if a bone is broken, a joint is dislocated or damaged, or if ligamene stretched or torn. The rule-of-thumb therefore, is not to guess, but to immobilize the injure

art. However, this is not the first step in the first aid of these victims.

Treat for any life-threatening condition first: check breathing, pulse and for any bleeding.nally stabilize the fractured bone or injured joint.

It is essential to keep movement of the individual and the injured part to a minimum. Thetional for minimal movement is to reduce the possibility of additional damage to bone, musclood vessels and nerves and the production of additional pain.

Immobilize the injured part with bandages, slings and splints.



42/67


If there is torn skin avoid contamination of exposed underlying structures using sterilempresses. Infections of bone are very serious and difficult to treat. If there is a compound o

pen fracture (bone sticking through the surface of the skin) never try to push the bone insidern muscle.



43/67


Swelling of joints can be avoided by cooling the injured part using ice wrapped in a cloth orwel.

Treat for shock and secure the aid of a medical corpsman and physician as soon as possible



44/67




45/67


Colle's fracture



46/67


Comminutedracture

Green-stick



47/67




48/67


mpacted

ncomplete



49/67


inear



50/67


Oblique



51/67


ott 's fract ure



52/67


piral fracture



53/67


54/67




55/67

Anatomy Atlases: Anatomy of First Aid: A Case Study Approach: Open Abdominal Wound

bdominal Wound w it h Prot ruding Viscera


Sailor, on liberty in a foreign port, was returning to his ship when a knife-wielding assasstacked him. He later remembered that he was slashed, but was able to chase his assailan

way, before he collapsed. Two of his shipmates found him, and when it was clear that thejury was severe, one of the shipmates was sent to get the ship's corpsman.

he attending shipmate was familiar with "first aid" and set about initial care to reduce theossibility of severe shock. The injured Sailor had regained consciousness and was rational

nd was told not to stand up. He was covered with his shipmate's jacket and his feet and leere elevated. His vital signs were satisfactory; pulse was regular (between 60 and 90 beaer second); breathing rate acceptable (about 15 to 20 per minute), and his blood pressureulse was judged, in the absence of a pressure cuff, to be strong.

he corpsman on duty and the other shipmate quickly returned from the ship. The corpsmaok over responsibility for first aid and examined the wound. He cut away the Sailor's shirt

xpose the abdominal wound and found that his intestines were protruding from the woundthough bits of the Sailor's shirt were adhering to the intestines they were not removed. T

orpsman told his shipmates that the intestines must not be touched and no attempt must ade to replace the intestines back into the abdominal cavity as part of first aid. This is to erformed in sickbay by the naval surgeon. The corpsman carefully covered the wound witherile moist gauze bandage taped to the abdomen.

he corpsman contacted the ship's duty officer to obtain a stretcher and to alert the medicaficer that a severe abdominal wound was on the way to the ship for surgical treatment.hen the stretcher arrived, the four Sailors carefully placed the injured Sailor on the stretch

nd transported him safely to sickbay for definitive medical care aboard ship.

ttp://www.anatomyatlases.org/firstaid/AbWound.shtml(1 of 3) [20/12/2007 19:30:58]


56/67




57/67




58/67

natomy Atlases: Anatomy of First Aid: A Case Study Approach: Amputation

mputation

nald Bergman, Ph.D.er Review Status: Internally Peer Reviewed

Sailor aboard a destroyer in the Atlantic Ocean lost her hand in angineering accident. A nearby Sailor called out for someone tommon the corpsman and he immediately applied a tourniquet (seection on Injury to Thigh) on the injured arm. He was able to stop

e bleeding and had the Sailor lie down. She was covered with aanket to reduce the possibility of severe shock. The Sailor alsocognized the necessity to elevate her feet by about 8 to 12 inches.e remembered that shock is essentially a sudden drop in bloodessure, which may be so severe that the brain and other vitalgans do not have adequate blood flow. These few, simple, thingslp prevent additional cardiorespiratory complications.

now the corpsman arrived on the scene and took charge of first aid. He checked her vital signs (pulsee, blood pressure, and respiratory rate), which were found to be at satisfactory and stable levels. He located

e severed hand, wrapped it in sterile bandages and placed the hand in a plastic bag and then into a carrierbrought with him. It was filled with ice to chill (not freeze) the amputated part. The corpsman then returnedthe patient and recorded the time of application of the tourniquet on the patient's forehead with a

ttp://www.anatomyatlases.org/firstaid/Amputation.shtml(1 of 2) [20/12/2007 19:31:25]
http://www.anatomyatlases.org/firstaid/ThighInjury.shtmlhttp://www.anatomyatlases.org/firstaid/ThighInjury.shtml


