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Bandaging and Dressing

There are no hard and fast rules for dressing and bandaging wounds as long as the following conditions are met:

1. Use sterile material or material that is as clean as possible.
2. Bleeding is controlled.
3. The dressing is opened carefully and handled in an aseptic manner.
4. The dressing adequately covers the wound.
5. Wounds are bandaged snugly, but not too tightly. Too tight a bandage may interfere with the blood supply and damage surrounding tissue.
6. There are no loose ends that could get caught on other objects while the patient is being moved.
7. The bandage is securely tied or fastened in a place so that it will not move.
8. In bandaging the arms or the legs, leave the tips of the fingers or toes uncovered where possible so that any interference with circulation can be detected.
9. Always place the body part to be bandaged in the position in which it is to be left. Because swelling frequently follows an injury, a tight bandage may cause serious interference with circulation. On the other hand, a loosely applied bandage may slip off and expose the wound.
10. If the patient complains that the bandage is too tight, loosen it and make it comfortable but snug. Unless otherwise specified, all knots should be tied over open wounds to help control bleeding.

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Shock

Types of Shock:

Hemorrhagic (resulting from the loss of blood).

Metabolic (resulting from profound fluid loss in an untreated illness).

Cardiogenic (resulting from injury to theheart itself).

Neurogenic (resulting from the loss of effective nervous control of blood vessels).

Toxic or septic (resulting from the effect of toxic substances on the body).

Respiratory (resulting from impaired breathing).

Psychogenic (fainting).

Anaphylactic (a form of toxic shock that follows an overwhelming allergic reaction).

 

Signs and Symptoms of Shock:

The most common early manifestation of shock include restlessness, mental confusion, and disorientation. These are accompanied by evidence of the body’s attempt to compensate, resulting in such associated signs and symptoms as skin paleness, rapid pulse, coldness of extremities, thirst, and dryness of the mouth. In early shock, the pulse rate may be normal or slowed, or it may be quite rapid. Late symptoms of shock include low or unobtainable blood pressure; rapid, “thready,” or unobtainable pulse; a bluish or purplish discoloration of the skin; dilated pupils; faintness or unconsciousness; and irregular, gasping respirations. It is important to remember that low blood pressure (hypotension) is a late and usually serious sign of shock. Remember — a restless hypoxic patient who is in need of oxygen and lower extremity elevation can be in shock and have near normal blood pressure. The signs and symptoms of shock should not be studied merely as a means of identify- ing shock; rather, they are of tremendous help in determining what will be required in treatment of shock. What we call “shock” is simply the total of the body’s response to a particular type of injury. For instance, consider the teenage boy who faints in the excitement of seeing a celebrity in person. He obviously represents a far different medical problem than the victim of an automobile accident who is found unconscious in a pool of blood; yet, both are in shock. Both can be described by the following signs of shock:

1. Condition of the skin — pale, covered with sweat, cold, and clammy.
2. Condition of the blood pressure — gradual drop or unobtainable.
3. Condition of the brain’s activity — confusion, restlessness, and possibly unconscious.
4. Condition of the pulse — weak, difficult to find.

There is a difference — if you know what to look for. The pulse rate of the boy is essentially normal, perhaps slower than normal, while the pulse rate of the accident victim is so rapid that it is difficult to count. The boy is in early neurogenic shock; the accident victim is in late hemorrhagic shock. In summary, the most common signs and symptoms of shock include:

1. Restlessness, anxiety, weakness, anxious or dull expression, and disorientation (often precede other signs and symptoms).
2. Weak and rapid (thready) pulse.
3. Cold, clammy, moist skin.
4. Profuse sweating.
5. Initially, a dull, chalklike appearance to the patient’s skin, regardless of color; later, a bluish (cyanotic) color to the skin.
6. Shallow, irregular breathing; may be labored, rapid, or gasping.
7. Closed or partially closed eyelids; dull, lusterless eyes; dilated pupils.
8. Extreme thirst.
9. Nausea and possible vomiting.
10. Gradual and steady drop in blood pressure (to 90/60, or lower); eventually, blood presure that is unobtainable.
11. Possible fainting in cases of rapidly developing transient shock.
12. Shaking and trembling of the arms and legs, as if chilled.
13. Feeling of impending doom.

