Wounds and Circulation

Chapter 6• To assess the victim’s condition quickly and calmly

• To control blood loss by applying pressure and elevating the injured part• To minimize the risk of shock

• To comfort and reassure the victim• To call 911 for emergency help if you suspect a serious injury or illness

• To be aware of your own needs, including the need to protect yourself against BBP

The Heart & Blood Vessels

• Circulatory system:• Heart• Blood vessels• Three functions

1. Supply body with constant flow of blood2. Brings oxygen and nutrients to the tissues3. Carries waste away

• Three types of vessels1. Arteries2. Veins3. Capillaries

• Blood pressure: force that is exerted by the blood flow through the main arteries

•THE CIRCULATORY SYSTEM

How the Heart Functions

• The heart pumps blood by muscular contractions called heartbeats• Each beat has three phases:• Diastole- blood enters the heart• Atrial systole- squeezed out of the atria• Ventricular systole- blood leaves the heart

Diastole

• The heart relaxes• Oxygenated blood from the lungs--- pulmonary veins--- left atrium• Deoxygenated blood flows from venae cavae ( large veins that enter

the heart) into right atrium

Atrial Systole

• Two atria contract and the valves between the ventricles (pumping chambers) open so that blood flows into ventricles.

Ventricular Systole

• Ventricles contract• The left ventricle forces blood into the aorta----the rest of the body• The right ventricle pumps blood into pulmonary arteries----lungs to

collect more oxygen

• NOTE:• THE HEART’S RIGHT SIDE PUMPS DEOXYGENATED BLOOD FROM THE

BODY TO THE LUNGS.• THE LEFT SIDE PUMPS OXYGENATED BLOOD TO THE BODY VIA THE

AORTA

Composition of Blood

• 10 pints (5 liters)• 1 pint per 14 pounds of body weight• 55% is clear yellow fluid (plasma)• Red blood cells • Contain hemoglobin (enables cells to carry oxygen)

• White blood cells• Defend body against infection

• Platelets • Help blood clot

45%

Bleeding & Types of Wound

• Bleeding (hemorrhage) is characterized by the type of blood vessel that is damaged:

1. Arteries1. Bleeding is profuse2. Blood will spurt out in time with the heartbeat

2. Veins1. Darker red

3. Capillaries 1. Occurs with any wound2. Brisk, but slight3. Bruising

How Wounds Heal

• When a blood vessel is severed/ damaged= constricts/ narrows• Injured tissue cells and platelets begin to form a mesh• This mesh traps blood cells= make a clot• Clot releases fluid (serum) that contains antibodies and begins to

repair area• Fibroblasts form a plug within the clot--- scab

Types of Wounds• Simple laceration

• Clean surface cut from a sharp object (razor)• Blood vessels cut straight across; bleeding may be profuse• Tendons/ nerves may be damaged

• Complex laceration• Crushing/ ripping forces• Wounds may bleed less; may be deep tissue damage• Often contaminated with germs; infection risk is high

• Abrasion (scrape)• Superficial wound• Raw/ tender area• Sliding fall/ friction burn• May contain embedded foreign particles that may cause infection

Types of Wounds

• Contusion (Bruise)• Blunt blow-rupture capillaries beneath skin• Skin may split

• Puncture wound• Standing on a nail/ pricked by a needle• Small entry site; deep track of internal damage• Infection risk

• Stab wound• Long/ bladed instrument (knife)• Penetrating the body• Must be treated seriously

• Gunshot wound• Bullet/ missile• Serious internal injury• High risk of infection

Heart Attack (myocardial infarction)

• Most commonly caused by a sudden obstruction of the blood supply to part of the heart muscle• Main risk= heart will stop beating• Effects of a heart attack depend largely on how much of the heart

muscle is affected• Video

Heart Attack

• Recognition:• Persistent, central chest pain which may spread to the jaw & down one/ both

arms• Breathlessness• Discomfort occurring high in the abdomen • Collapse• Fainting/ dizziness• “Ashen” skin and blueness in the lips• Rapid, weak or irregular pulse• Profuse sweating

Heart Attack

• Your aims:• To ease the strain on the victim’s heart by ensuring that he rests• Call for emergency medical help

1. Make the victim as comfortable as possible; half sitting position with head and shoulders supported & knees bent-place cushions behind and under knees

