Surgical Surgical EmergencyEmergency

Any Any abnormal break of the skinabnormal break of the skin or the or the body surfaces is known as body surfaces is known as woundwound. .

Open wounds Open wounds allow allow blood to be lost blood to be lost from the body & from the body & germs to entergerms to enter..

If the bleeding is If the bleeding is internalinternal, the wound , the wound is closed. This is most easily is closed. This is most easily recognized by recognized by bruisingbruising, indicating , indicating damage to blood vessels just beneath damage to blood vessels just beneath the skin.the skin.

First aid prioritiesFirst aid priorities

1.1. Control blood lossControl blood loss by applying pressure & by applying pressure & raising the injured part.raising the injured part.

2.2. Take steps to Take steps to minimize shockminimize shock, which can , which can result from severe blood loss.result from severe blood loss.

3.3. Cover any open wound Cover any open wound with a dressing to with a dressing to protect it from infection & promote natural protect it from infection & promote natural healing.healing.

4.4. Pay attention to hygienePay attention to hygiene, so that no spread , so that no spread of infection between the casualty & of infection between the casualty & yourself.yourself.

11 - -BleedingBleedingBleeding is a Bleeding is a loss of bloodloss of blood from from

the blood vessels. the blood vessels. Severe or continued bleeding Severe or continued bleeding

may lead to may lead to collapse and death. collapse and death.

Thus, the first aider must Thus, the first aider must aim to control severe aim to control severe bleeding.bleeding.

I- External Bleeding:I- External Bleeding:a)a) Minor Bleeding:Minor Bleeding:

Wounds that are Wounds that are relatively smallrelatively small and and involve only involve only slight bleedingslight bleeding. .

It may be accompanied with It may be accompanied with pain at pain at the sitethe site of the wound. of the wound.

Management: Wash your hands with soap and Wash your hands with soap and

water. water. Gently wash wound with soap and Gently wash wound with soap and

water. water. Place sterile gauze over the wound Place sterile gauze over the wound

and apply pressure to stop bleeding. and apply pressure to stop bleeding.

If If blood soaks through the blood soaks through the gauzegauze replace with new replace with new gauze. gauze.

If possible If possible elevate the injuryelevate the injury above the heart. above the heart.

When bleeding stops apply an When bleeding stops apply an antibacterial ointment. antibacterial ointment.

Cover wound with Cover wound with bandagebandage to to reduce chances of infection. reduce chances of infection.

B) Major or Severe BleedingB) Major or Severe Bleeding

If the damaged blood vessel is If the damaged blood vessel is too largetoo large or the blood is or the blood is flowing flowing too fast to clot.too fast to clot.

Bleeding may become Bleeding may become life life threateningthreatening, especially in , especially in children and infantschildren and infants whose whose blood volume is much blood volume is much smaller than an adult's.smaller than an adult's.

Management:Management: If you have timeIf you have time wash your hands wash your hands

and put on synthetic gloves.and put on synthetic gloves.Have the person Have the person lie downlie down. . This will This will

decrease the person's blood decrease the person's blood pressure and heart rate, and, pressure and heart rate, and, therefore, therefore, decrease the bleedingdecrease the bleeding. .

If possible If possible elevate the lower body elevate the lower body higher than the head.higher than the head. This reduces This reduces the chance of the chance of shockshock. .

Raise the injury above the heartRaise the injury above the heart to to slow the bleedingslow the bleeding as it will as it will eliminate the effects of gravity eliminate the effects of gravity pulling blood "down" and out of pulling blood "down" and out of the body. the body.

LightlyLightly remove any dirt or debris. remove any dirt or debris. DO NOTDO NOT remove any embedded remove any embedded objects or probe the wound.objects or probe the wound.

Using a sterile dressing Using a sterile dressing apply apply pressure to the woundpressure to the wound. . Use a Use a cloth, towel or even your hand if cloth, towel or even your hand if gauze is not available. gauze is not available.

Hold continual pressure on the Hold continual pressure on the wound for at least 20 minutes.wound for at least 20 minutes.

