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BASIC SURVIVAL TRAUMA CARE

MEDICAL EMERGENCIES
Hello doc! You are now going to be a doctor. Scary thought isn't it. Hooking up with a doctor before the shit hits the fan is something anyone seriously preparing for the end should consider. Nurses and first responders are also great to have around.

Severe bleeding is extremely dangerous. The loss of 1 liter (4.25 cups) of blood will produce moderate symptoms of shock. The loss of 2 liters (8.5 cups) will produce a severe state of shock that places the body in extreme danger. The loss of 3 liters (13 cups) is fatal. So stopping bleeding from yourself or a companion is the first treatment to attend to whenever there is major trauma.

Shock is another big concern. Shock is a condition that arises when cardiac out put is not sufficient to fill the arteries with blood. Usually brought on by blood loss but that is not the only cause.

LIFESAVING STEPS
First control panic... everyones! Reassure the victim and try to quiet them down if needed. First check their airway to make sure it isn't obstructed due to injury.

Open Airway and Maintain
You can open an airway and maintain it by using the following steps. Step 1. Check if the victim has a partial or complete airway obstruction. If he can cough or speak, allow him to clear the obstruction naturally. Stand by, reassure the victim, and be ready to clear his airway and perform mouth-to-mouth resuscitation should he become unconscious. If his airway is completely obstructed, administer abdominal thrusts until the obstruction is cleared.

Step 2. Using a finger, quickly sweep the victim's mouth clear of any foreign objects, broken teeth, dentures, sand.

Step 3. Using the jaw thrust method, grasp the angles of the victim's lower jaw and lift with both hands, one on each side, moving the jaw forward. For stability, rest your elbows on the surface on which the victim is lying. If his lips are closed, gently open the lower lip with your thumb.

Step 4. With the victim's airway open, pinch his nose closed with your thumb and forefinger and blow two complete breaths into his lungs. Allow the lungs to deflate after the second inflation and perform the following:
Look for his chest to rise and fall.
Listen for escaping air during exhalation.
Feel for flow of air on your cheek.
Step 5. If the forced breaths do not stimulate spontaneous breathing, maintain the victim's breathing by performing mouth-to-mouth resuscitation.

Step 6. There is danger of the victim vomiting during mouth-to-mouth resuscitation. Check the victim's mouth periodically for vomit and clear as needed.

Note: Cardiopulmonary resuscitation (CPR) may be necessary after cleaning the airway, but only after major bleeding is under control.

Control Bleeding
In a survival situation, you must control serious bleeding immediately because replacement fluids normally are not available and the victim can die within a matter of minutes. External bleeding falls into the following classifications (according to its source):

Arterial. Blood vessels called arteries carry blood away from the heart and through the body. A cut artery issues bright red blood from the wound in distinct spurts or pulses that correspond to the rhythm of the heartbeat. Because the blood in the arteries is under high pressure, an individual can lose a large volume of blood in a short period when damage to an artery of significant size occurs. Therefore, arterial bleeding is the most serious type of bleeding. If not controlled promptly, it can be fatal.

Venous. Venous blood is blood that is returning to the heart through blood vessels called veins. A steady flow of dark red, maroon, or bluish blood characterizes bleeding from a vein. You can usually control venous bleeding more easily than arterial bleeding.

Capillary. The capillaries are the extremely small vessels that connect the arteries with the veins. Capillary bleeding most commonly occurs in minor cuts and scrapes. This type of bleeding is not difficult to control.

You can control external bleeding by direct pressure, indirect (pressure points) pressure, elevation, digital ligation, or tourniquet.

Direct Pressure
The most effective way to control external bleeding is by applying pressure directly over the wound. This pressure must not only be firm enough to stop the bleeding, but it must also be maintained long enough to "seal off" the damaged surface.

If bleeding continues after having applied direct pressure for 30 minutes, apply a pressure dressing. This dressing consists of a thick dressing of gauze or other suitable material applied directly over the wound and held in place with a tightly wrapped bandage. It should be tighter than an ordinary compression bandage but not so tight that it impairs circulation to the rest of the limb. Once you apply the dressing, do not remove it, even when the dressing becomes blood soaked. Leave the pressure dressing in place for 1 or 2 days, after which you can remove and replace it with a smaller dressing.

In the long-term survival environment, make fresh, daily dressing changes and inspect for signs of infection.

Elevation
Raising an injured extremity as high as possible above the heart's level slows blood loss by aiding the return of blood to the heart and lowering the blood pressure at the wound. However, elevation alone will not control bleeding entirely; you must also apply direct pressure over the wound. When treating a snakebite, however, keep the extremity lower than the heart.

Pressure Points
A pressure point is a location where the main artery to the wound lies near the surface of the skin or where the artery passes directly over a bony prominence. You can use digital pressure on a pressure point to slow arterial bleeding until the application of a pressure dressing. Pressure point control is not as effective for controlling bleeding as direct pressure exerted on the wound. It is rare when a single major compressible artery supplies a damaged vessel.

If you do not know the exact location of the pressure points, follow this rule: Apply pressure at the end of the joint just above the injured area. On hands, feet, and head, this will be the wrist, ankle, and neck, respectively.

Maintain pressure points by placing a round stick in the joint, bending the joint over the stick, and then keeping it tightly bent by lashing. By using this method to maintain pressure, it frees your hands to work in other areas.

Digital Ligation
You can stop major bleeding immediately or slow it down by applying pressure with a finger or two on the bleeding end of the vein or artery. Maintain the pressure until the bleeding stops or slows down enough to apply a pressure bandage, elevation, and so forth.

Tourniquet
Use a tourniquet only when direct pressure over the bleeding point and all other methods did not control the bleeding. If you leave a tourniquet in place too long, the damage to the tissues can progress to gangrene, with a loss of the limb later. An improperly applied tourniquet can also cause permanent damage to nerves and other tissues at the site of the constriction.

If you must use a tourniquet, place it around the extremity, between the wound and the heart, about 3 inches (7.6cm) above the wound site. Never place it directly over the wound or a fracture. Use a stick as a handle to tighten the tourniquet and tighten it only enough to stop blood flow. When you have tightened the tourniquet, bind the free end of the stick to the limb to prevent unwinding.

After you secure the tourniquet, clean and bandage the wound. A lone survivor does not remove or release an applied tourniquet. In a buddy system, however, the buddy can release the tourniquet pressure every 10 to 15 minutes for 1 or 2 minutes to let blood flow to the rest of the extremity to prevent limb loss.

Cont. to Page 2 - Reading Shock and its Treatment







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