59/67

natomy Atlases: Anatomy of First Aid: A Case Study Approach: Amputation

terproof marker in large numbers. Ascertaining once again that the bleeding had stopped, he taped ase, sterile, moist bandage over the stump of the forearm but was very careful not to cover the tourniquet.then supervised the movement of the patient to his sickbay. Not equipped to handle amputations,communicated with the medical officer on a nearby ship for further instructions. He then made preparationship-to-ship transfer of the injured patient.

ttp://www.anatomyatlases.org/firstaid/Amputation.shtml(2 of 2) [20/12/2007 19:31:25]


60/67

natomy Atlases: Anatomy of First Aid: A Case Study Approach: Burns (by degree)

urns (by degree)


submarine rendezvoused with its submarine tender and an electrical power line was requisitioned by thebmarine to service the submarine while it took on supplies and the crew worked on its nuclear power plane of the submariners handling the power line was accidentally electrocuted. Immediately another crewme

oved the Sailor from the power line with a non-conducting wooden pole. A corpsman had been summoned arrived in time to take over the first aid treatment.

fore discussing first aid given to the submariner, burns, whether caused by flames, electricity, scalding wction, radiation or chemicals are described as first-, second- or third-degree burns. The first illustration dee tissues effected. A first-degree burn is one involving the epidermis causing erythema (redness) and edewelling) but no blisters. A second-degree burn involves the epidermis, the dermis and usually forms blisteat may be the result of superficial or deep dermal necrosis. Burns of this type have epithelial regenerationtending from skin appendages (sweat glands, hair follicles, etc.). A third-degree burn results in the

ttp://www.anatomyatlases.org/firstaid/Burns.shtml(1 of 6) [20/12/2007 19:32:25]


61/67


struction of skin, and may extend into the superficial (fatty) fascia, muscle and bone. Scarring is ansequence of this type of burn.



62/67


turning now to the Sailor with the electric shock; the corpsman knew that electrical burns, even the smale considered third-degree and both an entry and exit burn was possible. The clothing was removed from eas of both burns, which were quickly, but briefly, cooled with water. A cold wet compress was placed on ounds followed by clean dry (sterile) dressings. The patient was breathing rapidly, but denied the presencin. The absence of pain is typical because nerves are destroyed in the path of the burn. The burns were s

charred areas about two inches across. The corpsman asked for a blanket to keep the Sailor warm to rede possibility of severe shock; his feet were elevated and his vital signs (respiration rate, blood pressure anmperature) were monitored. The corpsman covered the burns with sterile dressings, and the patient wasken to the subtender's sickbay where a naval surgeon took charge of treatment of the burn victim.

fore he left, the corpsman told several interested crewmen that blisters and charred skin would be treateater time. In addition he said that butter, household remedies, pain relief medication, ointments or spraysere not to be used for burns of this type and further, if used, may even delay proper healing. The corpsmad that a small third-degree burn might be difficult to recognize if it is located in an area of second- or evest-degree burn skin damage. If there is any doubt, the whole area is treated as a third-degree burn. Indition, because of nerve damage in third-degree burns, a patient must not be allowed to use or put weighburned limb, foot or hand.

e knowledgeable medical corpsman continued by explaining to the assembled group the differences betwd treatment for, second- and first-degree burns. First-degree burns are characterized by red skin, mildelling with or without pain. Second-degree burns are deeper, with red coloration and other skin damage,ch as swelling, blisters, oozing or leaking skin, pain greater than 1st degree burns and the possibility ofock . See the first illustration to gain an understanding of the depth of tissue damage in various types ofrns. As with other first aid treatments, rapid and proper treatment will reduce the severity of the probleme patient. With burns of the face, or hot air or hot smoke inhalation assume the possibility of respiratoryrns; these require immediate medical attention. Do not remove dead burned tissue and do not open blist

at may form, particularly in second-degree burns. Do not remove clothing that may adhere to the burnedea. Do not use home remedies, margarine or butter, ointments or sprays except on the advice of a physicsenior corpsman. Pain relief sprays and ointments can be used on minor or small first-degree burns. Seevice of the corpsman for any burns but particularly those of the face, second-degree and extensive first-gree burns. Minor second-degree burns are those small enough to be covered by a small, 3" X 3," sterileessing but do not involve the face, hands or feet. First aid includes immersion of the burned part under conning water or if this is impractical, by using cold wet compresses. Continue the cool water treatment unte pain disappears. For second-degree burns of hands, feet, face and/or perineum, e.g., the entire arm or 15 % of the body, and burns that blister, see the corpsman for advice and additional treatment. Second-gree burns involve deeper areas of the skin that may release fluid from damaged blood vessels that caussters. Usual causes are: deep sunburns resulting from prolonged exposure to the sun by Sailors not wear



