How to survive a gunshot wound - Bleeding The most important part of surviving a gunshot wound is getting the victim to proper medical attention as soon as possible. Chances of survival improve the faster you get the victim in front of a doctor. Only in a worst case scenario where medical help is not available should you attempt to treat a firearm victim.

[Secure | Immobilize | Breathing | Bleeding | Stabilize]

4. Assess and Treat Bleeding

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Why Gunshot wounds may not bleed profusely. Remember gunshot wounds are serious. Just because they may not bleed profusely it doesn't mean you are out of the woods yet. - Entry and exit wounds are often small. - Bullets rarely transect or sever major arteries and blood vessels - Surrounding tissue acts as a barrier to blood loss - As blood pressure falls, bleeding slows.

While bleeding can be visually distressing it is one of the easiest problems to manage since treatment is straight forward. That said, gunshot wounds may not bleed profusely -- most of the damage is internal and inherently more serious than typical wounds. Bullet wounds are especially damaging because they penetrate deeply, take an unpredictable path through the body and are accompanied by a shock wave. [More on the physics of a gunshot wound]

As you treat the victim, bear in mind that almost 70% of gunshot victims survive. While victims who suffer gunshot wounds to the head or heart may succumb quickly, most will recover from wounds to other parts of the body.

Steps to stop bleeding
1. Remove clothing cover the wound so you can examine the source of blood -- i.e. exit and entry wounds.

2. Apply pressure directly to the wound with the heel of your hand using the cleanest available bandage, sterile gauze pad, or cloth compress.

3. Maintain pressure for a minimum of 10 minutes to allow several blood vessels to close by spasm and allow early blood clot formation. Do not peek at the wound as this will prolong bleeding.

4. If available, apply cold ice packs over the compress to aid the closure of damaged blood vessels.

5. If possible, get the victim to lie down and elevate the bleeding area above the level of the heart.

6. If direct pressure fails to stop bleeding, check to see that you are applying pressure in the correct location. You should be pressing directly on the bleeding point.

7. Try repositioning your pressure and hold again for another 10 minutes.

8. Once bleeding has subsided, apply a pressure dressing. Cover the wound with the cleanest available bandage, sterile gauze pad, or cloth compress and wrap firmly with rolled gauze or elastic bandage. Do not apply dressing so tightly as to compromise circulation where the victim loses feeling in fingertips or toes.

9. Watch dressing for blood soaking or dripping which could indicate continued bleeding.

10. Should bleeding continue ...

Indirect Pressure
If direct pressure fails to control bleeding or the application of direct pressure is not possible, you may need to apply indirect pressure to the appropriate pressure point. This pressure point is a place where the main artery to the injured part lies near the skin surface and over a bone. Pressure applied at such a point -- using the fingers, thumb, or the heel of the hand -- can compress the artery against the bone and shut off the flow of blood from the heart to the wound. Important pressure points include:
Brachial pressure point -- Located on inner side of the upper arm. Press fingertips in between the muscles to compress the artery against the bone.
Femoral pressure point -- Lay the victim down with leg raised and knee bent to locate the groin fold on the forward-facing part of the upper leg. Press very firmly on the artery with thumbs.

Tourniquet
The decision to use a tourniquet may be the decision to sacrifice a limb to save a life. A tourniquet should be applied to the limb between the bleeding site and the heart, as close to the injury as possible and tightened just to the point where the bleeding can be controlled with direct pressure over the wound.
Constructing a tourniquet -- Use a 2- to 4-inch wide bandage that will not cut the skin. Wrap the bandage around the limb several times then tie a knot, leaving loose ends long enough to tie another knot. Put a sturdy stick or rod over the knot then tie it in place with a knot formed with the loose ends. Twist the stick until the bandage is tight enough to stop the bleeding then secure it. Every 10-15 minutes briefly release the tourniquet to see if it is still needed to control the loss of blood. As soon as bleeding stops, remove the tourniquet.

11. After bleeding has ceased, immobilize the injury and regularly check all dressings to be sure that swelling has not caused tightness.

Types of Wounds. Scalp wounds bleed profusely and may require prolonged pressure. Position with head and shoulders slightly raised. Eye wounds: Victim should hold cloth over injured eye and keep eyes still Penetrating chest wounds: To seal wound, place plastic bag over dressing. If conscious, victim should be placed in sitting position leaning towards injury. In unconscious, lying on injured side. Abdominal wounds: position lying on back with knees raised. Amputation: do not apply cotton wool to raw surface. Wrap body part in plastic bag. on ice. do not wash severed part. Label part. Ice not to directly touch part.

Tips to Remember
- Arterial bleeding [from severed arteries] can be recognized by spurting and rapid outflow. Veinous bleeding is considerably slower and more moderate.
- External bleeding can almost always be stopped using pressure
- Ice can help close damaged blood vessels and slow blood loss
- A 25-30% loss on blood volume may result in shock
- Using a tourniquet may result in amputation of the affected limb
- Do not try to remove a deeply embedded object -- doing so may cause further bleeding.
- Internal bleeding is very serious and often the only effective treatment is surgery
- Signs of internal bleeding include firmness in the abdomen after injury, vomiting blood, blood in urine or feces, large bruises over the flank or abdomen, pale skin, cool and clammy skin, rapid heart rate, weakness, thirst, dizziness, shortness of breath.
- If victim has bones or internal organs protruding do not attempt to push these back inside the body. Cover the exposed tissue with moist sterile cloth pr bandages. Seek immediate medical attention.


Next: Stabilization of Victim
[Secure | Immobilize | Breathing | Bleeding | Stabilize]

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