18 DRUG TOPICS December 22, 1941 How To Apply Bandage Dressings To Facial Wounds And Burns Gauze square, which is always kept in a Cravat bandage, to hold dressing in place, Bandage is tied with a neat, flat-squared sterile package until moment of application. is looped under jaw, crossed at temple. knot. Cravat bandage is a folded standard is touched only at edges during withdrawal. Severe wounds require a doctor. first aid triangular bandage. To hold nose and jaw dressing in place, use a four-tail bandage, made by splitting regular gauze bandage lengthwise. Apply Mild Tincture of Iodine well down into the wound, then on the skin around the wound for a distance of from one-half to one inch. Let the iodine dry. If wrapped up while still wet, blistering is likely to occur. If allowed to dry, this practically never happens. Apply a sterile dressing or compress and bar.fhge snugly in place. Do not disturb blood clots—for example, do not tear a compress from a wound. Never re-apply iodine. Furthermore, do not use it near the eyes or body cavities. Some industrial plants, on advice of their physicians, may recommend that no antiseptics be used, only a sterile dressing. Others may desire that certain other antiseptics be used. Tincture of iodine has been found effective as a germ killer in an experience covering a period of many years. It is easy to obtain and is quite safe if properly used. 2. Wounds with Severe Bleeding. The chief duty of the first aider in this case is to stop the bleeding at once. In all serious bleeding, think first of pressure. One should not put fingers into a wound, but when other methods fail, or a compress is not available in a case of severe bleeding, do not hesitate to apply pressure directly on the bleeding point. It is much better to have a live patient with a dirty wound than a dead patient with a clean wound. Always remove enough clothing so that the wound may be clearly seen; use considerable speed as this is one of the few cases where speed is absolutely necessary. Arterial Bleeding. Blood from a cut artery comes in spurts except occasionally where the cut artery is buried very deep when it may appear to be a steady stream. Immediately apply digital or hand pressure between the cut and the heart at the proper one of the six points where the main arteries lie close to a bone. A tourniquet is always a dangerous instrument and should not be used if the bleeding can be readily checked otherwise. It cuts off jli olood to the part. If the circulation is cut off for too long a time the part dies, gangrene sets in. Therefore loosen the tourniquet every fifteen to twenty minutes, but do not remove it. If bleeding does not start again, let the tourniquet remain loose. If bleeding persists, tighten the tourniquet again. Severe burns should be dressed with warm bicarbonate of soda solution, not with oil or salves. Treat victim for shock. Be sure the tourniquet is tight enough to cut off the blood in the artery. Otherwise it usually increases bleeding by preventing the return flow through the veins. Do not cover a tourniquet with a bandage or splint; it may be forgotten and not loosened as necessary. Venous Bleeding. Bleeding from veins comes in steady stream and is under much lower pressure than an artery. Because of this lower pressure it is much easier to control. Always have the patient lying with the bleeding part elevated if the bleeding is at all serious, except in case of a fractured limb. Tight clothing, such as garters or collar, should be removed from the heart side of the wound. Apply pressure with the fingers along the edge of the wound, particularly on the edge away from the heart, until one can obtain material for a compress. Usually, bleeding from a vein can be controlled by placing a compress over the wound and bandaging snugly. Then if needed, apply firm pressure with the hand directly over the compress until a clot forms. Shock By the term "shock" is meant a condition in which all the activities of the body are greatly depressed. Especially characteristic are pale face, weak and rapid pulse, great lowering of the blood pressure, irregular gasping breathing, listlessness, dulling of sensibility and subnormal temperature. Shock results from injury, although strong emotions, such as fear, are sometimes an important factor. Shock may be slight, lasting only a few seconds, or it may be very serious and even fatal. Some degree of shock follows most injuries. It may come on immediately, or be delayed, "omiog'-on-even-several hours later. If-it-is at all severe, prompt treatment must be given. Shock is frequently the cause of death. Immediate shock treatment may save a life and permit the patient to live and recover from his other injuries. Prevention. The same measures are used to prevent shock as are used to treat it. They are: (1) Heat; (2) Position; (3) Stimulants. Symptoms. 1. The face is pale with an anxious expression. The lips, finger nails and For severe facial burns, use hood bandage, made of knotted triangular bandage, to keep dressings in place. gars have a bluish tinge. The weary, lusterless eyes, half covered by drooping eyelids, have a glassy and vacant expression. 2. Cold perspiration appears, particularly on the forehead and the palms of the hands. 3. The pulse is rapid and weak. It is not unusual for the pulse to get so weak that it cannot be felt at the wrist. . 4. A severe chill often develops. The body feels cold, shakes violently, and the teeth chatter. Those who have not seen severe shock can scarcely realize the terrific coldness of these patients. 5. Usually the patient lies quietly and takes little interest in what goes on around him, although sometimes he may be restless. 6. Nausea and vomiting are frequent. 7. Breathing is irregular. Long, deep, sighing breaths alternate with very shallow ones. Treatment. There are only three measures of value in the First Aid treatment of shock: 1. Heat. This is the most important. 2. Position. Second in importance. 