The emergency care of an individual with a head injury consists of the following:
1. Maintain an open airway.
2. Control the bleeding.
3. Cover skull wounds with sterile dressings.
4. Keep the casualty lying down.
5. Give no medications.
6. If necessary, administer cardiopulmonary resuscitation (CPR).
When controlling bleeding, do not use direct pressure or tie any knots over the wound. If there is a skull fracture, you would not want to force parts of the skull into the brain. When laying a person down, try to keep the head slightly elevated. If there is an injury to the back of the head or bleeding into the throat and mouth, position the casualty on his side so that blood can drain out of the mouth, not down the throat. (Try to keep the neck stiff.) Never raise the feet of a head injury victim. there is back injuries. By placing the patient on the wounded side, you will keep the good lung up so breathing will be easier. If the casualty is having difficulty breathing while on the wounded side, you can place him/her in a sitting position. This may help to make breathing easier.
CHEST WOUNDS. - All chest injuries are serious. They can cause severe breathing and bleeding problems. Any casualty showing signs of difficulty in breathing without signs of airway obstruction must be inspected for chest injuries. One of the most serious chest injuries is the sucking chest wound. This is a penetrating injury to the chest that produces a hole in the lung, causing the lung to collapse, and thus preventing normal breathing. Immediate medical aid must be provided. The sucking chest wound will result in death if not treated quickly. The procedures described above are also followed when treating a lung injury from the casualty's back.
A casualty with an open chest wound gasps for breath, has difficulty breathing out, and may have a bluish or grayish color to his face. When you remove clothing over the area, you may or may not hear a sucking sound at the wound site. Frothy blood may bubble from the wound during breathing.
To treat a casualty of a sucking chest wound:
1. Remove any clothing from the chest area.
2. Immediately seal the wound with your hand or any nonporous (airtight) material such as aluminum foil or plastic wrap (cellophane).
3. Wipe the blood from the surrounding skin while holding the airtight material over the wound. Apply tape (wide and nonporous, if possible) to all sides of the material, leaving one corner of the dressing unsealed. This procedure allows trapped air to escape when the casualty exhales and prevents air entry when the casualty inhales.
4. Give the casualty oxygen if it is available. If a lung is injured, more oxygen will be needed to compensate for the injury.
5. Place the casualty on the wounded side unless
6. Watch the casualty closely for signs of respiratory difficulty or shock. Treat accordingly.
7. Do not give a casualty with chest injuries anything to eat or drink.
8. Immediately transport the casualty, wounded side down, to a medical facility.
ABDOMINAL WOUNDS. - Many vital organs are located in the abdominal area, so a deep wound in the abdomen is likely to constitute a major emergency. Abdominal wounds usually cause intense pain, nausea and vomiting, spasms of the abdominal muscles, and severe shock. Immediate surgical treatment is almost always required, so the casualty must receive medical attention at once. Give only the most essential treatment, and concentrate your efforts on getting the casualty to a medical facility.
The general procedures for treating an abdominal wound are as follows:
1. Keep the casualty lying on his/her back. If the intestine is protruding or exposed, the patient may be more comfortable with the knees drawn up. Place a coat, a pillow, or some other bulky cloth material under the knees to help maintain this position. Do not attempt to push the intestines back in or to manipulate them in any way. Do not try to clean dirty intestines; this will be done thoroughly at the hospital.
2. If the intestine is not exposed, cover the wound with a dry, sterile dressing. If the intestine is exposed (fig. 13-10), apply a sterile bandage moistened with sterile water. If no sterile water is available, clean sea water or any water that is fit to drink may be used to moisten the bandage. The bandage should be large enough to cover the wound and the surrounding area.
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