Resist the urgeResist the urge to lift up the to lift up the gauze and check to see if the gauze and check to see if the wound has stopped bleeding.wound has stopped bleeding.

Indirect pressureIndirect pressure Direct pressure at the bleeding point can be Direct pressure at the bleeding point can be

impossible to apply or insufficient to stop bleeding. impossible to apply or insufficient to stop bleeding. In these cases, In these cases, indirect pressure can be applied to indirect pressure can be applied to a pressure point above the bleeding arterya pressure point above the bleeding artery, where , where the main artery runs close to a bone.the main artery runs close to a bone.

First First identify the artery by feeling for pulsationidentify the artery by feeling for pulsation, , then apply pressure until the blood supply to the then apply pressure until the blood supply to the limb is greatly reduced.limb is greatly reduced.

..

If the bleeding did not stop:If the bleeding did not stop: DO NOT remove pressure or the DO NOT remove pressure or the

gauzegauze. Instead add more gauze or . Instead add more gauze or material on top of it.material on top of it.

If the bleeding will not stop you can apply If the bleeding will not stop you can apply direct pressure to the artery delivering blood direct pressure to the artery delivering blood to the wound. The to the wound. The major pressure pointsmajor pressure points areare: :

For the ArmFor the Arm: : The inside of the arm just The inside of the arm just above the elbow below the armpit.above the elbow below the armpit.

For the LegFor the Leg: At the top of the thigh.: At the top of the thigh. For the faceFor the face: : in front of the earsin front of the ears

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.

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

II- Internal Bleeding: Bleeding within the body cavities may follow Bleeding within the body cavities may follow

injuryinjury, such as , such as fracturefracture or or penetrating woundpenetrating wound, , but also can occur spontaneously as from but also can occur spontaneously as from stomach ulcerstomach ulcer..

Internal bleeding is Internal bleeding is seriousserious, even if blood is , even if blood is not split from the body, it is still lost from the not split from the body, it is still lost from the circulation & circulation & shock can developshock can develop. . Accumulated blood can also exert damaging Accumulated blood can also exert damaging pressure on organs as lungs or brain.pressure on organs as lungs or brain.

Evidence of internal bleeding from Evidence of internal bleeding from some organs may be seen by the some organs may be seen by the first aider. first aider.

““Suspect internal bleeding if following Suspect internal bleeding if following injury, signs of shock develop without injury, signs of shock develop without

obvious blood loss.” obvious blood loss.”

Signs of internal bleeding: Signs of internal bleeding: Bleeding from ear, nose, rectum Bleeding from ear, nose, rectum

or vagina. or vagina. Coughing up blood Coughing up blood or blood found or blood found

in vomit. in vomit. Abdominal painAbdominal pain, tenderness, , tenderness,

rigidity or spasm in the abdomen. rigidity or spasm in the abdomen. Bruising Bruising on neck, abdomen or on neck, abdomen or

chest chest

Any wound that has Any wound that has penetrated the chest, skull penetrated the chest, skull or the abdomenor the abdomen. .

FracturesFractures.. PainPain and tenderness at the and tenderness at the affected area, affected area, swellingswelling and and tension may be felt. tension may be felt.

Signs of shockSigns of shock (Cold, pale (Cold, pale skin. weakness. anxiety. skin. weakness. anxiety. shallow breathing or shallow breathing or thirst). thirst).

ManagementManagementSeek medical aid Seek medical aid urgently or arrange to urgently or arrange to

transport the victim to the hospitaltransport the victim to the hospital lay the casualty down and raise the legs lay the casualty down and raise the legs loosen tight clothing and give nothing by loosen tight clothing and give nothing by

mouthmouthCheck breathing rate, pulseCheck breathing rate, pulse, and level of , and level of

responsivenessresponsiveness If the casualty is unconscious, open the If the casualty is unconscious, open the

airway and check breathing. airway and check breathing. Keep casualty coveredKeep casualty covered..