63/67


rts on outdoor work details, prolonged exposure with hot objects, scalding by hot water or steam, and bysh-burns from inflammable liquids. First-degree burns involve the superficial layers of the skin, whichcomes red but not broken or blistered. Pain receptors in the superficial layers of the skin become irritatedoduce the perception of pain, which may be intense. Recovery of the skin from the burn is usually quick amplete. Treatment may include cooling with water, aspirin or other analgesics.

e corpsman said he used the "rule of nines" to describe the extent of the burn or area of the burn exprespercent of the total body surface for an adult. The rule of nines allows that each upper limb is 9%, head

ck is 9%, anterior trunk (chest and abdomen) is 18%, the posterior trunk (back) is 18%, each thigh is 9%d each leg (not including thigh) is 9%, and the perineum is 1%. Burns need to be treated in the hospital ey are more than 20% of body area, involving a critical area such as face, hands, feet, genitalia, perineumd major joints, all electrical and chemical burns regardless of size, and smoke inhalation or carbon monoxisoning.

e corpsman also discussed chemical burns and stated that exposure to dangerous chemicals must be rinsm the skin and that contaminated clothing is removed. Water dilutes these substances and flushes them

way. No attempts to neutralize the substance should be attempted because greater damage may occur byemical reaction resulting in additional burning. Frequently encountered products that cause third-degreeemical burns include hydrofluoric acid (rust removers) nitric, sulfuric, phosphoric acids (commercial gradeds) hydrochloric acid (cement and drain cleaners); these chemicals must be used with great care.



64/67


eatment includes removal of contaminated clothes, flushing the affected area with running water for at leminutes. Relieve pain with cool, wet compresses until the corpsman arrives. The corpsman will decide if aval surgeon is required. He also said that in burns to the face or the inhalation of toxic chemicals; assumendition of respiratory burns, which require the immediate attention of a physician.



65/67




66/67

Anatomy Atlases: Anatomy of First Aid: A Case Study Approach: Smoke, Gas, and Chemical Fumes

moke, Gas, and Chem ical Fumes


umes from any unknown source may be flammable! Before proceeding to assist a shipmata "smoke-filled" room do not light a match, use a candle, or even turn on a light switch.

ot produce a flame or spark in the presence of gas or unknown sources of fumes.

he cruiser returned to port for refitting and the Executive officer was told to have the deckew remove the rust on the ship, to chip loose paint and to repaint those areas. The Chief

ent with a crewman to the paint locker to inventory existing supplies. On entering the lockey encountered overwhelming fumes, were quickly overcome, and collapsed before they

ould escape the room. Because the Chief was needed for another problem another crewment to the paint locker to find him. He smelled the fumes and remembered that he mighteed more assistance when he got to the locker. He also remembered the admonition abouparks and flames and also the need for a hospital corpsman. The Sailor told these things tnother shipmate to get help and he and still another Sailor proceeded to the locker. Althouark, he could make out two bodies on the deck. The two Sailors took several deep breathsesh air, inhaled and then held their breath. In cases where smoke and fumes are visible

ttp://www.anatomyatlases.org/firstaid/Smoke.shtml(1 of 2) [20/12/2007 19:32:46]


67/67

Anatomy Atlases: Anatomy of First Aid: A Case Study Approach: Smoke, Gas, and Chemical Fumes

bove the floor they would stay below them but in this case the paint fumes were evenlyspersed in the entire room. They removed the two men into an area with fresh air andxamined the two men for breathing. One was still breathing but the Chief was not. Theompt arrival of the corpsman began with attempts at artificial respiration to restoreeathing. Eventually the corpsman was successful and the Chief began to breathe on his

wn. The corpsman made a quick check of the victim's eyes and skin to see if the fumes wexic enough cause visual problems. The eyes were clear but were flushed with clean (or

erile) water. Before the Sailors could be moved they were treated for shock. Their vital sigere assessed and found satisfactory but weak. The Chief was placed on his back with hisead and chest slightly elevated. The Chief was unconscious and vomited. He was placed os side and his knee of his top leg was bent to help him from rolling forward. Both Sailorsere covered with blankets to lessen shock and were finally taken to sickbay for observatio

he corpsman provided additional information. The effects of inhaled smoke, gas, and fumeom other sources may not be totally evident immediately. A thorough medical examinatioecessary, and a period of observation in sickbay may be beneficial should other symptoms

gns appear subsequently.

anatomy atlases- anatomy of first aid, a case study approach

Documents