Gunshot Wounds - First Aid

Gunshot Wounds - First Aid
Collaboration - post with Zack Blackwell 
Gunshot wounds are one of the most traumatic injuries you can suffer.
The best option for most bullet wounds is to get the victim to a hospital as soon as possible.

Before we start, it is import to note that you have personal protective equipment with you at all times (i.e. latex or nitrile gloves and pocket rescue mask at minimum) This may seem hard to do but gloves can be very compact-able and you can also find rescue mask that are compact-able as well (the size of a credit card).  

What you can do to stabilize the victim?
First of all make sure you're safe, you're not going to help anyone if you also get shot ;). If you carry a pair of latex or nitrile gloves, protect yourself. After confirming that your scene is safe and you are out of harms way, call out to the victim and let them know who you are before approaching. You do not know if they are armed as well. In situations like these, the victim is scared and may try to harm you in an attempt to protect themselves. CALL FOR HELP! remember that you are limited in the treatment that you will be able to provide. Calling 9-1-1 will alert emergency response teams to your location. In situations as these, law enforcement and EMS will be responding to your location. Be sure to provide your location and your name and BRIEFLY describe what you see to the 9-1-1 operator.

It's important to not move the victim unless you must do so to keep him safe or to access care. Try to maintain calm and act quickly, victims who reach medical facilities during the "Golden Hour" have a much better likelihood of surviving.

Check:
☛ Airway: If the person is talking, their airway is probably clear. If the person is unconscious, check to make sure that his airway is not obstructed. Turn the victim's head to the side to facilitate better breathing and get the tongue out of the way. If the victim's mouth is filled with blood, try to help them remove it by coughing or quickly sop it up with a rag or piece of clothing. Use extreme caution not to obstruct the victim's airway with any rags or clothing you use to remove blood from the victims mouth. 

☛ Breathing: Is the victim taking regular breaths? Can you see his or her chest rising and falling? If the chest is rising and falling, does the chest rise seem symmetrical with each breath (Further on this later). If the victim is not breathing, sweep his or her mouth for obstructions and start rescue breathing immediately (Note: you will be possibly exposing yourself to pathogens. If you carry a rescue pocket mask, use it!) 

If you do not know how to do that:
http://www.instructables.com/id/How-to-do-rescue-breathing-Red-Cross/

☛ Circulation: apply pressure to any bleeding, then check the victim's pulse at the wrist. If you do not feel a pulse at the wrist, check for a pulse at the neck. If you find a pulse at the neck but none at the wrist, then this is sign that the victim is deteriorating rapidly into shock. If the victim has no pulse at the wrist or neck, begin CPR. Control any major bleeding. Do not spend more than 10-15 seconds checking for a pulse. 

☛ Disability: check to see if the victim can move hands and feet. If not, there may be an injury to the spinal cord. Look for obvious fractures, dislocations, or anything that looks out of place or unnatural. These injuries can be worsened by moving the victim.

Control Bleeding: is most important thing you can do to save a gunshot victim's life.

☛ Applying direct pressure is the best way to control most wounds. Use a pad over the wound and apply pressure directly to the wound. If you have nothing available, even your hand or fingers can be used to control bleeding. Add new bandages over the old; do not remove bandages when they become soaked. Elevate if an extremity is involved.

☛ Use pressure points in the arm (between the elbow and armpit), groin (along the bikini line), or behind the knee to control bleeding in the arm, thigh, or lower leg, respectively.

☛ There is little that can be done with conventional methods if the wound involves the torso, but chemical hemostats (QuickClot, Celox, etc.) have been proven to be very effective on all major bleeds. Ensure that you follow the instructions on the package for application, though it is usually as simple as holding the wound open, pouring in the powder or inserting the powder packet/sponge/applicator, and applying strong pressure for five minutes.