III- Bleeding from some particular III- Bleeding from some particular regions:regions:

a) a) Bleeding from the HeadBleeding from the Head Bleeding from the head is usually Bleeding from the head is usually

caused by a blow. caused by a blow. The scalp in particular has a rich blood The scalp in particular has a rich blood

supply and even a small wound can supply and even a small wound can bleed heavily.bleed heavily.

Bleeding may be profuse & will make Bleeding may be profuse & will make the injury appear worse than it is.the injury appear worse than it is.

However a scalp wound may be part of However a scalp wound may be part of a more serious underlying injury a more serious underlying injury such as skull fracture.such as skull fracture.

A - Skull fractureA - Skull fractureSigns: Signs: • Staining of the eye socket, Staining of the eye socket,

Pain, and a knock or cavity in Pain, and a knock or cavity in the skull the skull

• Straw-colour fluid coming from Straw-colour fluid coming from one or both ears one or both ears

• Casualty becomes increasingly Casualty becomes increasingly drowsy and unresponsive drowsy and unresponsive over over a period of time. a period of time.

B - ConcussionB - Concussion

• Pale skin Pale skin • Dizziness, blurred vision Dizziness, blurred vision

or nausea or nausea • Headache Headache • Brief or partial loss of Brief or partial loss of

consciousnessconsciousness

First Aid Management:First Aid Management:Treatment should include taking full Treatment should include taking full

details of what happened and details of what happened and checking for signs of head injury, checking for signs of head injury, such as skull fracture or concussionsuch as skull fracture or concussion. .

Help the injured person to sit or lie Help the injured person to sit or lie down. down.

Check for any signs of head injury. Check for any signs of head injury. Using a sterile bandage, Using a sterile bandage, apply direct apply direct

pressure to the woundpressure to the wound to stop the to stop the bleeding. bleeding.

Cover the wound with a sterile Cover the wound with a sterile dressing dressing or a clean pad. Tie this in or a clean pad. Tie this in place with a bandage. place with a bandage.

Take or send the casualty to Take or send the casualty to hospital as soon as possible. hospital as soon as possible.

If the casualty becomes If the casualty becomes unconscious, monitor and unconscious, monitor and maintain airway and breathing maintain airway and breathing and be prepared to resuscitate as and be prepared to resuscitate as necessary.necessary.

B - Bleeding from the Palm: B - Bleeding from the Palm:

The palm of the hand is commonly The palm of the hand is commonly cut while cutting objects or cut while cutting objects or through a fall. through a fall.

Bleeding is often severe Bleeding is often severe as the as the palm has a palm has a rich blood supplyrich blood supply. .

There are many tendons and There are many tendons and nerves in the hand, and wounds nerves in the hand, and wounds to the palm may be accompanied to the palm may be accompanied by loss of movement or feeling in by loss of movement or feeling in the fingersthe fingers. .

First Aid Management:First Aid Management:Help the casualty to sit or lie down. Help the casualty to sit or lie down.

Apply direct pressure to the wound Apply direct pressure to the wound and raise the armand raise the arm. .

lf the person has had a fall, take care lf the person has had a fall, take care to rule out a broken arm before to rule out a broken arm before raising the arm. raising the arm.

Place a sterile dressing or clean pad Place a sterile dressing or clean pad in the hand and ask the casualty to in the hand and ask the casualty to grip her fingers over itgrip her fingers over it. . Bandage the Bandage the fingersfingers so that they are clenched over so that they are clenched over the pad. Leave the thumb exposed. the pad. Leave the thumb exposed.

lf there is an embedded object in the lf there is an embedded object in the wound, treat the hand flat and wound, treat the hand flat and bandage around the object. bandage around the object.

lf tendon damage means that the lf tendon damage means that the fingers cannot be clenched, bandage fingers cannot be clenched, bandage the wound with the hand flatthe wound with the hand flat. .

Treat for shock if necessaryTreat for shock if necessary. Keep . Keep the casualty warm, at rest and the casualty warm, at rest and reassure him or her. reassure him or her.