Causes of Anaphylactic Shock

1. Insect stings — including bee, wasp, hornet, yellow jacket, and other stinging insects. Reaction is usually severe and rapid.
2. Injected serums or drugs. The tetanus antitoxin sometimes causes anaphylactic shock, as does the drug penicillin (whether ingested or injected, although the reaction is more rapid from injection).
3. Foods. Common foods that precipitate anaphylactic shock include shellfish, fish, berries (especially strawberries), and milk. The reaction is usually gradual but can become very severe.
4. Drugs. Depending on the sensitivity of the person, a simple drug like aspirin can cause fatal anaphylactic shock.
5. Inhaled substances. If a person is allergic to them, inhaled substances such as ragweed, pollens, animal hair, and dust can produce anaphylactic shock.

Signs & Symptoms of Anaphylactic Shock

1. Signs and symptoms involving the skin:
   • Itching and burning of the skin with flushing, especially around the face and chest.
   • Blueness (cyanosis) around the lips.
   • Raised, hivelike patches with severe itching.
   • Swelling of the face and tongue.
   • Paleness.
   • Swelling of the blood vessels just underneath the skin.
2. Signs and symptoms involving the heart and circulation:
   • Weak, rapid pulse.
   • Low blood pressure.
   • Dizziness.
   • Restlessness.
   • Diminished stroke volume and cardiac output.
3. Signs and symptoms involving the respiratory tract:
   • Spasm of the bronchioles.
   • A painful, squeezing sensation in the chest.
   • Difficulty in breathing.
   • Coughing, bronchial obstruction.
   • Swelling of the larynx.
   • Swelling of the epiglottis.
   • Respiratory wheezes.
4. Signs and symptoms involving the gastrointestinal tract:
   • Nausea.
   • Vomiting.
   • Abdominal cramps.
   • Diarrhea.

Heat and Cold Emergencies and Treating Snake Bites

Heat Related Illness

Heat cramps, heat exhaustion, and heat stroke are conditions caused by overexposure to heat. Heat cramps are the least severe, and often are the first signals that the body is having trouble with the heat. Heat cramps are painful muscle spasms. They usually occur in the legs and abdomen. Think of them as a warning of a possible heat-related emergency. To care for heat cramps, have the victim rest in a cool place. Give cool water or a commercial sports drink.

Usually, rest and fluids are all the person needs to recover. Lightly stretch the muscle and gently massage the area. The victim should not take salt tablets or salt water. They can make the situation worse. When the cramps stop, the per son can usually start activity again if there are no other signals of illness. He or she should keep drinking plenty of fluids. Watch the victim carefully for further signals of heat related illness.

Heat exhaustion is a more severe condition than heat cramps. It often affects athletes, fire lighters, construction workers, and factory workers, as well as those who wear heavy clothing in a hot, humid environment. Its signals include cool, moist, pale, or flushed skin, headache, nausea, dizziness, weakness, and exhaustion.

Heat stroke is the least common but most severe heat emergency. It most often occurs when people ignore the signals of heat exhaustion. Heat stroke develops when the body systems are overwhelmed by heat and begin to stop functioning. Heat stroke is a serious medical emergency. The signals of heat stroke include red, hot, dry skin; changes in consciousness; rapid, weak pulse; and rapid, shallow breathing.

When you recognize heat-related illness in its early stages, you can usually reverse it. Get the victim outof the heat. Loosen any tight clothing and apply cool, wet cloths, such as towels or sheets. If the victim is conscious, give cool water to drink. Do not let the conscious victim drink too quickly. Give about one glass (4 ounces) of water every 15 minutes. Let the victim rest in a comfortable position, and watch carefully for changes in his or her condition. The victim should not resume normal activities the same day.

Refusing water, vomiting, and changes in consciousness mean that the victim’s condition is getting worse. Call for an ambulance immediately if you have not already done so. If the victim vomits, stop giving fluids and position the victim on the side. Watch for signals of breathing problems. Keep the victim lying down and continue to cool the body any way you can. If you have ice packs or cold packs, place them on each of the victim’s wrists and ankles, on the groin, in each armpit, and on the neck to cool the large blood vessels. Do not apply rubbing (isopropyl) alcohol.

