(1) hemostasis
1, bleeding type
Hemorrhage can be divided into external bleeding and internal bleeding: external bleeding-visible on the body surface. After blood vessels burst, blood flowed out of the body through skin trauma.
Internal bleeding-invisible on the body surface. Blood flows from a ruptured blood vessel into a tissue, organ or body cavity.
According to the types of bleeding blood vessels, it can also be divided into three types: arterial bleeding, venous bleeding and capillary bleeding:
Arterial bleeding-the blood is bright red, and the bleeding is jet, which is the same as the pulse rhythm. It's dangerous.
Venous bleeding-dark red blood, slow blood flow, continuous outflow. The risk is less than arterial bleeding.
Capillary hemorrhage-the blood is bright red and oozing from the whole wound. Bleeding spots are generally difficult to find, and often can automatically coagulate and stop bleeding. The danger is small.
2, the performance of blood loss
Under normal circumstances, an adult loses 500 ml of blood, and it is impossible to have obvious symptoms. When the blood loss exceeds 800 ml, the injured person will appear pale, pale lips, cold sweat on the skin, cold hands and feet, shortness of breath, rapid and weak pulse and so on. When the amount of bleeding is greater than 1500 ml, it will cause insufficient blood supply to the brain, and the injured will have blurred vision, thirst, dizziness, confusion or anxiety, and even coma symptoms.
3. Hemostatic methods for external bleeding
(1) Finger pressure to stop bleeding. Finger pressure hemostasis is a simple and effective temporary hemostasis method. According to the trend of the artery, at the proximal end of the bleeding wound, press the blood vessel with your fingers to close it, so as to achieve the purpose of temporary hemostasis, and then choose other hemostasis methods. Finger pressure hemostasis is suitable for arterial bleeding of head, neck and limbs.
(2) Pressure bandaging to stop bleeding.
It is one of the most commonly used hemostasis methods in first aid.
It is suitable for bleeding of arterioles, veins and capillaries.
Methods: Sterile gauze or clean handkerchief, towel, clothes, etc. Apply it to the wound, and then wrap it with a triangular towel or bandage under pressure. Proper pressure is to stop bleeding without affecting the blood circulation of the injured limb. If the wound is fractured, it must be fixed with splint. This method is not used when there is joint dislocation and broken bone in the wound.
(3) Use padding to stop bleeding by limb flexion. Suitable for upper limb and calf bleeding. It can be used without fracture and joint injury.
(4) tourniquet to stop bleeding. When encountering arterial bleeding in limbs, the above methods are ineffective for hemostasis. Commonly used tourniquets include rubber bands and cloth tourniquets. Do not use a tourniquet to stop bleeding unless absolutely necessary.
@fenganping 1983
4. Precautions:
(1) When the tourniquet is tied, the skin and tourniquet should not be in direct contact. Dressing and cloth pad should be added or tourniquet should be placed on the outside of underwear to avoid damaging the skin.
(2) The tourniquet should be properly tightened to stop bleeding. Too loose ligation can't stop bleeding, and too tight ligation can easily damage skin, nerves and tissues, resulting in limb necrosis.
(3) It is easy to cause limb necrosis if the tourniquet is stuck for too long. Therefore, after the tourniquet is tied, record the time of tying the tourniquet, and relax every 40-50 minutes, each time 1-3 minutes. In order to prevent massive bleeding after the tourniquet is relaxed, the wound should be pressurized to stop bleeding during the relaxation period.
(4) When transporting the wounded, the tourniquet should be clearly marked. Don't cover the wound with clothes, so as not to interfere with observation, and mark the time when the tourniquet is put on and the time when the tourniquet is relaxed with labels.
(2) Bandage materials commonly used for dressing include bandages, triangular towels, four headbands and other temporary substitutes (such as clean wool handkerchiefs, towels, clothes, belts, ties, etc.). Bandage dressing is generally used to support injured limbs and joints, fix dressings or splints, and pressurize to stop bleeding. Triangle towel is mainly used for dressing, suspending injured limbs, fixing dressings and fixing fractures.
Commonly used dressing methods are as follows:
1, ring bandage method. This method is the most basic method of bandage dressing, which is often used to dress wrists, limbs, chest, abdomen and other parts.
Methods: Wrap the bandage in a circular overlapping way, and finally fix the belt tail with a pin, or cut the belt tail into two ends to fasten it.
Precautions:
(1) The winding direction of bandage should be from inside to outside, from bottom to top, and from far end to near end. At the beginning and end, you need to repeat the winding to fix it. Knotting and fixation should be done on the upper part of the wound and the outside of the limb.
