So what do you advice one should do if a victim is bleeding profusely after an accident?
When a patient severs his blood vessels, of course bleeding will occur and the patient can tolerate blood loss to an extent; up to one third of the blood volume. But when a patient is losing about half of his blood volume, he is at risk of going into circulatory shock.
Shock means that there’s a collapse of the circulatory system. The blood volume in the blood vessel is not sufficient to move around the body, to take oxygen around the body. Therefore, the brain begins to lack oxygen which it cannot tolerate so the brain shuts down; every other organ shuts down. That can lead to death. So when someone who is knowledgeable is around and the patient is bleeding, something can be done. Pressure can be applied to that part of the body. Compression can be applied too before taking the patient to the hospital.
How can one resuscitate an accident victim?
At the scene of an accident, many people lapse into unconsciousness. Many people from the impact of the collision can go into what we call cardiogenic shock. The heart can stop due to the trauma to the brain. They can go into unconsciousness. The three things that can threaten a life of a patient in that circumstance are; the patient has stopped breathing. When a patient stops breathing, within four to six minutes, the brain malfunctions and that is incipient death. So the heart can stop working and if it does, it’s referred to as cardiac arrest.
Trauma can lead to cardiac arrest. If the heart stops working, that means that the heart cannot pump up feeling to the brain and other vital organs. So, the brain also shuts down. That can lead to death within minutes of the occurrence.
Thirdly, the patient may be conscious but he’s not able to breathe due to one problem of the other. That can also lead to death. So, in resuscitating a patient who has just been involved in an accident or even a cardiac arrest at home, there are three things that people must know.
These are the basic pulmonary resuscitation algorithm, because you may just be a mere bystander that can save the life of the patient.
They are circulation, airways and breathing. Circulation is very important. When a patient collapses suddenly, or has been involved in an accident, the first thing you want to do is to take the patient out of danger as the accident may have occurred right in the middle of the road or maybe in the bush, while ensuring that you are also out of harm’s way.
Make sure you carry the patient out of the vehicle carefully because if you start attending to the patient in the middle of the road, right inside the car, another car can run into it. The car may even go into flames. You lie him down carefully by the side. Then you observe. You can tell whether he is conscious or not. When you shake the patient, if he’s conscious, he’s likely to open his eyes. But if he doesn’t do that and you apply some pressure to the skin, and there’s no response, that patient is probably unconscious.
You can also check if the patient is breathing because the patient can be unconscious and be breathing. If one is knowledgeable, you can check for the pulse. Its in front of the rib in the outer part. Everybody should be able to feel their pulse. If he’s unconscious and he is not breathing, then you immediately think of the ABC of resuscitation or the C, A, B depending on the school of thought.
You want to ensure that blood is still getting to the brain and the way to do that is to start what we call cardiac massage or chest compression. Make sure the patient is lying down flat, you put the heel of your right hand on his sternum, that is the lower part of his chest, just at the midline, in-between the two nipples and you put your other arm on top of your right arm.
Then you apply a compressive force to depress the chest to at least, five centimeters down. You have to do that a hundred times per minute. As you do that, you are pushing blood from the heart into the brain and therefore you are ensuring that oxygen continues to get to the brain. If that’s all that you can do before further help comes, you may have saved the patient’s life. In doing the compression, the patient can wake up and that might just be what you need.
But if you do the cardiac compression one hundred compression per minute and there’s no response, the next thing you do is; you need to check the airways. You lift the chin up because the tongue can be falling back to block the airways. So by lifting the chin up, we call it chin lift, the tongue can fall away. And if for instance, there are objects in the mouth maybe the patient was eating before the accident happened. You can actually with a gloved finger, or with cellophane in your hand, swipe your hand around in his mouth and bring out anything; maybe blood clot or food particles. That can free the airways.
In a case whereby the patient is not breathing what should one do?
You have to do the mouth to mouth resuscitation. That is what we call the kiss of life. Just make sure you clean the patient’s mouth quickly. You may want to put handkerchief to cover the mouth and you use your mouth to cover the patient’s mouth and make sure it is completely covered so that the air does not escape. After 30 compressions, then you blow twice into the patient’s mouth while extending the head. You put one hand on the forehead and one hand on the chin, you lift the head up and you blow into the mouth of the patient two times, then you go back to your compression.
If there are two people there, one would face the compression while the other one would face the airways. While your partner does the compression, he waits a second and you blow air into the mouth, one second, then another second. As you do that, you will notice the chest wall expanding if you are doing it correctly. As you push air into the mouth, you need to block the nostrils so that the air does not escape from the nose. That can keep the patient going until the ambulance comes and the patient is taken to the hospital. That is what we call the C, A, B of resuscitation.
What kills an accident victim quickly?
Road accident is the second commonest cause of death among young people, second only to infectious diseases. Road traffic accident occurs on the highway but many of them are preventable.
At the scene of the accident, the things that kill an accident victim fast, range from three major things.
One is severe head injury, where you have injury to the brain due to a high energy impact. It can lead to death on the spot. The second is chest injury; whether penetrating chest injury or blunt chest injury because the chest contains vital organs like the heart, the lungs and other important structures.
These are vital to life. When there has been a penetrating chest injury or blunt chest injury that pierces the heart, the lungs or any of the major blood vessels, this can result to death. Then closely following that is haemorrhage. A major organ may not have been injured but if there has been severance of a major blood vessel, a patient can bleed until he extenuates and that can lead to death at the scene of accident.
We cannot do much if there’s a severe head injury, a cervical spine injury, or if the heart is crushed, pierced or the great vessels are ruptured or the lungs are severely pierced.