Gunshot wounds
Posted: Tue May 15, 2007 10:24 am
An interesting article in the TOI which I think would be informative to all
So, based on my own Casualty responder experience and the ATLS ethos, here are a few suggestions (bit my tongue on CPR for dummies), to manage the scene on site when poor Pappu finds himself on the wrong end of a speeding bullet.
Gunshot wound : Bystander management
1. Assess : is it safe to approach? Is anyone firing at you. You are not going to be much help to the groaning mass on the floor if you get hit yourself. This might be the time that someone peels off to phone the Police and the Ambulance. If you are alone, you might do just that. (except if the victim is a child, when you would stay and try to stabilise it before leaving the scene).Only when you are sure you’re not in the sights of the Secundrabad sniper , move on to :2. Assess(2) : Is the victim conscious? Ask a few simple questions :how are you….is a good opener, even if it seems a silly question at the time (how the **** do you think I am ?). if conscious, on to the next bit , if not you might have to brush up your BLS skills, (see the link below)
3. Immobilise : make sure his neck stays neutral, no twisting, no turning. a couple of bricks gathered from around should do that. Also, resist the temptation to turn him on his side to look for the exit wound. Keep him perfectly still and as neutral as you can (difficult with bony fractures), on his back, otherwise you may accentuate any spine injury he might have received.
4. Bleed : Apply direct, firm continuous pressure to visible bleeding points….this might be a few fingers to his wrist, or your whole fist on his groin, smaller bleeds do well with a bit of bandage…..but avoid tourniquets…they accentuate bleeding, since very few people know how to tie them properly.
Keep the pressure on till someone relieves you….either the paramedics or another good samaritan.Take turns with the pressure, don't let it come off. Telling you this seems an insult to your intelligence, but I know of one instance in Delhi where a DTC conductor bled to death in the bus itself after being injured by pickpockets……sadly avoidable, because simple, firm pressure on his groin would have stopped the femoral artery bleed and bought time.
5. Other injuries : try to spot any obvious problems, but keep him still and on his back. If he has knives/axes/tree trunks/arrows sticking out of him at odd angle: DO NOT TOUCH THEM. They need to be removed in the operating theatre. Any attempt to remove them before will only increase the damage.
6. The Rest : there is a lot to gunshots, which is why everyone in A/E, ITU and theatres groans when one is brought in. But, a sensible , basic outline, started in the field by you, will certainly help in limiting damage. Also, this is the link to the Resuscitation council BLS scheme.
http://www.resus.org.uk/pages/bls.pdf
Reading it will give you a rough idea, but please enrol yourself in a local bystander BLS (bystander CPR) course. In case you’ve done one, make sure you go for a refresher every three years….remember the guidelines have changed recently.
All in all, keep cool. An Ounce of common sense will go a long way to help you, and poor Pappu pager
Anand
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