MANAGEMENT OF GUNSHOT INJURIES, BLEEDING & FRACTURES.

BY Dr Ejidike Amaka

OUTLINE
Introduction Gunshot wounds Fractures Control of bleeding Shock CPR Cardiopulmonary Resuscitation Conclusion

INTRODUCTION
As a rule, all gunshot wounds are considered medical emergency that requires immediate hospital treatment. It can vary widely from case to case with wide variations in entry points since the location of injury can be in any part of the body. The immediate damaging effect of the bullet are typically severe bleeding and frequently fracture of surrounding bones.

 With the potential of hypovolemic shock in severe bleeding (a condition characterized by inadequate delivery of oxygen to vital organs) as well as the unpredictability of bullet wounds, it is paramount that immediate aid be given while awaiting help or transportation to a hospital.

GUNSHOT WOUNDS
Unpredictable puncture wounds that cause major tissue damage Has entry/exit points It is difficult to assess the extent of damage and most far exceed what you can reasonably treat with first aid. For this reason, the best option for most bullet wounds is to get the victim to a hospital as soon as possible.

How do you to stabilize the victim in the meantime?

Make sure you are safe
If shooting was unintentionally (e.g., while hunting or at the range),secure all firearms If shooting was at a crime, ensure the shooter is no longer on the scene and that both you and the victim are safe from further injury.

Call for help. Do not move the victim unless you must do so to keep him safe or to access care. Assess quickly how deep the gunshot wound is- a big hole indicates serious injury Avoid moving the victim as unnecessary motion worsens the condition Apply direct pressure to the wound to stop bleeding

Do NOT attempt to remove the bullet If victim is not breathing, commence CPR Transfer to hospital

 If wound is on the chest Apply direct pressure to control bleeding. Seal wound with hand or airtight material (e.g., plastic film) to keep air from being sucked into the wound DO NOT elevate the legs to treat for shock in wounds on the chest or stomach Victim should NOT eat or drink anything including water

 If wound is to the arm or leg Use direct pressure to control bleeding. Elevation of limbs can be employed in this case to control bleeding and prevent shock.

FRACTURE
A broken or cracked bone Occurs when pressure is applied to bone Occurs with / without displacement of bone fragments

Types of fracture
Open fracture: Skin breaks causing open wound Closed fracture: Skin not broken Commuted fracture: involving 3 or more bone fragments Stress fracture: hairline crack due to repeated stress eg marching (soldiers)

Severe pain Difficulty in movement Swelling/ bruising / bleeding Deformity / abnormal twist of limb Tenderness on applying pressure Discoloration +/- signs of shock

SYMPTOMS

First-aid
Depends on type & location of fracture For open fractures:
Control bleeding Rinse and dress the wound

For open / closed fractures

Check the breathing Calm the person Check for other injuries Immobilize the broken wound Apply ice, if available, to reduce pain / swelling Consult a doctor

DO NOT:
Massage the affected area Straighten the broken bone Move without support to broken bone Move joints above / below the fracture Give oral liquids / food

HOW TO CONTROL BLEEDING

Could be mild, moderate or severe All bleeding however must be controlled , if left uncontrolled, severe bleeding may lead to shock or even death First step is to plug the hole, blood needs to clot in order to begin the healing process

1) Apply direct pressure

2) Elevate above the heart

Only for wounds outside the chest or abdomen This is because gravity helps blood flow down easier than it flows up

3) Use pressure points Areas of the body where blood vessels run close to the surface By pressing on these vessels, blood flow towards the wound will be slowed Press on a point above the wound (ie closer to the heart) than below it

Common pressure points:

Arm between the shoulder and the elbow - brachial artery Groin area along bikini line femoral artery Behind the knee popliteal area

 You should almost never apply tourniquet to these pressure points as they have the potential to damage the entire limb by blocking blood flow

SHOCK
Uncontrolled bleeding may lead to a condition known as shock. Shock is essentially a decrease in blood flow to the brain and other important organs. Untreated, shock from bleeding will almost always cause death. Hence,the most important step in treating shock is to control bleeding.

WHAT ARE THE SIGNS?

Pallor Fast tready pulse Cold clammy extremities (hands and feet) Air hunger Oliguria (not making urine)

 If the victim is already showing signs of shock, it's important to take these necessary steps to stabilize the victim until help arrives.
As with all emergency treatment, make sure you remain safe. Call for help Make sure the victim is breathing. If not, begin rescue breathing.

 Bleeding must be stopped. If you do not suspect a neck injury, lay the victim on his or her back (supine) and elevate the legs. If you suspect a neck injury, do not move the victim. Car and other vehicle accidents often lead to neck injuries as well as falls from a height taller than the victim.

 Keep the victim warm. Continue to check on the victim. If the victim stops breathing, begin rescue breathing. If the victim vomits, roll the victim to one side and sweep the vomit from his or her mouth with your fingers

CPR- Cardiopulmonary Resuscitation

Life saving technique Useful in emergencies (heart attack, drowning) where a persons breathing or heartbeat has stopped WHY IS IT NECESSARY? Without oxygenated blood = brain damage in a few mins and death in 8-10 mins Do something!!!

CAB is the new ABC

C = CIRCULATION ensure blood flow A = AIRWAY is the airway patent? B = BREATHING breathe for the victim

*Call for help* Put patient on his back, on a flat surface Kneel next to him Place the heel of your hand in the middle of his chest, other hand on top the first with your fingers interlaced Aim for 100 compressions/min If not trained, continue with chest compressions only

CIRCULATION

AIRWAY
Ensure airway is patent Remove any debris in the mouth Head tilt (if no spine injury) + chin lift = opens airway Look out for chest motion, listen for normal breath sounds

BREATHING
Breathe for the person Mouth to mouth (or mouth to nose if the mouth is seriously injured) Give 2 rescue breathes, look out to see if chest rises 30 compressions to 2 rescue breathe If after 5 cycles (about 2 mins) no movement patient would need advanced life support DO NOT stop CPR until help comes

IN SUMMARY:

CONCLUSION
Aim to DO SOMETHING before medical help arrives The difference between what you do and not doing anything could just be SOMEONES LIFE.

Thank you for listening.