Care of Seriously Wounded Persons
Care of the seriously injured persons requires proper evaluation and thoughtful emergency management. Certain conditions demand immediate attention. In order of priority they are listed as follows:
- Maintenance of airway.
- Management of visceral injuries.
MAINTENANCE OF AIRWAY
This is important, and the management varies according to the severity of the case.
- Clean the mouth and remove any secretions, blood or vomitus by gauze or by suction apparatus.
- Maintain the air entry by mouth to mouth respiration where other immediate methods are not available. This can also be done by pressure mask.
- Endotracheal intubation and oxygen administration may be required.
- Tracheostomy and oxygen administration are necessary for the serious cases.
- Attention is paid for any injury to the respiratory tract, pleura and thoracic cage.
Haemorrhage may be internal or external. Internal or concealed haemorrhage can be deceptive. Careful examination of the patient and experience will enable to detect any existing internal pathology. Average internal loss of blood due to fractures at different sites can be predicted as follows:
Fracture of tibia … … 1 litre
Fracture of femur … … 1½ litres
Fracture of iliac crest … … 1½ litres
Supracondylar fracture … … ½litre.
The loss may increase considerably especially in cases of fracture of the iliac crest and fracture of femur.
Assessment of Blood Loss
- Clinical assessment: This is made by pulse rate, pulse volume, blood pressure and by assessing the nature of wound.
- Haematological examination: Estimation of haemaglobin and packed cell volume can give some idea.
Amount of Blood Loss in Relation To Shock
The average total blood volume in the body of an adult is 6 litres. This is almost equivalent to 12 bottles of blood. The effects produced by various amount of blood loss are as follows:
- 20% loss of blood- Blood is compensated by body mechanism.
- 30% loss of blood- Loss of 30% blood produces slow onset of shock and the condition is reversed by replacing the blood loss.
- 40% loss of blood- 40% blood loss produces severe shock. Irreversible shock may be produced even after blood replacement.
- Above 40% loss of blood- Above 40% blood loss produces shock of severe nature.
It is essential to avoid overloading by over transfusion during the process of treatment. This is not an uncommon condition when management is done without proper knowledge and by haphazard methods.
TREATMENT OF SHOCK
A few basic facts should be remembered to combat the shock.
- Maintenance of airway: Follow the principles as mentioned before.
- Blood and blood substitutes: Replacement of lost blood by administering blood is the ideal procedure. Other substitutes like plasma, Dextraven, polylvinylpyrrolidone may be given when blood is not available.
- Relief of pain: This is done by the following methods:
- Splintage of the fractured part.
- Administration of morphine sulphate intravenously or intermuscularly; subcutaneous injection should be avoided because of impaired absorption suring the period of shock from this route.
(d) Vasopressor drugs: These drugs may be given when shock is notresponding even after correcting the blood loss.
(e) Cortisone: This can be given in unresponsive cases and to patients who have been on steroid therapy previously.