3. Stimulants. Valuable in mild cases, but a poor third in serious cases. Heat. A person suffering from shock loses heat very rapidly due to the poor circulation of blood. And to make the situation worse, the more heat lost and the more exposure to cold, the worse the shock becomes. Hence, keeping the body of the patient warm is the most important thing both in treating and preventing shock. Position. Remembering that there is an insufficient supply of blood particularly to the brain and heart, and that there is a stagnation of blood in the vessels of the abdomen, the most logical thing to do is to place the patient in such a position so that gravity will help the blood flow to these parts. Lay the patient on his back with the head low. Above all, do not have the patient sit up, except in chest injuries and nose bleed. If the -sfam fs fraeftfri^^rthere-trwrttstrs-heatrm-jury keep the patient level instead of elevating the feet. Stimulants. Stimulants often fail woefully when most needed. But they have an important place particularly in the milder cases and in prevention, and surely will do no harm in the very serious cases. Aromatic Spirits of Ammonia—a teaspoon-ful in half a glass of water is one of the most satisfactory stimulants. This can be safely repeated every 30 minutes as needed. Coffee and tea both contain the drug caffein which is an excellent stimulant. Do not attempt to make an unconscious per son drink. An inhalation stimulant place near the patient's nose, should be used in case where the patient is not conscious. Do not give a stimulant in severe bleedini whether internal or external, until the bleedin has been checked. Do not give a stimulant if patient has a fra> tured skull, or in cases with a strong pulse ar red face, such as sunstroke. Wounds Requiring Additions Consideration Powder Burns. Exploding firecrackers blank pistols, etc., are common causes. Som< actual burning of the skin may be present, bul the chief danger is usually from the many verj small punctured wounds caused by the smali particles of burned powder penetrating th skin. These carry in tetanus germs from th skin, which is apt to be covered with stree. dirt, and unless proper treatment is given, tetanus often develops. The first aid treatment depends upon whether there is actually a burr or merely small wounds. Always take the injured person to a physician so that he can givt further treatment to the injury and administei tetanus antitoxin. The value of having th< antitoxin given in these cases can not be overemphasized. Gunshot wounds vary with the character o! the projectile. Military rifle and machine gui bullets have a very high muzzle velocity anc tremendous striking power. At ranges undei 500 yards, the effects on the soft tissues ar< frequently explosive. At longer ranges th( wounds of entrance and exit may be drilled sc clean as to be hardly noticeable and, escaping vital structures, very little damage may b< caused. Shrapnel wounds are caused by leac shrapnel balls about the size of marbles. The} are not ragged or sharp and are not so apt tc carry portions of clothing deep into the wound; as high explosives. The severest forms ol wound infections usually result from the introduction of dirty clothing into the tissues. High explosive wounds are particularly destructive. The shell particles are jagged and sharp and may do extensive damage after entering the body. The wound of entrance is usually small, much smaller than it would seem possible for the fragment to enter. The destruction of the deeper tissues may be very marked, and these wounds are usually infected. Pistol wounds are somewhat similar to shrapnel wounds. The first aid treatment follows that given for other types of wound viz., applications of the first aid dressings, control of hemorrhage, splinting the part, and the combating of shock. In gunshot wounds of the joints the extremity should be splinted. Emergency operation may be required later to remove foreign bodies in the joint cavities. Wounds of the abdomen usually require early operation. Sue' cases should be'given emergency treatment, receive nothing by mouth and be moved promptly to the nearest hospital. Extensive wounds of the chest are very serious. It is important to fill the defect in the chest wall at once with ample dressings and packs. Unless the lung is promptly compressed and immobilized, death may rapidly supervene from changes in intrathoracic pressure and mediastinal flutter with the production of paradoxical or pendulum breathing. The rule in gaping wounds of the chest is: Plug the defect in the chest wall at once with whatever comes to hand. IFounds In Which Foreign Bodies Remain Splinters of wood are the most frequent cause of such wounds. Small pieces of glass and metal shavings are also frequent causes. If the foreign body is very near the surface, it can be picked out with a sterile needle or tweezers. Sterilize the skin with iodine be-. fore and after removing foreign body. A splinter under the nail is removed the same way, unless it has been broken off. In the latter case, scrape the nail until thin, cut out a small V shaped piece over the splinter and remove it as above. If the body is buried deeply, or if the wound is of considerable size, always consult a doctor. Simply apply iodine and a proper dressing and then take the case to the physician. Internal Bleeding Internal bleeding is most likely to be from one of the three following sources: 1. Stomach. Blood from the stomach is usually vomited up and has the appearance of coffee grounds. The digestive juices begin to act on the blood causing it to turn brown and Break up into smail dots about the size of large coffee grounds. The most common causes are wounds of the stomach and stomach ulcers. 2. Lungs. Blood from the lungs is coughed up and is bright red in color and frothy in appearance. Tuberculosis is the most common cause of spontaneous bleeding. Punctured wounds and especially an injury where-a rib is broken and driven into the lung will also cause bleeding. 3. Bowels. If the bleeding is from any point