Chapter
3 - First Aid for Special Wounds
Introduction
* Basic lifesaving
steps are discussed in Chapters 1 and 2: clear the airway/restore breathing,
stop the bleeding, protect the wound, and treat/prevent shock. They apply
to first aid measures for all injuries. Certain types of wounds and burns will
require special precautions and procedures when applying these measures. This
chapter discusses first aid procedures for special wounds of the head, face, and
neck; chest and stomach wounds; and burns. It also discusses the techniques for
applying dressings and bandages to specific parts of the body.
Section I. GIVE PROPER FIRST AID
FOR HEAD INJURIES
3-1. Head Injuries
A head injury may consist of one
or a combination of the following conditions: a concussion, a cut or bruise of
the scalp, or a fracture of the skull with injury to the brain and the blood vessels
of the scalp. The damage can range from a minor cut on the scalp to a severe brain
injury which rapidly causes death. Most head injuries lie somewhere between the
two extremes. Usually, serious skull fractures and brain injuries occur together;
however, it is possible to receive a serious brain injury without a skull fracture.
The brain is a very delicate organ; when it is injured, the casualty may vomit,
become sleepy, suffer paralysis, or lose consciousness and slip into a coma. All
severe head injuries are potentially life-threatening. For recovery and return
to normal function, casualties require proper first aid as a vital first step. 3-2.
Signs/Symptoms (081-831-1000)
A head injury may be open or
closed. In open injuries, there is a visible wound and, at times, the brain
may actually be seen. In closed injuries, no visible injury is seen, but the casualty
may experience the same signs and symptoms. Either closed or open head injuries
can be life-threatening if the injury has been severe enough; thus, if you suspect
a head injury, evaluate the casualty for the following:
• Current or recent
unconsciousness (loss of consciousness).
• Nausea or vomiting.
•
Convulsions or twitches (involuntary jerking and shaking).
• Slurred speech.
•
Confusion.
• Sleepiness (drowsiness).
• Loss of memory (does casualty
know his own name, where he is, and so forth).
• Clear or bloody fluid
leaking from nose or ears.
• Staggering in walking.
• Dizziness.
•
A change in pulse rate.
• Breathing problems.
• Eye (vision) problems,
such as unequal pupils.
• Paralysis.
• Headache.
• Black
eyes.
• Bleeding from scalp/head area.
• Deformity of the head. 3-3.
General First Aid Measures (081-831-1000)
a. General Considerations.
The casualty with a head injury (or suspected head injury) should be continually
monitored for the development of conditions which may require the performance
of the necessary basic lifesaving measures, therefore be prepared to—
•
Clear the airway (and be prepared to perform the basic lifesaving measures).
•
Treat as a suspected neck/spinal injury until proven otherwise. (See Chapter 4
for more information.)
• Place a dressing over the wounded area. DO NOT
attempt to clean the wound.
• Seek medical aid.
• Keep
the casualty warm.
• DO NOT attempt to remove a protruding object from
the head.
• DO NOT give the casualty anything to eat or drink.
b.
Care of the Unconscious Casualty. If a casualty is unconscious as the result
of a head injury, he is not able to defend himself. He may lose his sensitivity
to pain or ability to cough up blood or mucus that may be plugging his airway.
An unconscious casualty must be evaluated for breathing difficulties, uncontrollable
bleeding, and spinal injury.
(1) Breathing. The brain requires a constant
supply of oxygen. A bluish (or in an individual with dark skin—grayish) color
of skin around the lips and nail beds indicates that the casualty is not receiving
enough air (oxygen). Immediate action must be taken to clear the airway, to position
the casualty on his side, or to give artificial respiration. Be prepared
to give artificial respiration if breathing should stop.
(2) Bleeding. Bleeding
from a head injury usually comes from blood vessels within the scalp. Bleeding
can also develop inside the skull or within the brain. In most instances bleeding
from the head can be controlled by proper application of the field first aid dressing. CAUTION
(081-831-1033)
DO NOT attempt to put unnecessary pressure on the wound
or attempt to push any/brain matter back into the head (skull). DO NOT apply a
pressure dressing. (3)
Spinal injury. A person that has an injury above the collar bone or a head
injury resulting in an unconscious state should be suspected of having a neck
or head injury with spinal cord damage. Spinal cord injury may be indicated
by a lack of responses to stimuli, stomach distention (enlargement), or penile
erection.
