Wounds & Bleeding Flashcards
Definition of a Wound
A wound is a break in the continuity of tissue.
It frequently includes a break in the surface of the skin or mucous membrane exposing it to infection.
Types of Wounds:
Incision. Laceration. Puncture. Contusion. Gunshot/Blast.
Incision
Usually made by a sharp edged object.
Bleeds freely but heals quickly.
Laceration
Usually results from snagging or tearing of tissue.
Bleeds less freely and heals slowly.
Puncture
Usually caused by a pointed object.
Difficult to asses if any internal damage done and healing time required.
Contusion
Usually caused by a blunt instrument.
May have associated tissue damage and fractures.
Swelling and bruising could be signs of fracture.
Gunshot/Blast
Usually caused by a bullet, shot or shrapnel.
May have both an entry and exit wound.
Pressure waves precede bullets so damage can be greater then first appears.
2 types of bleeding
External
Internal
Arterial bleeding characteristics
Spurts out in time with the pulse rate.
Venous bleeding characteristics
Constant flow.
Capillary bleeding characteristics
Oozes to the wound surface
Internal bleeding diagnosis
Bleeding may not be obvious and difficult to diagnose.
It can sometimes be detected by a swelling (haematoma).
If internal organs are affected blood may appear via body orifices.
Areas internal bleeding could be present
Abdominal cavity from damage to internal organs.
Thoracic cavity from damage to the lungs.
In closed fractures.
In contusions.
Penetrating injury complications
May be difficult to stop bleeding.
May affect underlying tissues/organs.
Difficult to assess severity of injury.
Increased risk of infection.
Complications of bleeding
Depth, type and size of wound. Size of blood vessel involved. Duration of bleeding. Position of injury. Age/Size of patient Infection Emotional distress.
Assessing severity of bleeding - signs
Pulse rate increases - weakens with deterioration.
Respiration - increased to air hunger.
Pupils become dilated.
Skin pallor, cold extremities, cyanosis.
Blood pressure lowers - a late stage but a dramatic sign.
Management of bleeding
Primary survey: DRABC
Control any serious/obvious haemorrhage.
Administer high % oxygen as appropriate.
Consider paramedic assistance where needed.
Apply direct pressure as required.
Elevate wound if possible.
Raise lower limbs if possible.
Treat for shock.
Reassurance.
If conscious position patient flat with head and shoulders slightly raised.
If unconscious place patient in stable side position.
Treat other injuries and bleeding.
Do not remove foreign bodies.
Check dressings for security and effectiveness.
Consider pressure points if necessary.
Arterial tourniquet
Under the direct of paramedic, you may require to apply the Arterial Tourniquet to arrest external haemorrhage.
Application of tourniquet - step 1
The tourniquet should be slid into position over the limb.
The tourniquet is not to used on the lower arm or lower leg.
The tourniquet should be placed as distal as possible on either side of the humerus or femur as required, but at least 5cm proximal to the injury, sparing joints as much as possible. It should be placed directly onto skin.
Application of tourniquet - step 2
Once in place the tourniquet should be tightened by pulling on the long loose end of the tourniquet.
Application of tourniquet - step 3
Once in place the tourniquet can be tightened using the windlass rod. The effective application of the tourniquet is determined by the cessation of external haemorrhage (not the presence or absence of external or distal pulse).
If the cessation of haemorrhage does not occur the tourniquet should be further tightened; if this does not work consideration should be given to repositioning the tourniquet and/or the application of a second tourniquet.
Application of tourniquet - step 4
Once control of the haemorrhage has been achieved the windlass rod should be secured using the triangular plastic clip.
Application of tourniquet - step 5
The time of application should be noted on the tourniquet.
Types of dressing
Standard ambulance minor wound dressings-various. Various paramedic dressings. Triangular bandage (support, immobilisation, elevation)
Wound dressings should be:
Large enough to completely cover injury.
Sterile and made of soft absorbent material that will not stick to wound.
Applied so as to provide enough pressure to control bleeding.
Infection of wounds
Is usually caused by contamination of an open wound by bacteria. The source can be: Clothing/Foreign bodies or other infected material coming into contact with the wound.
Infection risk reduction
By good aseptic technique and personal cleanliness of crew.
Universal precautions must be applied when dealing with body fluids.
What is a pressure ulcer?
A localised area/s of soft tissue destruction caused by compression of soft tissue over a bony prominence and an external surface for prolonged period of time.
Pressure ulcers are caused by:
Pressure
Shear
Friction
Moisture
Pressure ulcers - Pressure - definition
created when the external surface against the skin and the persons skeleton compress soft tissue sufficiently to interrupt blood flow. Tissue ischaemia and tissue death occur.
A patient sitting on an ambulance buckle or rumpled blanket for 10-20 minutes is enough!
Pressure ulcers - Pressure - pressure points
Elbow Knees Back of head Shoulder Lower back and buttocks Heel
Pressure ulcers - Shear - definition
Shear occurs when the skeleton moves, but the skin remains fixed to an external surface. Blood vessels are kinked or twisted. (i.e. pulling a patient up in bed, sliding a patient from a bed to a stretcher).
Pressure ulcers - Friction ulcers - definition
Friction ulcers are generally superficial and easily reversed unless the cause is not removed.
Common in bed ridden patients who use heels and elbows to aid movement.
Pressure ulcers - Moisture - definition
Moisture is a chemical cause of promoting pressure ulcers. It weakens the cell wall of the skin cells. It can change the pH of the skin.
Pressure ulcers - Moisture - causes
Faecal & urinary incontinence
Wound drainage
Respiratory secretions
Perspiration
Pressure ulcers - Who is vulnerable?
All patients with spinal cord injury, the chronically unwell and the elderly are at high risk of developing pressure damage due to:
Lack of sensation
Lack of movement
Pressure ulcers - Intervention
Minimize pressure for all patients.
Encourage weight shifting every 15 minutes.
Handover to staff with pressure sore information.
Use transfer devices.
Position with pillows to elevate pressure points.
Use 2 people minimum & draw sheet to pull patient up bed.
don’t drag a patient.
Keep head of bed <=30degrees incline
Pas skin surfaces - elbows, heels, etc.
Pressure ulcers - Consequences
Septicaemia, death Amputation Prolonged hospital admission Loss of independence Family disruption Massive financial cost to the NHS
