What are the first aid measures after traumatic bleeding or fracture?

Author: Jia Dacheng, first aid expert at Beijing Emergency Center

Reviewer: Zhao Yu, Chief Physician, Peking Union Medical College Hospital

Various accidental injuries often occur in life, such as traumatic bleeding, fractures, etc. For these accidental injuries, there are four basic first aid techniques: hemostasis, bandaging, fixation, and transportation. These are temporary measures for pre-hospital emergency treatment.

It is particularly important to master some first aid knowledge so that you can take the correct method to save others or yourself in an emergency.

1. How to stop bleeding and bandage traumatic bleeding?

When encountering a patient with injury and heavy bleeding, the following treatment measures can be adopted.

First, apply direct pressure to the wound. For example, if you have a fall or a cut with a knife and are bleeding, you can immediately put sterile gauze on the wound and apply direct pressure. If sterile gauze is not available at the scene, you can tear open your clothes and fold them into several layers and apply pressure on the wound. Direct pressure to stop bleeding is the most commonly used, quickest, and most convenient method in on-site first aid.

The next step is to apply pressure bandage. Put the sterile dressing, or towel, handkerchief, or clothing on it, make it thicker, and wrap it a little tighter with a bandage, triangular bandage, or other cloth. This is called pressure bandage, which can stop bleeding.

The pressure bandage should not be too tight. If it is a hand injury with bleeding, compare the two hands after bandaging. If the bandaged hand appears bruised, swollen, and is cooler than the other hand when touched, the bandage should be loosened and readjusted.

Second, packing to stop bleeding. For deeper wounds or tissue defects, you can use sterile gauze to pack them. If there is no sterile gauze on site, you can use cloth that looks cleaner to pack them. For example, penetrating injuries and blind tube injuries, those with an entrance and an exit are called penetrating injuries, also called penetrating injuries; those with an entrance but no exit are called blind tube injuries. In these cases, you can use packing to stop bleeding.

Third, tourniquet to stop bleeding. There are two main methods, one is to stop bleeding with a rubber tourniquet, and the other is to stop bleeding by tightening.

Figure 1 Original copyright image, no permission to reprint

There are two main materials for bandaging: one is a bandage, and the other is a triangular bandage. Triangular bandages are widely used. They are the quickest and most convenient in on-site first aid, and they can be used to bandage any part of the body, such as the head, face, perineum, and chest. Many difficult-to-bandage parts can be bandaged with triangular bandages.

2. How to provide correct first aid after a fracture?

The parts of the body with the highest incidence of fractures are the limbs, but fractures can also occur in other parts of the body, such as the skull, ribs, sternum, pelvis, and spine.

Without knowledge of first aid, people often do bad things with good intentions when encountering traumatic fractures. For example, if a person's thigh is fractured after being hit by a car, one person holds the upper body while the other lifts the legs when carrying the patient, causing the thigh bone, which was not dislocated, to shift, resulting in deformity and aggravating damage to surrounding blood vessels and nerves.

First aid for fractures must include fixation measures. What is the purpose of fixation?

It is not reduction, but immobilization, which means limiting the movement of the injured limb. For example, if a part of the body is fractured, not fixing it will not only increase the pain, but also aggravate the injury, and even cause serious sequelae. For example, the function of the corresponding part will be affected after nerve damage, and shock may occur after heavy bleeding.

What is the most classic fixing measure?

Just put a piece of wood on one side and tie the two ends with a bandage, a triangular bandage, or a rope. If there is bleeding, stop the bleeding first, bandage it and then fix it. If there is no bleeding, just fix it directly. If there is no material around, the simplest method is to tear the pants, fold them into strips, and tie the two legs together.

For example, to fix a broken finger, you can find a small stick, such as a popsicle stick, put it on the broken finger, and then wrap it with tape or bandage to fix it. If you don't have a small stick, you can tie the broken finger and the good finger together and stick them with tape.

Figure 2 Original copyright image, no permission to reprint

For spinal fractures, fixation measures must be taken, and non-professionals are not recommended to move the patient. Because moving patients with spinal fractures requires certain conditions and equipment, such as a neck brace, head immobilizer, rescue sleeve, shovel stretcher, or spinal board, or even a vacuum stretcher. Only with these conditions and the presence of professionals can the patient be moved to avoid aggravating the patient's condition.

So, how do you determine whether the spine is fractured after trauma?

Spinal cord injury first requires a history of injury that causes excessive flexion or extension of the spine. For example, cervical fractures, excessive flexion, extension, lateral flexion, and rotation may all cause cervical injuries, including sudden braking, rear-end collisions, and head tilting back; diving in a diving area, car accidents, and falling from heights are even more dangerous and can cause cervical injuries.

In the case of spinal fracture, if the patient is conscious, ask the patient what is wrong, such as back pain, and touch the waist with your hand. The fractured area has kyphosis or scoliosis, which in layman's terms means it is bulging, there is a bag, and there is tenderness.

The two more important points are: first, movement disorder. The patient's legs cannot move. If it is a high-level spinal fracture, the entire upper limb cannot move, the fingers cannot move, and the arm cannot be lifted; second, sensory disorder. Paraplegic patients will experience decreased or absent sensation, and will not feel anything whether they are stabbed or pinched. If there is no sensation below a certain plane after the injury, it can be roughly judged that there is spinal cord injury and paraplegia is considered.

Whenever encountering these situations, non-professionals should not touch the injured person at will. If they do not touch the injured person, the condition will not get worse. However, if they do touch the injured person, the condition may get worse and cause lifelong disability.