Surgical Emergency

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Surgical Emergency
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• Any abnormal break of the skin or the body
  surfaces is known as wound.
• Open wounds allow blood to be lost from the body
  germs to enter.
• If the bleeding is internal, the wound is closed.
  This is most easily recognized by bruising,
  indicating damage to blood vessels just beneath
  the skin.

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First aid priorities

1. Control blood loss by applying pressure raising
   the injured part.
2. Take steps to minimize shock, which can result
   from severe blood loss.
3. Cover any open wound with a dressing to protect
   it from infection promote natural healing.
4. Pay attention to hygiene, so that no spread of
   infection between the casualty yourself.

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1- Bleeding

• Bleeding is a loss of blood from the blood
  vessels.
• Severe or continued bleeding may lead to collapse
  and death.
• Thus, the first aider must aim to control severe
  bleeding.

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• I- External Bleeding
• a) Minor Bleeding
• Wounds that are relatively small and involve only
  slight bleeding.
• It may be accompanied with pain at the site of
  the wound.
• Management
• Wash your hands with soap and water.
• Gently wash wound with soap and water.
• Place sterile gauze over the wound and apply
  pressure to stop bleeding.

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• If blood soaks through the gauze replace with new
  gauze.
• If possible elevate the injury above the heart.
• When bleeding stops apply an antibacterial
  ointment.
• Cover wound with bandage to reduce chances of
  infection.

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• B) Major or Severe Bleeding
• If the damaged blood vessel is too large or the
  blood is flowing too fast to clot.
• Bleeding may become life threatening, especially
  in children and infants whose blood volume is
  much smaller than an adult's.

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• Management
• If you have time wash your hands and put on
  synthetic gloves.
• Have the person lie down. This will decrease the
  person's blood pressure and heart rate, and,
  therefore, decrease the bleeding.
• If possible elevate the lower body higher than
  the head. This reduces the chance of shock.
• Raise the injury above the heart to slow the
  bleeding as it will eliminate the effects of
  gravity pulling blood "down" and out of the body.
  

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• Lightly remove any dirt or debris. DO NOT remove
  any embedded objects or probe the wound.
• Using a sterile dressing apply pressure to the
  wound. Use a cloth, towel or even your hand if
  gauze is not available.
• Hold continual pressure on the wound for at least
  20 minutes.
• Resist the urge to lift up the gauze and check to
  see if the wound has stopped bleeding.

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Indirect pressure

• Direct pressure at the bleeding point can be
  impossible to apply or insufficient to stop
  bleeding. In these cases, indirect pressure can
  be applied to a pressure point above the bleeding
  artery, where the main artery runs close to a
  bone.
• First identify the artery by feeling for
  pulsation, then apply pressure until the blood
  supply to the limb is greatly reduced.
• .

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• If the bleeding did not stop
• DO NOT remove pressure or the gauze. Instead add
  more gauze or material on top of it.
• If the bleeding will not stop you can apply
  direct pressure to the artery delivering blood to
  the wound. The major pressure points are
• For the Arm The inside of the arm just above the
  elbow below the armpit.
• For the Leg At the top of the thigh.
• For the face in front of the ears

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• Squeeze the main artery against the bone in these
  parts of the body. Use flat fingers on the artery
  and continue to apply pressure to the wound with
  your other hand.

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DO NOT apply a tourniquet, it may result in
tissue damage or even gangrene.
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II- Internal Bleeding

• Bleeding within the body cavities may follow
  injury, such as fracture or penetrating wound,
  but also can occur spontaneously as from stomach
  ulcer.
• Internal bleeding is serious, even if blood is
  not split from the body, it is still lost from
  the circulation shock can develop. Accumulated
  blood can also exert damaging pressure on organs
  as lungs or brain.

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• Evidence of internal bleeding from some organs
  may be seen by the first aider.
• Suspect internal bleeding if following injury,
  signs of shock develop without obvious blood
  loss.
• Signs of internal bleeding
• Bleeding from ear, nose, rectum or vagina.
• Coughing up blood or blood found in vomit.
• Abdominal pain, tenderness, rigidity or spasm in
  the abdomen.
• Bruising on neck, abdomen or chest

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• Any wound that has penetrated the chest, skull or
  the abdomen.
• Fractures.
• Pain and tenderness at the affected area,
  swelling and tension may be felt.
• Signs of shock (Cold, pale skin. weakness.
  anxiety. shallow breathing or thirst).

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• Management
• Seek medical aid urgently or arrange to transport
  the victim to the hospital
• lay the casualty down and raise the legs
• loosen tight clothing and give nothing by mouth
• Check breathing rate, pulse, and level of
  responsiveness
• If the casualty is unconscious, open the airway
  and check breathing.
• Keep casualty covered.