2. Call 9113. Give aspirin tablet (if not allergic)4. Monitor/ record vital signs5. Stay calm

Angina

• Constriction of the chest• Coronary arteries become narrowed & can’t carry sufficient blood• Once victim rests- pain should ease soon • Recognition: • Central chest pain• Shortness of breath• Fatigue• Anxiety

Angina

1. Help the victim stop what they are doing and sit them down2. Help administer angina medication (nitroglycerin) if they have it3. Encourage the victim to rest4. If the pain persists, call 911

Fainting

• Brief loss of consciousness • Temporary reduction of the blood flow to the brain• May be caused by:

• Reaction to pain• Lack of food• Emotional stress• After long periods of physical inactivity

• Pulse rate becomes very slow• Pale, cold skin and sweating• DO NOT advise a person to sit on a chair with her head between her knees

because if she faints she may fall

Fainting

1. Advise to lie down. Raise her legs, supporting her ankles on your shoulders to improve blood flow to the brain

2. Make sure victim has plenty of fresh air3. Reassure the victim & help her sit up gradually

Internal Bleeding

• Bleeding inside body cavities may follow an injury• Fracture• Blow from a blunt object• May occur spontaneously (stomach ulcer)

• Main risk= shock• Initially pale, cold clammy skin• Rapid, weak pulse• Thirst• Rapid, shallow breathing• Confusion• “Pattern bruising”• Pain • Check for bleeding from orifices

Severe External Bleeding

• Your aims:• Control bleeding • Prevent & minimize the effects of shock• Minimize infection• Arrange urgent removal to hospital• Caution: do not allow victim to eat/ drink anything because an anesthetic

may be needed

Severe External Bleeding

1. Remove/ cut clothing if necessary2. Apply direct pressure over the wound using a sterile dressing (if you do not

have, ask victim to apply direct pressure)1. If there is an object in the would apply pressure on either side of the object

3. Maintain direct pressure on the wound to control bleeding. Raise and support injured limb above level of heart

4. Help victim lie down; raise and support legs above heart5. Secure dressing with a bandage 6. Support injured part in a raised position; check circulation beyond the

bandage every 10 minutes7. Call 911

Shock• Life-threatening condition occurs when circulatory system fails & vital organs are deprived of oxygen• Most common cause = severe blood loss (exceeds 2 pints)• Loss of other body fluids:

• Diarrhea• Vomiting• Bowel obstruction

• Serious burns• Blood infection• Severe heart disease• Heart attack• Acute heart failure• Hypoglycemia• Hypothermia• Anaphylactic shock• Drug overdose• Spinal cord injury

Shock: Recognition

Initially: • Rapid pulse• Pale, cold, clammy skin• Sweating

As shock develops: • Rapid, shallow breathing• Weak “thread” pulse• Cyanosis• Weakness & dizziness• Nausea; possibly vomiting • Thirst

As the brain’s oxygen supply weakens:Restlessness, confusion, aggressiveness; yawning & gasping for air; unconsciousness…. Finally the heart will stop

Shock: Caution

• Do not allow victim to eat/ drink• Thirsty- moisten lips with water

• Do not leave unattended • Unless you call for emergency help

• Do not warm the victim with a hot-water bottle/ direct sources of heat• DO cover him with a blanket

• Pregnancy: lay down leaning toward left side• Prevents baby from restricting blood flow

Shock: Treatment

1. Treat any possible cause of shock that you can detect1. Severe bleeding2. Serious burns

2. Help victim lie down on a rug/ blanket; raise & support legs above heart level

3. Loosen tight clothing at the neck, chest & waist4. Keep victim warm by covering body and legs with coats/ blankets5. Monitor/ record vital signs

Impalement

• Never attempt to left victim off the object 1. Call 9112. Support victim’s body weight; reassure victim

Crush Injury

• May include a fracture, swelling & internal bleeding • May cause impaired circulation• Numbness at or below site of injury1. Under 15 minutes- try to release

1. Control external bleeding2. Treat for shock

2. More than 15 minutes- leave in position found1. Reassure victim

3. Call 9114. Monitor/ record vital signs

Cuts & Scrapes (Abrasions)

• Easily controlled by pressure & elevation• Adhesive bandage• Seek medical help:• Bleeding does not stop• Foreign object embedded in the cut • Risk of infection• Human/ animal bite

