Bleeding from most external wounds is fairly easy to control; however, when some of the larger arteries are cut, hemorrhage may be so rapid that death will result within a few minutes. Methods of controlling the flow of blood in some of these emergency situations are briefly described below. Wounds of the neck are often caused by sharp objects, such as knives, razors, and glass fragments. Sometimes a large artery is cut, sometimes a large vein, and sometimes both. In any event, the blood loss is extremely rapid. In treating wounds to the neck, an occlusive dressing should be applied over a sterile absorbent dressing to prevent air from entering the circulation system. It may also be possible to control the bleeding from these wounds by applying hand pressure above and below the cut; such pressure must be maintained until a medical officer gives further instructions. It is a good idea to use cloth under your hands, if any is available, because the blood makes his neck very slippery and difficult to hold.

When the large artery in the leg is cut, the bleeding is very rapid. At least partial (and perhaps complete) control of the hemorrhage can be attained by applying extreme pressure directly over the wound. Cover your clenched fist with clothing or type of other cloth that is available, and thrust your fist directly onto the wound. (If no cloth is available, use your fist alone; but you will find it more difficult to control the bleeding by this method because your fist and the wound will both become very slippery.) If a tourniquet becomes necessary, continue to apply direct pressure with your hand while the tourniquet is being applied.

Internal bleeding may be caused by deep wounds or by heavy blows that rupture internal blood vessels. When you suspect internal bleeding, anticipate that the victim may vomit blood. Give the victim nothing by mouth and keep him lying down, preferably on his side with a loosened collar and belt. Make him as comfortable as possible and reassure him. The victim should always be treated for shock (discussed below).

GENERAL FIRST-AID MEASURES

In addition to knowing ways to control serious bleeding by the application of pressure, you must be familiar with the following measures that are important in the first-aid treatment of a person who has suffered severe bleeding. Any person who has lost a large amount of blood must be treated by medical personnel as soon as possible. In the meantime, you can greatly improve his chances for recovery by treating him for shock as soon as possible and by keeping the person quiet. Shock is always present in persons who have lost a great amount of blood. If you do not notice symptoms of shock treat the victim for it anyway. Since the measures used to prevent shock are the same as those used to treat it, you may prevent its occurrence or, at least, lessen its severity.

Equally important, you must keep the casualty quiet. Try to keep him from getting excited. Do not move the victim unnecessarily, and do not handle him roughly. Keeping him quiet allows a clot to form in the wound and also helps to prevent the occurrence of shock. Try in every way to be careful and gentle in handling the victim, and do everything you can to make him as comfortable as possible under the circumstances.

SHOCK

You recall that in our discussion of hemorrhage, we said that the loss of 2 or more pints of blood usually causes shock You should also know that shock can occur with any injury. And, in fact, some degree of shock usually accompanies serious injuries. You should, therefore, consider shock whenever handling a person who has been injured.

To understand how shock develops, let us look at what happens when you hit the end of your finger with a hammer. Your whole body responds. Since your finger hurts, you might think it is the only part of you that is responding to the injury; but, in fact, a great many changes are taking place in your body while you are concerned with the immediate pain. Your body AS A WHOLE is injured and your body AS A WHOLE attempts to recover from the injury. A series of changes takes place, designed to restore the body to its normal, healthy condition.

Sometimes, however, the changes that occur may in themselves cause further damage to the body. To some extent, this is what happens in shock. When a person is injured, the blood flow in his entire body is disturbed. To overcome this difficulty, the heartbeats faster and the blood vessels near the skin and in the arms and legs constrict, thus sending most of the available blood supply to the vital organs of the body and to the nerve centers in the brain that control all vital functions. While this is occurring, the other cells do not receive enough blood and, therefore, do not receive enough oxygen or food. The blood vessels, like the rest of the body, suffer from this lack and eventually lose their ability to constrict. When this happens, the vital organs and the brain do not receive enough blood, and the condition of shock becomes worse and worse. If this continues, the present damage becomes so extensive that recovery is impossible. In less severe cases, prompt first-aid treatment for shock may mean the difference between life and death. In mild cases of shock, recovery usually occurs naturally and rather quickly.

Basically, then, SHOCK is a condition in which the circulation of the blood is seriously disturbed. As we will see later, the measures used to combat shock are aimed at helping the body recover from this disturbance of the blood flow.