(2) Pay attention to the tightness when dressing. Not too tight and not too loose, so as not to interfere with blood circulation.
(3) Don't cover your fingertips or toes when dressing your limbs, so as to observe the blood circulation.
(4) Check the pulse at the far end and touch hands and feet for chills.
2. Triangle bandage method.
Triangle towel full towel: triangle towel is fully open and can be used to wrap or suspend upper limbs;
Triangle scarf broadband: fold the top corner of the triangle scarf to the bottom edge, and then fold it in half. It can be used to fix lower limb fractures or strengthen upper limb suspension.
Narrow band of triangular scarf: fold the wide band of triangular scarf in half again. Can be use for that figure-8 fixation of feet and ankles.
(3) Fracture fixation
1, fracture type:
(1) Closed fracture: the skin at the fracture site is intact, and the fracture end is not communicated with the outside world.
(2) Open fracture: The depth of traumatic wound is enough to penetrate the skin at the fracture site or the broken end and expose the body surface.
(3) Compound fracture: the broken end of the fracture damages blood vessels, nerves or other organs, or is accompanied by joint dislocation.
(4) Incomplete fracture: the integrity and continuity of bone are not completely interrupted.
(5) Complete fracture: the integrity and continuity of bone are completely interrupted.
2. Fracture symptoms: pain, swelling, deformity, bone rubbing, dysfunction and massive bleeding.
3. Fracture fixation material: splint.
4, first aid principles and matters needing attention:
(1) Pay attention to the wound and general condition. If the wound bleeds, stop the bleeding first, and then bandage and fix it. If there is shock or respiratory or cardiac arrest, rescue should be done immediately.
(2) When dealing with open fractures, the local area should be cleaned and disinfected, and the wound should be bandaged with gauze. It is forbidden to send the broken end exposed outside the wound back to the wound, so as not to pollute the wound and stab the blood vessels and nerves again.
(3) For the injured with thigh, calf and spine fractures, they should generally be fixed in place. Don't move the injured casually, and don't reset blindly, so as not to aggravate the injury.
(4) The length and width of the splint used to fix the fracture should be commensurate with the fractured limb, and its length should generally exceed the upper and lower joints of the fracture.
(5) The splint used for fixation should not be in direct contact with the skin. Soft materials such as gauze, triangular towel pad, towel and clothes can be used to pad the splint and limbs, especially at the two ends of the splint, the protruding part of the joint bone and the gap, which can be properly thickened to avoid skin wear or local tissue compression and necrosis.
(6) The tightness of fixing and binding should be appropriate. Too loose can not achieve the purpose of fixation, too tight will affect blood circulation, leading to limb necrosis. When fixing the limb, the finger (toe) end should be exposed so as to observe the blood circulation of the limb at any time. If you find that your fingers (toes) are pale, cold, numb, painful and swollen, and the nail bed is blue, it means that the fixation and binding are too tight and the blood circulation is not smooth. It should be loosened immediately and fixed again.
(7) When limb fracture is fixed, the upper end of the fracture should be bound first, and then the lower end of the fracture should be bound. If the binding order is reversed, it will lead to dislocation again. When the upper limb is fixed, the limb should be bent and bound (elbow bend); When fixing the lower limbs, straighten and tighten the limbs.
(4) treatment
1. Handling method: There are two commonly used handling methods: bare-handed handling and stretcher handling. Appropriate treatment methods can be selected according to the severity and transportation distance of the injured person. The unarmed handling method is suitable for the wounded with minor injuries and short transportation distance, and the stretcher handling method is suitable for the wounded with serious injuries, which are not suitable for unarmed handling and need long-distance transportation.
2. Precautions:
(1) When moving the injured, first check the head, neck, chest, abdomen and limbs of the injured. If you are injured, give first aid first, and then choose different treatment methods according to different injuries.
(2) Patients with serious illness (injury) and long journey should be well cared for on the way, and pay close attention to the changes of consciousness, breathing, pulse and illness (injury) potential of the injured.
(3) The injured person with tourniquet should record the time for tying tourniquet and relaxing tourniquet.
(4) When transporting the wounded with spinal fracture, keep the wounded body fixed. In addition to body fixation, the injured person with cervical spine fracture should also have a special person to traction and fix his head to avoid moving.
(5) When the wounded are carried on a stretcher, the head is generally slightly higher than the feet, and the feet of the shock wounded are slightly higher than the head. When marching, the injured person's feet are in front and his head is behind, so as to observe the injured person's situation.
(6) When transporting by car or cart, the bed should be fixed to prevent the injured from being injured again when starting and braking.