Cold Related Illness

Frostbite and hypothermia are two types of cold emergencies. Frostbite is the freezing of body parts exposed to the cold. Severity depends on the air temperature, length of exposure, and the wind. Frostbite can cause the loss of fingers, hands, arms, toes, feet, and legs. The signals of frostbite include lack of feeling in the affected area and skin that appears waxy, is cold to the touch, or is discolored (flushed, white, yellow, or blue) To care for any frostbite, handle the area gently. Never rub an affected area. Rubbing causes further damage to soft tissues. Instead, warm the area gently by soaking the affected part in water no warmer than 105° F. If you don’t have a thermometer, test the water temperature yourself. If the temperature is uncomfortable to your touch, the water is too warm. Keep the frostbitten part in the water until it looks red and feels warm. Loosely bandage the area with a dry, sterile dressing. If fingers or toes are frostbitten, place cotton or gauze between them. Don’t break any blisters. Get professional medical attention as soon as possible.

In hypothermia the entire body cools because its ability to keep warm fails. The victim will die if not given care. Signals of hypothermia include shivering, numbness, glassy stare, apathy, and loss of consciousness. The air temperature does not have to he below freezing for people to develop hypothermia. Elderly people in poorly heated homes can develop hypothermia at higher temperatures. The homeless and the ill also are at risk. Substances that interfere with the body’s normal response to cold, such as alcohol, may cause HYPERTHERMIA to occur more easily. Any medical condition that impairs circulation, such as diabetes or cardiovascular disease, can also make a person more likely to get hypothermia. Anyone remaining in cold water or wet clothing for a long time may also easily develop hypothermia.

To care for hypothermia, start by caring for any life-threatening problems. Call the local emergency number. Make the victim comfort able. Remove any wet clothing and dry the victim. Warm the body gradually by wrapping the victim in blankets or putting on dry clothing and moving him or her to a warm place. If they are available, apply heat pads or other heat sources to the body. Keep a barrier, such as a blanket, towel, or clothing, between the hear source and the victim to avoid burning him or her. If the victim is alert, give warm liquids to drink, no not warm the victim too quickly, such as by immersing the victim in warm water. Rapid re-warming can cause dangerous heart problems. Handle the victim gently.

In cases of severe hypothermia the victim may be unconscious. Breathing might have slowed or stopped. The pulse may be slow and irregular. The body may feel stiff because the muscles become rigid. Call for an ambulance. Keep checking breathing and pulse. Give rescue breathing if necessary. Continue to warm the victim until EMS personnel arrive. Be prepared to start CPK. In general, illnesses caused by overexposure to extreme tempera- tures can be prevented. To prevent heat or cold emergencies from happening to you or anyone you know, follow these guidelines:

1. Avoid being outdoors in the hottest or coldest part of the day.
2. Change your activity level according to the temperature.
3. Take frequent breaks.
4. Dress appropriately for the environment.
5. Drink large amounts of fluids.

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Snake Bites

Steps to Take for a “Poisonous” Snake Bite:

1. Have the patient lie down on his or her back keeping patient quite and still with the bite area raised above the level of the Heart.
2. Wipe the wound area with alcohol, soap and water, or hydrogen peroxide.
3. If you do not have a sterile scalpel or razor blade, sterilize a knife in a match flame, in soap and water, in alcohol, or in hydrogen peroxide. Only make an incision if you are thirty minutes or more away from a medical facility.
4. Find the fang marks. Wrap soft rubber tubing around the extremity both above and below the fang marks. Tubing should be tight enough to stop the flow of blood through the veins but not through the arteries.
5. Make longitudinal (vertical) cut marks through each fang mark. Cut marks should be about one-eighth to one-fourth inch in length and should be parallel to each other; they should be made in the direction that the fang entered. The incisions should not be cross marks.
6. Apply suction to the wound directly over the incisions. (A suction cup from a snakebite kit is ideal, but you can “milk” the incision with your fingers if necessary.) Note: There is some controversy about incising and suctioning a snakebite injury, using constricting bands, and when it should be done. Always follow local protocol and poison control center instructions.
7. The most effective countermeasure is an antivenin shot obtained at a medical facility.
8. Give the patient emergency care for shock. Monitor vital signs, keep the patient warm and lying down, and administer oxygen if needed.
9. Transport him to the hospital as soon as possible.