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| EMERGENCY ASSESSMENT |
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| FIRST-AID |
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| FIRST-AID |
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| Hemorrhage and Bleeding |
| The Tourniquet A tourniquet should be used when it is difficult to exert hand or digital pressure that will effectively stay the flow of the blood from the large vessel, or when it is difficult to maintain such pressure for a rather long time. With a tourniquet, the pressure is directed and continued to a definite spot on the main vessel, without too much interference with the circulation in the other vessels.Obviously, a tourniquet can be applied only to an extremity. The correct place for the tourniquet is at the main pressure point of the affected extremity: around the middle of the upper arm if the bleeding is below this site; around the middle of the thigh in wounds similarly located in the leg.However the location and the degree of injury have a bearing on the selection of the place most fitting for the tourniquet.In general, it should not be so far from the wound to cut off the blood supply from too large an area; nor so close to the wound to interfere with it's cleansing and treatment (not less than 2 or 3 inches from it. The tourniquet is preferably bound over a firm pad of suitable size, which must be put over the artery at the exact place where the digital pressure would be exerted. Articles that may serve as an improvised tourniquet are: Handkerchief Garter Belt Suspenders Straps Put a pad beneath the knot or buckle to protect the underlying skin from injury. Fasten the article on the outer side of the limb. Insert in the knot a pencil or a stick for leverage Precautions in applying a tourniquet Although a tourniquet possesses certain advantages, keep in mind that its use can be dangerous. Do not keep it tightened too long at a time. Loose it completely for at least one minute , evrey twenty minutesin the case of the arm, every thirty minutes in the case of the thigh, the thicker limb. Meanwhile, exert digital pressure directly on the wound. This one minute relaxing of the tension is long enought to restore momentarily the circulation in order to maintain the vitality of the tissues, and short enough to prevent the loss of an undue quantity of blood. Never cover the tourniquet with clothing, blankets or anything else that may conceal it. Do not even briefly loose sight of its effect on the circulation. A far greater danger is that if covered, the tourniquet will be forgotten and consequently will so thoroughly cut-off all circulation that gangrene will inevitably follow. Be careful to keep the tourniquet from direct contact with the wound. It is a potential source of infection if it is handled with unsterile hands, or is itself is unsterile. Elevation Elevating a part to a level higher than the heart is a help in staying the flow of blood from a wound, since the heart must overcome gravitation. Consequently, the blood flows more slowly, less blood is lost, and a clot forms |
| more quickly. Elevation also prevents an oversupply of blood in the part while it is being bandaged. Elevation is usually applicable only to bleeding from the extremities. But whenever it is possible to do so, elevate other parts of the body also. Clotting Clotting or coagulation is natures way of arresting the flow of blood. The clot acts as a stopper or cork that plugs the opening in the vessel. It is also the framework on which new tissue is built.Assist nature by using measures that tend to reduce the amount of blood and its force, such as using pressure and elevating a part. In order not to dislodge a newly formed clot, do not hastily withdraw the pressure or a temporary dressing. Ask the patient not to make any sudden or strong movement of the part of the body as a whole. Other Beneficial Measures Rest, quiet and reduction of motion. These are essential in the treatment of any hemorrhage. They promote the slackening of the flow and the formation of the clot. Position of the patient. He should be placedin the reclining position so that the normal flow may re-establish itself. Comfort of the patient. he should be made as comfortable as possible and once arranged should not be disturbed. Avoidance of agitation. All the activity round bout, noise and conversation should be reduced to a minimum. Any excitement increases the heart action and this may inrease the bleeding. Impediments to the circulation. Any tight article of clothing, such as collars, belts, garters, brassieres, and corsets, is an impediment to the circulation and should be removed or loosened. Body temperature. Bleeding diminishes the energy and lowers the body temperature. Therefore, the patient should be covered with light but warm blankets. Liquids. No liquids, whether stimulants or not, should be given. Stimulants especially are dangerous when the bleeding is internal, since they have an unfavorable influence on the physiologic functions of the body. Whenever organs are at work under normal conditions a correct diagnosis is rendered difficult. Presence of shock. If there is a degree of shock, the foot of the bed ought to be elevated 12 to 18 inches so that the force of gravity can draw back the blood to give the heart its needed supply and to nourish the anemic brain. Transportation. if the patient has to be moved he should be transported in the reclining position, be protected from jolts and strains that may aggravated his condition, and be kept warm. |