Do not use direct pressure to control hemorrhage if the skull is depressed or obviously fractured . Facial Wounds Wounds of the face are treated, in general, like other fresh wounds. However, in all facial injuries make sure neither the tongue nor injured soft tissue blocks the airway, causing breathing obstruction. Keep the nose and throat clear of any obstructing materials, and position the victim so that blood will drain out of the mouth and nose. Facial wounds that involve the eyelids or the soft tissue around the eye must be handled carefully to avoid further damage. If the injury does not involve the eyeball, apply a sterile compress and hold it in place with a firm bandage. If the eyeball appears to be injured, use a loose bandage. (Remember that you must NEVER attempt to remove any object that is embedded in the eyeball or that has penetrated it; just apply a dry, sterile compress to cover both eyes, and hold the compress in place with a loose bandage). Any person who has suffered a facial wound that involves the eye, the eyelids, or the tissues around the eye must receive medical attention as soon as possible. Be sure to keep the victim lying down. Use a stretcher for transport. Chest Wounds Since chest injuries may cause severe breathing and bleeding problems, all chest injuries must be considered as serious conditions. Any victim showing signs of difficulty in breathing without signs of airway obstruction must be inspected for chest injuries. The most serious chest injury that requires immediate first aid treatment is the sucking chest wound. This is a penetrating injury to the chest that produces a hole in the chest cavity. The chest hole causes the lung to collapse, preventing normal breathing functions. This is an extremely serious condition that will result in death if not treated quickly. Victims with open chest wounds gasp for breath, have difficulty breathing out, and may have a bluish skin color to their face. Frothy-looking blood may bubble from the wound during breathing. The proper treatment for a sucking chest wound is as follows: 1. Immediately seal the wound with a hand or any airtight material available (e.g., ID card). The material must be large enough so that it cannot be sucked into the wound when the victim breathes in. 2. Firmly tape the material in place with strips of adhesive tape and secure it with a pressure dressing. It is important that the dressing is airtight. If it is not, it will not relieve the victim’s breathing problems. The object of the dressing is to keep air from going in through the wound. NOTE: If the victim’s condition suddenly deteriorates when you apply the seal, remove it immediately. 3. Give the victim oxygen if it is available and you know how to use it. 4. Place the victim in a Fowler’s or semi-Fowler’s position. This makes breathing a little easier. During combat, lay the victim on a stretcher on the affected side. 5. Watch the victim closely for signs of shock, and treat accordingly. 6. Do not give victims with chest injuries anything to drink. 7. Transport the victim to a medical treatment facility immediately. Abdominal Wounds A deep wound in the abdomen is likely to constitute a major emergency since there are many vital organs in this area. Abdominal wounds usually cause intense pain, nausea and vomiting, spasm of the abdominal muscles, and severe shock. Immediate surgical treatment is almost always required; therefore, the victim must receive medical attention at once, or the chances of survival will be poor. Give only the most essential first aid treatment, and concentrate your efforts on getting the victim to a medical treatment facility. The following first aid procedures may be of help to a person suffering from an abdominal wound:  Keep the victim in a supine position. If the intestine is protruding or exposed, the victim may be more comfortable with the knees drawn up. Place a coat, 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! 4-38