I pray that you never need to use this information. Treating puncture wounds is a critical part of first aid. It could be as innocent as tripping and falling onto something sharp, or it could be a malicious attack with a knife. But knowing this could make all the difference. A cool head under pressure saves lives. Let’s get stuck in. Poor choice of words? Maybe…
- Begin First Aid
- Danger: Are you as the first aider in any risk of approaching the casualty? Is there a violent knife fight underway? Are there many sharp objects on a slippery surface? As brutal as it sounds, you need to protect yourself first and foremost. Adding a second casualty only exacerbates the situation for the medical professionals.
- Response: Is our casualty responsive? If so, we can rule out a whole host of problems. If not, we will need to be checking around their airways and looking for breathing.
- Send for help: I am of the opinion that this might actually be best done straight away. Either way, as long as it gets done. First aid is not really intended to heal somebody of their injury. More often than not, you are simply buying time until a paramedic can arrive.
- Airways: Is there anything obstructing their airways? This could be vomit, the implement of the puncture itself, or if the patient is unconscious, they might have swallowed their tongue. No amount of first aid will help you if the patient can’t begin breathing for themselves
- Breathing: If they are breathing consistently of their own accord, you can also take a deep breath. Things are not as bad as they could have been. You can assess this by looking for movement in the chest, listening for air leaving the body, and feeling the exhale with your hand around their mouth and nose (Look, listen and feel is a helpful way to remember this). Be aware that infrequent shaky breaths don’t count. They need to be breathing regularly.
- Compression: Don’t waste time feeling around for circulation. Most people can’t find it even when someone is calmly sitting by their side in a practice simulation, so it is a waste of time to try and find it when the heat is on. The worst case scenario is that you begin CPR on someone who already has a heartbeat. You might break a few ribs and temporarily raise their blood pressure. But in the high stakes world of first aid, this is a relatively small price to pay. Aim for 30 compressions and 2 rescue breaths. Each compression should push down about 5cm otherwise all you aren’t doing enough. I like to sing Stayin Alive by the Bee Gees to keep me working at the right tempo. It’s also good positive thinking.
- Defibrillation: You give the patient the best chance of survival if someone fetches a defibrillator. They physically talk to you through the entire process so you don’t need to be a rocket scientist to figure it out.
Treating for shock
Once you have treated the immediate needs you will need to treat shock. Contrary to common belief, going into shock isn’t the same thing as feeling quite startled. It is a medical condition to describe when you don’t have enough blood in your system. Your body responds to this by narrowing the blood vessels going to the extremities so that it can be funnelled to the vital organs, keeping you alive for longer. However, your body also releases adrenaline which reverses this effect and can be fatal. Symptoms of shock include:
- A clamminess of the skin
- Shallow breaths
- Feeling anxious
- Feeling nauseous
If the patient is conscious, make them lie down, loosening their clothing. If you can, elevate their legs above their chest to help keep the blood flowing to the vital organs. You also need to address the source of bleeding.
- Apply pressure to the wound: Make sure the dressing is sterile otherwise you end up introducing a whole host of germs into the body which can become infected. Betadine can help here, but cleanliness is preferable. If you can’t find anything clean, it is still vital that you apply pressure somehow. It could be with a hand if nothing else presents itself.
- Raise the wound: You will allow gravity to work its course by keeping the wound elevated.
- Leave the foreign body in the wound: It can actually be plugging some of the blood loss, and by wrenching it out, you risk doing further damage. Instead, apply padding on either side and wrap carefully so that you don’t touch the object.
- Continue to monitor the wound: If blood begins to seep through the first bandage, apply a second bandage, applying as much pressure as possible
All throughout this, I have mentioned keeping the wound clean. This is extremely important if you want avoid getting infections. While this is very difficult for serious puncture wounds, it is very possible with less serious abrasions. Something like betadine is a wonderful option here. It is a topical antiseptic that kills all the bacteria that is threatening to get in and spread around the body. The reason you would avoid betadine for a puncture wound is that you can accidentally get too much in, and all of a sudden doctors have something else they are working with. You can treat the minor secondary wounds with betadine, but you are better of leaving the serious emergencies to the trained professionals.
As I said, I hope that you never have to use this. But it is worth having this knowledge in your locker should you ever find yourself in a sticky situation. I’m touching wood that I never get to test it out first hand…
Floyd - Senior Pharmacist
Sterilising the wound
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Image Author: @svbalan