Travel Reference
In-Depth Information
these vessels can be easily controlled by compression because the pressure within them is
low.
Arteries have much thicker, elastic walls and are deeper structures. However, arterial
bloodisundermuchhigherpressure,andbloodlossishardertocontrolwhenthesevessels
aredamaged.Theonlydependablewaytoidentifyarterialbleedingistoseebloodspurting
from the wound with each heartbeat. The color of the blood is not a reliable indicator of its
source. Arterial bleeding also must be controlled by direct pressure, but the pressure must
be maintained for a much longer time.
If bleeding persists, even after direct pressure has been applied for more than fifteen
minutes,particularlywhenanarterialinjuryissuspected,thewoundshouldbepackedwith
sterile gauze and wrapped snugly with a continuous bandage.
Bandages that completely surround a limb may act as tourniquets and obstruct circula-
tion to the rest of the limb. Absent pulses, bluish discoloration of the skin or nails, tingling
sensations, or pain indicate that the blood supply to the tissues beyond the bandage is inad-
equate. Since swelling at the site of the wound can greatly increase the pressure beneath a
circumferential bandage,thelimbbeyondthebandagemustbecarefullycheckedforcircu-
latory impairment every few minutes. If the bandage initially is too tight, or becomes too
tight, it must be loosened. After bleeding has been controlled, the circumferential bandage
should be removed.
Movement may cause bleeding to recur after it has been controlled. To avoid further
bloodloss,severelyinjuredlimbsshouldbesplintedorimmobilizedinsomeotherwaybe-
fore the individual is evacuated.
CONTROLLING INFECTION
Wound infection results from contamination, and all open wounds are contaminated to
someextent.Preventinginfectionbyminimizingcontaminationandeliminatingconditions
that promote bacterial growth is far preferable to treating an established infection.
Wound Cleansing
Afterbleedinghasbeencontrolled,furthercontamination ofsoft-tissuewoundsmustbe
avoided. All persons caring for the injured individual must wash their hands, preferably
with an antibacterial agent such as PhisoHex®, a povidone-iodine preparation such as
Betadine®, or an alcohol-based skin disinfectant. Sterile gloves, if available, should be
usedbutonlyafterthehandshavebeencleaned.Theskinaroundthewoundshouldbevig-
orously cleaned, preferably by scrubbing with the same antibacterial agent. Washing dirt,
dried blood, or other contaminants into the wound must be avoided.
Finally, the wound itself must be cleaned. A 20 ml or 50 ml syringe with a large bore
needle (18 gauge or larger) is ideal for this purpose because a jet of water can be directed
into the wound with sufficient force to rinse out any foreign material. (A plastic bag with a
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