First Aid for Bleeding, Trauma, Burns, Poisoning and Fractures

Signs of Shock and External Bleeding

External bleeding is blood loss through the skin or natural orifices, or from internal origin. Common forms include the following:

• Epistaxis (nosebleed): Compress the nose for 5 to 10 minutes while the person is seated with the head tilted slightly forward (do not tilt the head back). If bleeding continues after 15 to 20 minutes, transfer to the hospital.
• Otorrhagia (ear bleeding): Do not compress the ear. Have the person lie down with the affected ear facing down. Urgent hospital transfer is required.
• Hematemesis (vomiting blood): Vomiting of blood originating in the digestive tract.
• Hemoptysis (coughing blood): Expulsion of blood from the respiratory tract, with a frothy appearance.
• Hematuria (blood in the urine).

First Aid for External Bleeding

The same general rules apply, placing the affected area as high as possible. The main objective is to stop the bleeding as quickly as possible.

Actions in order of priority:

1. Manual pressure (local) on the wound.
2. Remote manual compression.
3. Tourniquet, only if the other measures fail, applied above the wound over a compressive bandage.

Avoid internal bleeding and shock.

Trauma Accidents

1. Injuries

An injury is an effect or lesion produced rapidly and instantaneously by mechanical, physical or chemical agents acting on specific body parts.

Based on environmental or personal circumstances, trauma accidents include: school accidents, domestic accidents, sports accidents, occupational accidents, catastrophes, traffic accidents and wars.

By etiological classification, they are: mechanical, physical and chemical aggressions.

2. Accidents from Mechanical Aggressions: Soft Tissue Lesions

Soft tissue lesions are the most superficial injuries. An impact on the body can produce two types of lesions: those without loss of skin continuity (simple contusion) or with it (wound from contusion).

Contusion: A traumatic lesion produced in living tissue by a violent impact with a blunt object. It is considered a closed trauma when the skin remains intact.

• First-degree contusions: Low intensity, with pain and local redness.
• Second-degree contusions: Moderate intensity, with pain, hematoma and swelling.
• Third-degree contusions: Very intense, with necrosis of tissue.

General behaviors: RICE (rest, ice locally, elevation of the injured limb, compression bandage on the injured limb). Do not apply heat for 48 hours. Do not massage for 48 to 72 hours. Medical evaluation is advised.

3.2 Wounds

Definition: A break in the skin with bleeding and pain in the area. Infection is a possible complication.

Depending on the agent, traumatic wounds are classified by type and severity:

• Severity: Minor or simple (abrasions) and severe (involving deeper tissues).

Clinical picture: The fundamental signs and symptoms are:

• Fundamental symptoms: Pain and bleeding from the edges of the wound.
• Signs of severity: Location, depth, extent, degree of contamination, and whether it is accompanied by contusion and the condition of the affected person.

3.3 Conduct: It is important to know how to differentiate them. For wounds without clothing, expose the area completely. Do not clean deep wounds; apply a gauze secured with a bandage, immobilize the area and transfer to the hospital.

Physical Aggression Accidents

4 and 5. Accidents from Thermal Aggressions

Heat stroke is caused by direct action of intense rays over a prolonged period on the uncovered head, such as sunbathing in an uncontrolled manner. There are two phases:

• Prodromal phase: Headache, no fever, congested face, sweating. Behavior: drowsiness.
• Phase of state: Sweating disappears, fever appears, skin becomes hot and dry, confusion and agitation, and convulsions may occur.

Conduct: Lay the person down in a supine position, loosen clothing, take temperature every 10 to 15 minutes, apply cold water. Transfer to the hospital.

5.2 Definition of Heatstroke

Heatstroke is an accident produced by excessive ambient heat, with failure of the hypothalamic thermoregulatory system, with cessation of sweating and vasodilation. It occurs in closed locations and in cars, on days of high temperature and no wind. Clinical symptoms are similar to sunstroke, plus dehydration.

5.3 Burns

Definition: Lesions resulting from the action of physical, chemical or biological agents acting on the skin and tissues, with local reactions or general effects depending on extent and depth.

Degrees:

• First degree: Erythema (redness).
• Second degree: Blisters.
• Third degree: Scarring.

Severe burns can cause a complication known as shock.

Simple burns: Less than 10% of body surface area in second degree, with blisters.

Extent: Less than 10% = mild, 10 to 33% = severe, 33 to 50% = very severe, almost always fatal.

Chemical Aggression Accidents

6.1 Poisoning

Definition: A set of signs and symptoms that appear after the toxic action. Poisonings can be acute, subacute (lasting some weeks) and chronic (after months or years).

Causes: Accidental, suicide attempts, drug abuse or medication overdose.

Routes of entry: digestive route, respiratory route, cutaneous route, and parenteral (injection).

A poison is any substance capable of disturbing or ending life. Poisons may be biological (of animal or plant origin), toxic (alcohols and alkaloids) and inorganic (metals and caustics). Some common nontoxic substances can also produce relevant clinical symptoms.

General objectives of antitoxic action: Restore and/or maintain vital functions. Keep toxic concentrations as low as possible: prevent further absorption of the toxic, delay absorption and promote elimination.

Poisoning by Ingestion

Technique: Induced vomiting (forced emesis) and gastric lavage.

Contraindications to forced emesis:

• Ingestion of caustic substances
• Unconsciousness
• Stimulants of the central nervous system
• Hydrocarbon ingestion
• Ingestion of sharp objects
• Children under 6 months
• Unknown toxic
• Pregnancy and convulsions

To reduce absorption of the toxic or dilute it, demulcents can be given: water or albuminous liquid (4 to 6 beaten egg whites in 1 liter of water). Effective against acids, alkalis and some metals. Albuminous liquid ingestion is contraindicated after liposoluble products or phosphorus. Do not give it if the poison is a caustic; for caustic poisoning, give water or albuminous liquid only.

6.2 Allergic Reactions

Definition: The clinical expression of an adverse interaction between an individual and a susceptible contact agent. It usually develops within minutes and is often severe, with a shorter latency period between contact and onset of symptoms.

Shock can cause anaphylactic incontinence, hypotension, vascular collapse and, if not treated urgently, death from cardiac arrest.

Trauma to the Locomotor System

7. Fractures and Sprains

Definition: A fracture is an interruption in the continuity of a bone.

Fractures can result from direct trauma (impact) or indirect trauma.

• Simple closed fracture: The skin is intact.
• Open fracture: The bone ends pierce through the skin.
• Compound fracture: Associated with injuries to adjacent tissues.
• Displaced fractures: Bone ends may be aligned or displaced.

Fissure: An incomplete interruption in the bone, where the edges may or may not be partially separated.

Conduct: Cover the fracture with bandages, immobilize, remove weight from the limb and transfer. For an elbow fracture, immobilize in the position found (extension or flexion) with a splint.

Sprain: A twisting or forced movement of a joint without dislocation, which may cause rupture of some ligament. Types:

• Distension: Without ligament rupture.
• Partial tear: Partial ligament rupture, joint stability is not lost.
• Complete tear: All ligament fibers are ruptured, the joint is unstable.

Cryotherapy: Therapeutic use of cold on tissues, with local pain relief (anesthesia), vasoconstriction and relaxation.

Topic 8

Provide prophylaxis against tetanus for those without immunity by vaccination with toxoid.