Bandaging is one of the important measures for on-site emergency treatment of external injuries. Timely and correct bandaging can achieve the purposes of compression hemostasis, reducing infection, protecting the wound, alleviating pain, as well as fixing dressings and splints. On the contrary, incorrect bandaging may lead to increased bleeding, aggravated infection, new injuries, and adverse consequences such as sequela.
When bandaging wounds, it's necessary to understand whether there are any internal injuries. At the scene of an external injury emergency, one must not focus solely on bandaging visible surface wounds while ignoring other hidden internal damages.
For example, with limb wounds, if there is a concurrent fracture, the method of bandaging will be different. When there is a fracture, bandaging should consider the proper fixation of the fractured area. Similarly, for wounds on the trunk, if there is a concurrent internal organ injury, such as liver rupture, intra-abdominal bleeding, or hemothorax, priority should be given to treating the internal organ damage instead of wasting time on bandaging the surface wound. For head wounds, if there is a concurrent brain injury, it’s not enough to simply bandage and stop the bleeding; enhanced monitoring is also required. For patients who have suffered a head impact, even if they feel fine, they need to be observed for 24 hours. If symptoms such as headache aggravation, nausea, or vomiting appear, it indicates the presence of intracranial injury requiring urgent treatment.
Therefore, before or while bandaging the visibly obvious wounds on the injured person, it's essential to determine whether there are injuries in other areas, especially more concealed internal organ injuries.
Bandaging wounds that communicate with body cavities
For open wounds that communicate with body cavities, at the scene, generally, only simple coverage of the wound is needed, then the patient should be sent to or medical personnel contacted immediately for further treatment.
For example, abdominal wounds that communicate with the abdominal cavity can be covered with clean gauze, towels, or bed sheets. If intestinal loops or omentum protrude from the wound, do not attempt to push them back into the abdominal cavity, as this could increase contamination of the abdomen. For protruding intestines or omentum, use a clean bowl to completely cover them or surround them with clean gauze before bandaging to prevent squeezing the protruding intestines or omentum.
For chest wounds that communicate with the thoracic cavity, they can cause open pneumothorax. "Communicating pneumothorax" and "high-pressure (tension) pneumothorax" can present severe symptoms and even lead to coma or death.
The former should be quickly sealed with sterile gauze or other clean dressings, fixed by bandaging to prevent paradoxical breathing, thereby alleviating symptoms and preventing continuous harm. For "high-pressure (tension) pneumothorax", due to the formation of a unidirectional valve at the rupture site, when inhaling, the opening allows gas to continuously enter the pleural cavity; when exhaling, the opening closes, preventing gas from being expelled. The pressure inside the thoracic cavity increases continuously, compressing the lungs, leading to progressive respiratory difficulty. In this case, emergency decompression is required, which can be performed by inserting a large-gauge needle through the second intercostal space along the mid-clavicular line on the affected side.
In cases of head trauma where "a relatively large amount of light red fluid flows from the nostrils and ears," a skull base fracture should be considered, with the wound communicating with the cranial cavity. Do not attempt to press or plug the patient's nostrils or ears at the scene to avoid causing intracranial infection. If the fracture penetrates the scalp or if brain tissue protrudes, handle it according to the principle for protruding abdominal organs.
Wound bandaging primarily aimed at stopping bleeding
In the presence of bleeding, the implementation of external wound bandaging must be based on hemostasis. Without timely hemostasis, serious blood loss, shock, or even life-threatening conditions can occur.
Sometimes, bandaging itself is a measure of hemostasis. For example, capillary bleeding caused by tissue damage appears as beads of water-like flow from the wound, slightly pressing can stop the bleeding, sometimes it can automatically coagulate to stop the bleeding. This type of bleeding often requires only applying a hemostatic patch to the wound or covering the wound with sterilized gauze, followed by slightly pressurized bandaging to simultaneously achieve both hemostasis and bandaging. However, for "arterial bleeding" caused by arterial vessel damage and "venous bleeding" caused by venous vessel damage, simple pressure bandaging often cannot achieve the purpose of hemostasis.
Arterial bleeding presents as pulsatile, jet-like bleeding, bright red in color, and can result in significant blood loss within a short period, posing a life threat; venous bleeding presents as slow, continuous outflow, with blood appearing dark purple. These situations can be temporarily managed with emergency measures like "digital pressure" and "tourniquets" before sending the patient to or requesting medical personnel for further treatment.
Digital pressure involves finding the pulsating vessel above the wound, closer to the heart, and firmly pressing it with your fingers. Note: this method can only control blood flow for a short time and should be followed by the "tourniquet" hemostasis method.
A tourniquet is an elastic rubber band (with padding between the band and skin), and items like cloth bands, towels, or ties wider than 3 cm can also be used as substitutes. It should be tied at the upper or middle third of the arm or thigh (Note: when tying the arm, it shouldn't be too low to avoid nerve damage). The tightness of the tourniquet should be adjusted so that there is no fresh blood flowing from the wound. Additionally, the time the tourniquet was applied should be clearly marked, and it should be loosened for a few minutes every hour before retying.
Incorrect bandaging can lead to serious consequences
Someone, while bandaging a child's "elbow injury," kept the "forearm and upper arm fixed in a straight line" for a long time, resulting in the "loss of normal elbow flexion function" and eventual disability. The reason is that the reader did not know that during bandaging, joints should be fixed in a "functional position." Keeping the joint in a functional position ensures that even if the joint cannot move after injury, some physiological functions of the original joint can still be maximally retained.
For the upper limbs, ensuring hand function is most important; for the lower limbs, mainly ensuring weight-bearing and walking functions. Therefore, the functional position of the elbow joint is approximately 90 degrees of flexion, the knee joint is slightly flexed at 10 degrees, the finger joints are flexed at 45 degrees, and the ankle joint is at 90~95 degrees.
Using fractures as another example: loose bandaging that fails to fixate properly is an important cause of malunion or false joint formation. As we all know, the reduction of fractures and dislocations relies on fixation. If the bandage is loose and does not provide proper fixation, immediate risks such as bleeding, pain, and shock can occur, and long-term risks include malunion and false joints.
On the other hand, excessively tight bandaging can also cause new injuries to the body. Tight bandaging affects blood circulation, potentially causing swelling, pallor, cyanosis, coldness, or numbness in the extremities. If not promptly relaxed and appropriately re-bandaged, it could lead to limb ischemia and necrosis.
Additionally, inappropriate movement of the patient for the sake of bandaging can also cause irreparable damage. For instance, causing the fractured ends of long bones to pierce vital vessels or nerves, or causing spinal cord injury leading to paraplegia in patients with spinal fractures. Therefore, skillful techniques must be employed during bandaging. (Editor-in-charge: Ye Xin - Body Care Free)