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• III- Bleeding from some particular regions
• a) Bleeding from the Head
• Bleeding from the head is usually caused by a
  blow.
• The scalp in particular has a rich blood supply
  and even a small wound can bleed heavily.
• Bleeding may be profuse will make the injury
  appear worse than it is.
• However a scalp wound may be part of a more
  serious underlying injury such as skull fracture.

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• A - Skull fracture
• Signs
• Staining of the eye socket, Pain, and a knock
  or cavity in the skull
• Straw-colour fluid coming from one or both ears
• Casualty becomes increasingly drowsy and
  unresponsive over a period of time.

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• B - Concussion
• Pale skin
• Dizziness, blurred vision or nausea
• Headache
• Brief or partial loss of consciousness

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• First Aid Management
• Treatment should include taking full details of
  what happened and checking for signs of head
  injury, such as skull fracture or concussion.
• Help the injured person to sit or lie down.
• Check for any signs of head injury.
• Using a sterile bandage, apply direct pressure to
  the wound to stop the bleeding.

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• Cover the wound with a sterile dressing or a
  clean pad. Tie this in place with a bandage.
• Take or send the casualty to hospital as soon as
  possible.
• If the casualty becomes unconscious, monitor and
  maintain airway and breathing and be prepared to
  resuscitate as necessary.

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• B - Bleeding from the Palm
• The palm of the hand is commonly cut while
  cutting objects or through a fall.
• Bleeding is often severe as the palm has a rich
  blood supply.
• There are many tendons and nerves in the hand,
  and wounds to the palm may be accompanied by loss
  of movement or feeling in the fingers.

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• First Aid Management
• Help the casualty to sit or lie down. Apply
  direct pressure to the wound and raise the arm.
• lf the person has had a fall, take care to rule
  out a broken arm before raising the arm.
• Place a sterile dressing or clean pad in the hand
  and ask the casualty to grip her fingers over it.
  Bandage the fingers so that they are clenched
  over the pad. Leave the thumb exposed.

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• lf there is an embedded object in the wound,
  treat the hand flat and bandage around the
  object.
• lf tendon damage means that the fingers cannot be
  clenched, bandage the wound with the hand flat.
• Treat for shock if necessary. Keep the casualty
  warm, at rest and reassure him or her.
• Support the arm in an elevation sling and take or
  send the casualty to hospital

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• C) Bleeding from the Nose
• The nose is a very vascular area of the body that
  contains many arterioles (tiny blood vessels)
  that can bleed easily.
• Nosebleeds occur more frequently in the winter
  when heated indoor air can dry the membranes of
  the nose. 
• Also, air moving through the nose can also dry
  out the membranes and can form crusts. These
  crusts bleed when irritated by rubbing, picking,
  or blowing the nose.
• Occasionally, nosebleeds may indicate other
  disorders such as bleeding disorders, high blood
  pressure, or hardening of the arteries.

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• Nosebleeds most commonly occur when blood vessels
  inside the nostrils are ruptured by a blow to the
  nose or as a result of sneezing, picking or
  blowing the nose.
• Infection as a cold or flu makes the blood
  vessels in the nose more fragile.
• Nosebleeds may also occur as a result of high
  blood pressure.

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• Nosebleeds can be dangerous if the casualty loses
  a lot of blood.
• If a nosebleed follows a head injury, the blood
  may appear thin watery.

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• First Aid management
• Have the patient tilt their head forward. Tilting
  the head backwards can cause blood to go down the
  throat
• Pinch the soft part of the nose just below the
  bone. Instruct the patient to breathe through
  their mouth
• Apply pressure for 10 minutes
• Seek medical help if...
• You cannot stop the bleeding in 15 to 20 minutes
• If the patient becomes dizzy or disoriented
• If the patient has begun new medication recently
• If they have frequent nose bleeds or bruise easily

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• D- Bleeding from the Gums
• A progressive disease affecting oral cavity
  characterized by chronic bleeding of gums that
  may lead to tooth loss. 
• Causes
• Poor oral hygiene or inadequate plaque removal.
• Oral trauma (like toothbrush abrasion) or
  inflammation (infection).
• Vitamin C / K deficiency.
• Hot food.
• Leukemia.
• Pregnancy. 

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• First Aid Management
• Apply pressure using ice-pack. 
• Mouth rinse using pinch of salt in warm water
  (twice a day to reduce swelling).
• Take vitamin supplements if necessary.
• Consult a dentist if bleeding continues.
• Avoid Taking aspirin, cigarette smoking, or
  using hard brush.