Gunshot wounds frequently lead to shock, a condition caused by trauma or loss of blood that leads to reduced blood flow throughout the body. There are 3 stages to shock, compensative shock, deteriorating shock, irreversible shock.
Early signs of shock include a rapid pulse (Heart rate above 100 beats per min), pale skin, and rapid breathing.
Deteriorating shock includes a drop in blood pressure with rapid heart rate (Pulse may not be felt at wrist but at more central locations such as the neck or thigh) increased breathing, and pale skin.
Irreversible shock is more obvious with pale skin, SLOW pulse (if able to feel), and an even further decrease in blood pressure.

Victim will show signs of shock  treat it accordingly by making sure the victim's body temperature is as normal as possible – cover him up if his skin feels cold, or remove clothing and fan him if he's burning up. However, do not elevate the legs if the gunshot wound is to the torso, as this will increase bleeding and make it more difficult for the victim to breathe. 

If the victim was shot in the:

☛ Head: gunshot wounds to the head are frequently fatal. Keep the head elevated and get the victim to a trauma center as soon as possible. If obvious brain tissue is present, the gunshot was fatal. (Note: Try to continue treatment until emergency personal arrive on scene)

☛ Face & Neck: these wounds typically bleed severely. Use direct pressure to control bleeding and keep the victim upright. Be careful not to obstruct breathing while controlling bleeding. With injuries to the neck, be careful that blood flow to the carotid arteries isn't disrupted, as this can reduce blood flow to the brain.

☛ Chest & Back: apply direct pressure to control bleeding; it may be difficult to control chest bleeding because the ribs make it difficult to compress the structures that are bleeding. Gunshots to the chest can cause what is known as a "sucking chest wound." These happen when air travels in and out of the wound with each breath. You may see an asymmetrical (uneven) rise and fall of the chest when a victim is breathing. 

Treat these as follows: 
 - Seal wound with hand or airtight material ( plastic film)
 - Apply an airtight bandage on three sides of the wound ( Do NOT close the bandage on the fourth side). This will allow the chest to achieve its usual negative pressure state. Air will escape through the valve during inhalation. This may be difficult to do with large amounts of blood. Clear the area as best as possible before applying an airtight material to seal the sucking chest wound. 

☛ Abdomen: apply direct pressure to the injury site. As with the chest, controlling bleeding in these cases can be quite difficult. Injuries to the abdomen can be very dangerous for a victim in the long run. Gastrointestinal fluids may spill or leak causing infection. 

☛ Arm or Leg: use direct pressure to control bleeding. If you have a length of fabric or string on hand (or can tear one off clothing), make a tourniquet. Arm and leg injuries from gunshots can be elevated above the heart to help control bleeding. Use pressure points in the arm, groin, or behind the knee if direct pressure does not control bleeding.

☛ Do not forget to look for exit wounds or lack thereof. Exit wounds will appear much larger than the entrance wound. Exit wound will produce massive damage depending several factors. The type of weapon fired, the ammunition used, and distance. When bullets enter the body, they will produce massive cavitation through the body. If bones are in the path, fragments of bone will also cause further damage. Always try to immobilize extremities and try to move them as little as possible. Further movement of broken bones may lacerate local blood vessels causing further bleeding.   

☛ After providing care to the victim and the victim is alert enough to answer questions, ask them about any medical conditions they may have and any medications they may be taking. Certain medications may complicate treatment such beta-blockers which slow the heart rate and may mask the signs of shock. The victim may know the type of weapon that they were assaulted or injured with. If the victim knows, ask them what type. How close was the victim when the firearm was fired? 

☛ Providing comfort and emotional support for the victim should not be overlooked. Many victims are in extreme pain and emotional shock from the situation. Be careful of what you say around the victim and provide as much emotional support as possible.  

Watch video:
Gunshot Wound First Aid DVD Title2

References:
Nancy Caroline's emergency care in the streets
NAEMT-PHTLS
http://www.practicaltrauma.com/gsw.shtml
http://depts.washington.edu/learncpr/quickcpr.html
Infographic via Surgical Department /Medical College of Wisconsin  

#trauma   #gunshotwounds   #firstaid   #cpr