(a) Lack of responses to stimuli. Starting with the feet,
use a sharp pointed object–a sharp stick or something similar, and prick the casualty
lightly while observing his face. If the casualty blinks or frowns, this indicates
that he has feeling and may not have an injury to the spinal cord. If you observe
no response in the casualty’s reflexes after pricking upwards toward the chest
region, you must use extreme caution and treat the casualty for an injured
spinal cord.
(b) Stomach distention (enlargement). Observe the casualty’s
chest and stomach. If the stomach is distended (enlarged) when the casualty takes
a breath and the chest moves slightly, the casualty may have a spinal injury and
must be treated accordingly.
(c) Penile erection. A male casualty may
have a penile erection, an indication of a spinal injury. CAUTION
Remember
to suspect any casualty who has a severe head injury or who is unconscious
as possibly having a broken neck or a spinal cord injury! It is better
to treat conservatively and assume that the neck/spinal cord is injured rather
than to chance further injuring the casualty. Consider this when you position
the casualty. See Chapter 4, paragraph 4-9 for treatment procedures of spinal
column injuries. c.
Concussion. If an individual receives a heavy blow to the head or face, he
may suffer a brain concussion, which is an injury to the brain that involves a
temporary loss of some or all of the brain’s ability to function. For example,
the casualty may not breathe properly for a short period of time, or he may become
confused and stagger when he attempts to walk. A concussion may only last for
a short period of time. However, if a casualty is suspected of having suffered
a concussion, he must be seen by a physician as soon as conditions permit.
d.
Convulsions. Convulsions (seizures/involuntary jerking) may occur after a
mild head injury. When a casualty is convulsing, protect him from hurting himself.
Take the following measures:
(1) Ease him to the ground.
(2) Support his
head and neck.
(3) Maintain his airway.
(4) Call for assistance.
(5)
Treat the casualty’s wounds and evacuate him immediately.
e. Brain Damage.
In severe head injuries where brain tissue is protruding, leave the
wound alone; carefully place a first aid dressing over the tissue. DO NOT
remove or disturb any foreign matter that may be in the wound. Position the
casualty so that his head is higher than his body. Keep him warm and seek medical
aid immediately. NOTE
•
DO NOT forcefully hold the arms and legs if they are jerking because this can
lead to broken bones.
• DO NOT force anything between the casualty’s teeth-especially
if they are tightly clenched because this may obstruct the casualty’s airway.
•
Maintain the casualty’s airway if necessary. 3-4.
Dressings and Bandages (081-831-1000 and 081-831-1033)
*a. Evaluate
the Casualty (081-831-1000). Be prepared to perform lifesaving measures. The
basic lifesaving measures may include clearing the airway, rescue breathing, treatment
for shock, and/or bleeding control.
b. Check Level of Consciousness/Responsiveness
(081-831-1033). With a head injury, an important area to evaluate is the casualty’s
level of consciousness and responsiveness. Ask the casualty questions such as—
•
“What is your name?” (Person)
• “Where are you?” (Place)
• “What
day/month/year is it?” (Time)
Any incorrect responses, inability to answer,
or changes in responses should be reported to medical personnel. Check the casualty’s
level of consciousness every 15 minutes and note any changes from earlier observations.
c.
Position the Casualty (081-831-1033). WARNING
(081-831-1033)
DO NOT move the casualty if you suspect he has sustained
a neck, spine, or severe, head injury (which produces any signs or symptoms other
than minor bleeding). See task 081-831-1000, Evaluate the Casualty. •
If the casualty is conscious or has a minor (superficial) scalp wound:
o Have
the casualty sit up (unless other injuries prohibit or he is unable); OR
o
If the casualty is lying down and is not accumulating fluids or drainage in his
throat, elevate his head slightly; OR
o If the casualty is bleeding from or
into his mouth or throat, turn his head to the side or position him on his side
so that the airway will be clear. Avoid pressure on the wound or place him on
his side –opposite the site of the injury (Figure 3-1).
• If the casualty
is unconscious or has a severe head injury, then suspect and treat him as having
a potential neck or spinal injury, immobilize and DO NOT move the casualty.
