When the kitchen knife falls on the instep...

This is the 3024th article of Da Yi Xiao Hu

story

During the day shift, around 11 a.m., the crew received an order: a patient in a village in the city complained of a knife wound.

After I got in the car, I immediately called to inquire about the other party's situation. The patient's wife answered the phone. She said anxiously: "When my husband was cutting vegetables, the kitchen knife fell from the chopping board and landed on his instep. Now the instep is bleeding!"

When I heard this, I immediately felt something was wrong. There is a dorsalis pedis artery right in the middle of the dorsum of the foot. After it is cut off, blood will spurt out as the other party described. Moreover, this kind of arterial bleeding can be fatal within two or three minutes if the bleeding is not stopped immediately.

So I immediately said to the patient's wife: "Hurry up and find a clean towel and press hard on the wound!"

The patient’s wife replied: “Okay!”

The ambulance arrived at the scene in more than 10 minutes. I saw the patient's wife coming downstairs to meet the car, holding a plastic bag full of blood. There were probably several hundred milliliters of blood in the bag. I immediately felt something was not good and urged the nurse and stretcher bearer to move faster.

When we got closer, the patient's wife raised the plastic bag and asked me, "Doctor, this is the blood I collected from my husband. Can I give it back to him?"

Nurse Xiao Li answered first: "That depends on whether your husband has athlete's foot!"

I was feeling uneasy as I looked at the blood in the plastic bag. I knew the patient had lost a lot of blood, but I thought it might not be fatal because I had taught the patient's wife how to stop bleeding over the phone. I guessed the patient would be fine, so I didn't blame the nurse deliberately after hearing her teasing.

However, when we arrived at the patient's home, we saw the patient collapsed at the kitchen door, lying in a pool of blood, no longer breathing.

The subsequent rescue efforts were ineffective because the patient had lost too much blood, and he was declared dead after a 30-minute procedure.

I was very frustrated and asked the patient's wife, "Didn't I tell you to put pressure on the wound with a towel? Why is there so much blood?"

The patient’s wife replied: “Doctor, I pressed, but he cried out in pain!”

I was speechless. Either it was pain or death, but some people chose the latter...

Now that the story is over, let’s review what was said in the “Emergency Call 120” column:

The basic routine of first aid is "six questions and three don'ts", that is, when a sudden injury or illness occurs, no matter what the situation is at the scene, ask yourself six questions and remind yourself not to do three things.

The six questions are:

1. Are there any safety issues?

2. Is the airway open?

3. Is there any active bleeding?

4. Is the condition serious?

5. Is the body position appropriate?

6.Do you want to call 120?

The mnemonic for the six questions is “Ammonia comes out, the body is healthy and well”, “ammonia” means safety, “air” refers to airway, “out” means bleeding, “disease” refers to the condition, “body” refers to body position, and “well” means 120.

The six questions are:

1. Don’t over-process.

2. Do not move the patient at will.

3. Do not feed or give medicine at will.

Those who are interested can search "Emergency Call 120" in the official account to view details. In the last issue of "First aid veterans, one move determines the level", we talked about airway problems. In this issue, we will talk about the third of the six questions, "active bleeding".

We all know about bleeding, but what is active bleeding?

During first aid training, a student once answered: "Active bleeding means bleeding when moving, and no bleeding when not moving!"

Is that so? The answer is definitely not!

If our palm is cut by a knife, will the bleeding continue? Usually not. If the wound is not very deep and the blood coagulation function is normal, the bleeding will stop quickly. But if the artery is cut, like the blood-spurting wound in the story, if no hemostatic measures are taken, the bleeding will not stop by itself, but will continue to bleed until the patient dies!

The latter is active bleeding!

So how do you stop bleeding? If you want to know how to stop bleeding, you must first know why the wound bleeds.

As shown in the picture, wound bleeding and water pipe leakage are based on the same principle. There are two conditions for bleeding: one is that there is a rupture in the blood vessel, and the other is that the pressure inside the blood vessel is higher than that outside the blood vessel. The greater the pressure difference, the more severe the bleeding! This is why venous bleeding drips and arterial bleeding sprays.

Now that we know the cause of blood vessel bleeding, how do we stop the bleeding?

There are two answers: one is to sew up the blood vessel rupture, and the other is to make the pressure outside the blood vessel higher than that inside the blood vessel. The former cannot be done by ordinary people on the spot, so the only option is to do the latter, that is, to change the pressure difference between the inside and outside of the blood vessel. The specific principle will be understood by looking at the following animation.

In short, just remember one thing: find a way to make the pressure outside the blood vessels higher than that inside the blood vessels, and the bleeding will stop!

Ways can be pressing with hands, pinching with fingers, tying with bandages, stepping with feet, sitting with buttocks... Of course, the latter methods are not very civilized and are not recommended for routine use.

The most practical method is to use your hands to press where the blood is coming out until the bleeding stops. Mom no longer has to worry about us not being able to stop the bleeding!

Compression hemostasis can usually stop 70 to 80 percent of bleeding, but if it still doesn't stop the bleeding, you may have to use a tourniquet. For more information on how to use a tourniquet, please search "What to do if your wound is bleeding? Here are three tricks to stop bleeding!" on the Big Doctor Little Hu WeChat public account.

The biggest cause of death in trauma patients is bleeding. At the same time, most bleeding can be successfully stopped on the spot, and the knowledge and methods of stopping bleeding are not complicated.

However, in reality, if you want to save people, it is not enough to just know first aid knowledge, you also have to overcome your fear.

Whenever I think of this real case at the beginning, I feel a dull pain in my heart, but who can we blame? If a person really encountered a bleeding wound, the pungent smell of blood and the bloody scene, it is possible that a coward would faint on the spot.

Therefore, it is unrealistic to teach people how to stop bleeding without overcoming the fear.

So how do you overcome your fear? It is necessary to listen to more real cases, understand the serious consequences of blood loss, and watch more bloody pictures and videos, such as the three pictures below.

Author: PhD candidate in Internal Medicine, Kunming Medical University

Zhou Guozhong