Support the arm in an elevation sling Support the arm in an elevation sling and take or send the casualty to and take or send the casualty to hospitalhospital

C) Bleeding from the Nose:C) Bleeding from the Nose: The nose is a The nose is a very vascular area very vascular area of the of the

body that contains many arterioles body that contains many arterioles (tiny blood vessels) that can bleed (tiny blood vessels) that can bleed easily. easily.

Nosebleeds occur more frequently in Nosebleeds occur more frequently in the winter when heated indoor air can the winter when heated indoor air can dry the membranes of the nose. dry the membranes of the nose. 

Also, air moving through the nose can Also, air moving through the nose can also dry out the membranes and can also dry out the membranes and can form crusts. These crusts bleed when form crusts. These crusts bleed when irritated by rubbing, picking, or blowing irritated by rubbing, picking, or blowing the nose. the nose.

Occasionally, nosebleeds may indicate Occasionally, nosebleeds may indicate other disorders such as bleeding other disorders such as bleeding disorders, high blood pressure, or disorders, high blood pressure, or hardening of the arteries. hardening of the arteries.

Nosebleeds most commonly occur Nosebleeds most commonly occur when when blood vessels inside the nostrils are blood vessels inside the nostrils are rupturedruptured by a by a blowblow to the nose or as a to the nose or as a result of result of sneezing, picking or blowing sneezing, picking or blowing the the nose.nose.

InfectionInfection as a cold or flu as a cold or flu makes the blood makes the blood vessels in the nose more fragilevessels in the nose more fragile..

Nosebleeds may also occur as a result of Nosebleeds may also occur as a result of high blood pressurehigh blood pressure..

Nosebleeds can be Nosebleeds can be dangerousdangerous if the if the casualty casualty loses a lot of bloodloses a lot of blood..

If a nosebleed If a nosebleed follows a head injuryfollows a head injury, the , the blood may appear thin & wateryblood may appear thin & watery..

First Aid management:First Aid management: Have the patient Have the patient tilt their head forwardtilt their head forward. .

Tilting the head backwards can cause Tilting the head backwards can cause blood to go down the throat blood to go down the throat

Pinch the soft part of the nose Pinch the soft part of the nose just below just below the bone. Instruct the patient to breathe the bone. Instruct the patient to breathe through their mouth through their mouth

Apply pressure for 10 minutes Apply pressure for 10 minutes Seek medical help if... Seek medical help if...

You cannot stop the bleeding in 15 to 20 You cannot stop the bleeding in 15 to 20 minutes minutes

If the patient becomes dizzy or If the patient becomes dizzy or disoriented disoriented

If the patient has begun new medication If the patient has begun new medication recently recently

If they have frequent noseIf they have frequent nose bleeds or bleeds or bruise easilybruise easily

D- Bleeding from the Gums:D- Bleeding from the Gums:

A progressive disease affecting oral cavity A progressive disease affecting oral cavity characterized by chronic bleeding of characterized by chronic bleeding of gums that may lead to tooth loss.  gums that may lead to tooth loss. 

Causes:Causes:

1.1. Poor oral hygiene or Poor oral hygiene or inadequate plaque inadequate plaque removalremoval. .

2.2. Oral trauma (like toothbrush abrasion) Oral trauma (like toothbrush abrasion) or inflammation (infection). or inflammation (infection).

3.3. Vitamin C / K deficiency. Vitamin C / K deficiency.

4.4. Hot food. Hot food.

5.5. Leukemia. Leukemia.

6.6. Pregnancy.  Pregnancy. 

First Aid Management: First Aid Management: Apply pressure using ice-packApply pressure using ice-pack.  .  Mouth rinse using pinch Mouth rinse using pinch of salt in warm of salt in warm

waterwater (twice a day to reduce swelling). (twice a day to reduce swelling). Take vitamin supplements if Take vitamin supplements if

necessary.necessary.Consult a dentist if bleeding continues. Consult a dentist if bleeding continues.

AvoidAvoid: : Taking aspirin, cigarette Taking aspirin, cigarette smoking, or using hard brush.smoking, or using hard brush.