1. Clean wound by rinsing under water/ alcohol- free wipes; pat wound dry- cover with sterile gauze

2. Raise & support injured part above heart level3. Clean area around wound with soap & water

Bruising

• Caused by bleeding into skin/ tissue beneath skin• Can indicate deep injury1. Elderly/ anticlotting medications= bruise easily2. Raise & support injured part3. Apply firm pressure to the bruise using cold compress

Blisters

• Skin is repeatedly rubbed against another surface or it is exposed to heat• Damaged area of skin leaks fluid that collects under the top layer of skin=

blister1. Wash area with clean water & rinse; Gently pat area around skin & dry

with a sterile gauze pad2. Cover the blister with an adhesive dressing with a pad larger than the

blister

• CAUTION: do not burst a blister because it increases the risk of infection

Infected Wound

• Any open wound can become contaminated with bacteria• Any wound that does not begin to heal within 48 hours is likely to

become infected• Antibiotics

• Recognition: • Increasing pain & soreness• Swelling, redness, & heat around the injury• Pus/ oozing from the wound• Advanced= signs of fever: sweating, thirst, shivering

Infected Wound

1. Cover wound with a sterile dressing/ nonstick pad2. Raise & support injured part

1. Helps reduce swelling

3. Advise the victim to seek medical advice; if advanced take/ send to hospital

Foreign Object in a Wound

• If left in the wound may cause infection/ delay healing• Superficial pieces of glass/ grit from skin= tweezers• Rinse loose pieces off with running water• Firmly embedded= do not remove

1. Apply pressure on either side of object & raise area above heart level2. Build up padding on either side of object until high enough for you to

bandage over object1. Rolled bandages

3. Arrange to take/ send to hospital

Scalp & Head Wounds

• Scalp has many small blood vessels running close to skin surface• Cut= profuse bleeding• Appears worse

1. Carefully replace any displaced area of skin over the wound

2. Cover with sterile dressing & apply firm, direct pressure3. Keep pad in place with a roller bandage4. Help victim lie down with head and shoulders raised

slightly; call 911 if there are any signs of shock

Eye Wound

• Potentially serious because of risk to victim’s vision1. Help victim lie on his back; hold head still2. Give victim a sterile dressing to hold over affected eye3. Arrange to take/ send to hospital

• CAUTION: do not touch/ attempt to remove anything that is sticking to/ embedded in the eyeball or on the colored part (iris) of the eye.• Place a paper cup over eye & bandage in place

Bleeding from the Ear

• Perforated eardrum• Ear infection• Blow to the side of the head• Explosion• Skull fracture• Symptoms:

• Sharp pain• Earache• Deafness• Dizziness

1. Help victim into half sitting position with head tilted to the injured side to allow blood to drain away

2. Hold sterile dressing lightly in place on the ear. DO NOT plug ear

3. Send/ take to hospital

• Clear fluid= more serious injury

Nosebleed (Epistaxis)

• Blood vessels inside nostrils= ruptured• Blow to the nose• Sneezing• Picking/ blowing nose• High blood pressure• Anticlotting medication1. Sit victim down & tilt head slightly forward; tell them to breathe through their

mouth & pinch soft part of his nose2. Advise not to speak, cough, spit, or sniff3. Once bleeding has stopped, clean around nose with lukewarm water4. Longer than 30 minutes= hospital

Knocked- Out Adult Tooth

• Options: • Replant in socket ASAP

• Gently rinse off any dirt• Ask victim to keep tooth inside his cheek/ under tongue• Place in small container of milk

1. Gently push tooth into socket; place gauze pad between bottom & top teeth2. Ask victim to hold tooth in place3. Send to hospital/ dentist

• DO NOT rinse off fleshy debris= reduce chance of reimplantation

Wound to the Palm

• Palm has good blood supply= profuse bleeding• Deep wound may sever tendons & nerves• Bandaging fist is effective as long as there are no foreign objects

embedded in the wound1. Press sterile dressing firmly into palm & ask victim to clench fist

over it2. Raise & support the hand; bandage fingers so they are clenched

over the dressing; leave thumb free (check circulation)3. Support arm in elevation sling

Bleeding Varicose Vein

• Veins contain one-way valves• Fail= blood collects (pools) behind them & swells (varicose vein)

• Usually develops in legs• Taught, thin walls• Often raised• Knobbly skin

• If injured, shock will develop if not controlled1. Help victim lie down; raise & support leg2. Rest leg on shoulder/ chair & apply direct pressure3. Call 911 for emergency help