This is a very important aspect of your Module 1 training. This teaches you how to manage bleeds and other wounds that you may encounter on duty.

Bleed Control - Gauze:

• Apply gauze pads to the wound and apply pressure
• Add more gauze as bleeding goes through
• Add trauma dressings after 5 minutes of bleeding
• Should bleeding continue, go to TQ/Packing/Hemostatic Agents

Bleed Control - Tourniquet

• On limbs
• Strap it high and tight, cranking the bar until the bleeding slows/stops
• Secure the bar, note down the time

Bleed Control - Packing

• Usually for joints (pelvis, armpits, behind knee) 
• Grab gauze roll, wrap around fingers
• Put the fingers into the wound and apply direct pressure to vein/artery
• Push gauze off and into the wound
• Repeat until full of gauze

Bleed Control - Hemostatic Agents

• If the above fails/isn’t applicable
• CELOX Granules OR CELOX Hemostatic Gauze
• CELOX Granules - pour contents into wound, reapply pressure w/ gauze
• CELOX Hemostatic Gauze - remove other gauze, apply to wound w/ pressure

Bleed Control - Impalement 

• Don’t remove the object, unless obstructing airway/interfering w/ resus attempts
• Secure the object w/ dressings wrapped around the base of the object
• Consider TXA for bleed control
• Transporting is priority - you may have to cut down the object in some cases to achieve this.

Wound Management - Chest Seal

• Adhesive plastic coverings used to cover sucking chest wounds
  • Wounds where air enters the chest wall - not the lungs
  • Listen for gurgling/hissing coming from a chest wound
• Identify exit wound. If present, 3 sided chest seal, otherwise 4
• Wipe area around wound clean, place seal firmly over wound, tape and secure 

Wound Management - Cleaning

• Alcoholic prep pad for shallow wounds
  • Wipe area around the wound clean first, then wipe in one direction
• Saline solution for all wounds, particularly deep wounds
  • Pour saline in and around wound

Wound Management - Dressings

• Cover wound with gauze pad
• If on a limb, wrap a bandage to secure gauze in place
• If elsewhere, tape down gauze

Wound Management - SteriStrips

• Avoid in joints, counter-indicated on face/bite wounds
• Ensure wound has been cleaned 
• Line up wound edges and push together
• Starting at middle, apply half of the strip to one side of the wound, gently bringing the other side of the wound to the other, and placing the other half of the strip on the other side
• Place strips alternately above and below
• Secure in place with two big strips vertically across the other

Wound Management - Glue

• Not suitable on joints, groin, hands
• Small minor wounds w/ straight edges
• Apply to edges and push close

Wound Management - Foreign Embodiment

• Do not remove, control bleed
• Drape gauze over, build up padding, and bandage over

Trauma Care - Burns

Skin is made up of three layers - the epidermis (outer layer), dermis, and subcutis (subcutaneous fat, the deepest layer). 

Types of burns:

• Superficial epidermal - red skin, slight swelling, a bit painful
• Superficial dermal - pale pink, blistering, more painful
• Partial thickness - blotchy, red, dry/moist, swelling, blistering, extremely painful/not at all depending on the severity
• Full thickness - visible tissue (pale/black), leathery/waxy skin, painless

Superficial burn treatment:

• Remove the source of heat
• Cool burn w/ water/Saline
• Remove clothing/jewellery if necessary 
• Cover w/ cling film if necessary 
• Refrain from giving patient fluid unless otherwise indicated
  • Burn victims lose a lot of Sodium. Paracelsus tells us that patients drinking sodium-free fluids will result in water intoxication as this further dilutes the remaining Sodium.

Partial thickness:

• Cover site w/ hydrogel pre-soaked gauze/saline-soaked gauze 
• Consider managed IV fluids, pain relief

Full thickness:

• Cover site w/ hydrogel pre-soaked gauze/saline-soaked gauze 
• IV fluids are essential, prescribe pain relief