When dressing a wound, you should know whether there is any internal injury. At the scene of trauma first aid, you can't just dress the superficial wound and ignore other internal injuries.
It is the same wound on the limb. Whether there is a fracture or not, the dressing method is different. When there is a fracture, the correct fixation of the fracture site should be considered in dressing. It is also a wound on the body. If it is combined with internal organ damage, such as liver rupture, intra-abdominal bleeding, hemothorax, etc., priority should be given to the treatment of internal organ damage, and time should not be delayed in dressing the surface wound; The same head wound, such as combined with craniocerebral injury, is not simply wrapped to stop bleeding, but also needs to strengthen monitoring. For patients with head impact. Even if you feel good, you need to observe for 24 hours. If there is head swelling, headache aggravation, even nausea and vomiting, it indicates that there is intracranial injury and urgent treatment is needed. Therefore, before or at the same time of dressing the obviously visible wound of the injured person, it is necessary to know whether there are any injuries in other parts, especially whether there are hidden visceral injuries.
dressing of wounds communicating with body cavity
For open wounds communicating with body cavity, it is generally only necessary to simply cover the wounds on site, and then send them to the hospital as soon as possible or contact medical personnel urgently for treatment. For example, an abdominal wound communicating with the abdominal cavity can be covered with clean gauze, towels, sheets, etc. If the intestine or omentum bulges from the wound, do not try to put it back into the abdominal cavity, so as not to aggravate the abdominal cavity pollution. Cover the swollen intestine or omentum completely with a clean bowl, or wrap it around with clean gauze to prevent it from squeezing. Another example is a chest wound communicating with the chest cavity, which can cause an open pneumothorax. Among them, "traffic pneumothorax" and "high pressure (tension) pneumothorax" have serious symptoms, which may even lead to coma and death. The former should close the wound with sterile gauze or other clean dressings as soon as possible, bind it up and fix it to prevent abnormal breathing, so as to alleviate symptoms and continuous injuries. For "high pressure (tension) pneumothorax", because the rupture mouth forms a one-way valve, when people inhale, the rupture opens and the gas continues to enter the pleural cavity; When exhaling, the gap closes, so that the gas cannot be discharged. The increasing pressure in the chest cavity increases the pressure on the lungs, which leads to progressive dyspnea. At this time, emergency exhaust treatment is needed, and a large injection needle can be used to stab the pleura in the second intercostal space of the clavicle midline of the affected side. Furthermore, if there is "a large amount of reddish liquid flowing out of nostrils and ears" in patients with head trauma, skull base fracture should be considered, and the wound is connected with cranial cavity. Don't try to compress and plug the nostrils and ears of the injured at the scene, so as not to cause intracranial infection. If the fracture pierces the scalp or brain tissue bulges, it can be treated according to the principle of abdominal organ bulging.
wound dressing with bleeding as the main symptom. In case of bleeding, the implementation of wound dressing must be based on hemostasis. If the bleeding is not stopped in time, it can cause serious blood loss, shock and even life-threatening. Sometimes, dressing itself is a measure to stop bleeding. For example, capillary bleeding caused by tissue injury, when bleeding, blood flows out of the wound like water droplets, which can be stopped by a little compression, and sometimes it can be automatically coagulated to stop bleeding. For this kind of bleeding, it is often only necessary to put a hemostatic patch on the wound, or cover the wound with sterile gauze, and then apply a little pressure to bandage it, so as to complete the dual tasks of hemostasis and bandaging. However, for "arterial bleeding" caused by arterial vascular injury and "venous bleeding" caused by venous vascular injury, simply compressing and dressing the wound often cannot achieve the purpose of hemostasis. When arterial bleeding occurs, the bleeding is pulsating and jet-shaped, and the blood color is bright red, which can cause a lot of blood loss in a short time, causing life-threatening; When the vein bleeds, the bleeding flows out slowly and continuously, and the blood color is purple. These can be temporarily stopped by emergency measures such as "finger pressure" and "tourniquet", and then sent to the hospital or invited ambulance personnel to come for treatment. Finger pressure to stop bleeding is to find the beating blood vessel above the wound, that is, near the heart end, and press it tightly with your fingers. It should be noted that this method can only be used to control blood flow for a short time, and the "tourniquet" method should be used immediately to stop bleeding. The tourniquet is an elastic rubber band (a dressing should be placed between the band and the skin), and it can also be replaced by a cloth band, towel and tie with a width greater than 3cm, and it can be used to tie the upper arm or the upper and middle 1/3 of the thigh (note: the upper arm should not be tied too low, otherwise it will easily damage the nerves), and the tightness of the binding is based on the fact that there is no blood outflow from the wound. In addition, be sure to mark the time when the tourniquet is put on in a prominent position, and loosen the tourniquet for a few minutes every hour. Tie it again.
Wrong bandaging can lead to serious consequences. When someone bandaging a child's elbow injury, the forearm and upper arm are fixed in a straight line for a long time. As a result, the child's elbow joint loses its proper bending function and becomes disabled. The reason is that Liu readers don't know that the joints should be fixed in the "functional position" when dressing. Even if the joint can't move after injury, it can retain some physiological functions of the original joint to the maximum extent. For the upper limbs, the most important thing is to ensure the function of the hand; For the lower limbs, it is mainly to ensure the function of holding weight and walking. Therefore, the functional position of elbow joint is nearly 9 degrees, the functional position of knee joint is slightly 1 degrees, and the functional position of finger joints of hand is 45 degrees. The functional position of ankle joint is 9~95 degrees.
Take traumatic fracture as an example: loose dressing and no fixation are the important reasons leading to abnormal healing or pseudarthrosis. As we all know, the restoration of fracture and dislocation depends on fixation. If the dressing is loose and can't be fixed, there may be dangers such as bleeding, pain and shock in the near future, and abnormal healing and pseudarthrosis may be caused in the long term. On the contrary, wrapping too tightly may also cause new damage to the body. Too tight dressing affects blood circulation, and may cause limb swelling, pallor, cyanosis, chills, numbness and other manifestations. If it is not relaxed in time and properly bandaged again, it may cause limb ischemia and necrosis. In addition, improperly moving the patient for dressing the wound can also cause irreparable damage. For example, the fracture end of patients with complete long bone fracture stabbed important blood vessels and nerves, and the spinal cord of patients with spinal fracture was injured and paraplegia occurred. Therefore, we must pay attention to skills when dressing.