NOTE
(081-831-1033)
If the casualty is choking and/or vomiting or is bleeding
from or into his mouth (thus compromising his airway), position him on his side
so that his airway will be clear. Avoid pressure on the wound; place him on his
side opposite the side of the injury. WARNING
(081-831-1033)
If it is necessary to turn a casualty with a suspected neck/spine
injury; roll the casualty gently onto his side, keeping the head, neck, and body
aligned while providing support for the head and neck. DO NOT roll the casualty
by yourself but seek assistance. Move him only if absolutely necessary, otherwise
keep the casualty immobilized to prevent further damage to the neck/spine. d.
Expose the Wound (081-831-1033).
• Remove the casualty’s helmet (if
necessary).
• In a chemical environment:
o If mask and/or hood is not
breached, apply no dressing to the head wound casualty. If the “all clear”
has not been given, DO NOT remove the casualty’s mask to attend the head
wound: OR
o If mask and/or hood have been breached and the “all clear”
has not been given, try to repair the breach with tape and apply no
dressing; OR
o If mask and/or hood have been breached and the “all clear” has
been given the mask can be removed and a dressing applied. WARNING
DO
NOT attempt to clean the wound, or remove a protruding object. NOTE
If
there is an object extending from the wound, DO NOT remove the object. Improvise/bulky
dressings from the cleanest material available and place these dressings around
the protruding object for support after applying the field dressing. NOTE
Always
use the casualty’s field dressing, not your own! e.
Apply a Dressing to a Wound of the Forehead/Back of Head (081-831-1033). To
apply a dressing to a wound of the forehead or back of the head—
(1) Remove
the dressing from the wrapper.
(2) Grasp the tails of the dressing in both
hands.
(3) Hold the dressing (white side down) directly over the wound. DO
NOT touch the white (sterile) side of the dressing or allow anything except the
wound to come in contact with the white side.
(4) Place it directly over the
wound.
(5) Hold it in place with one hand. If the casualty is able, he may
assist.
(6) Wrap the first tail horizontally around the head; ensure the tail
covers the dressing (Figure 3-2).
(7)
Hold the first tail in place and wrap the second tail in the opposite direction,
covering the dressing (Figure 3-3).
(8)
Tie a nonslip knot and secure the tails at the side of the head, making sure they
DO NOT cover the eyes or ears (Figure 3-4).
f.
Apply a Dressing to a Wound on Top of the Head (081-831-1033). To apply a
dressing to a wound on top of the head–
(1) Remove the dressing from the wrapper.
(2)
Grasp the tails of the dressing in both hands.
(3) Hold it (white side down)
directly over the wound.
(4) Place it over the wound (Figure 3-5).
(5)
Hold it in place with one hand. If the casualty is able, he may assist.
(6)
Wrap one tail down under the chin (Figure 3-6), up in front of the ear, over the
dressing, and in front of the other ear.
 WARNING
(Make
sure the tails remain wide and close to the front of the chin to avoid choking
the casualty.) (7)
Wrap the remaining tail under the chin in the opposite direction and up the side
of the face to meet the first tail (Figure 3-7).
(8)
Cross the tails (Figure 3-8), bringing one around the forehead (above the eyebrows)
and the other around the back of the head (at the base of the skull) to a point
just above and in front of the opposite ear, and tie them using a nonslip knot
(Figure 3-9).
g. Apply a Triangular Bandage to the Head. To apply a triangular bandage
to the head–
(1) Turn the base (longest side) of the bandage up and center
its base on center of the forehead, letting the point (apex) fall on the back
of the neck (Figure 3-10 A).
(2) Take the ends behind the head and cross the
ends over the apex.
(3) Take them over the forehead and tie them (Figure 3-10
B).
(4) Tuck the apex behind the crossed part of the bandage and/or secure
it with a safety pin, if available (Figure 3-10 C).
h.
Apply a Cravat Bandage to the Head. To apply a cravat bandage to the head–
(1)
Place the middle of the bandage over the dressing (Figure 3-11 A).
(2) Cross
the two ends of the bandage in opposite directions completely around the head
(Figure 3-11 B).
(3) Tie the ends over the dressing (Figure 3-11 C).
 Continue
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