FIRE COLLEGE NOTES

FIRE COLLEGE NOTES

Data of Interest to Progressive Chiefs and Firemen

Bleeding from Upper Part of Body

To the Editor:

A few weeks ago you published a reply to a communication, in which the writer inquired the exact method of stopping bleeding from the leg. Would it be too much to ask you what method should be pursued in the case of a wound in the upper part of the body—say the arm, or the head. I note your caustic comment as to the necessity of all firemen knowing something of first aid to the injured, and—I “acknowledge the corn.” But in a small town, such as ours, we are not able to get any instruction on the subject, and even books on it are hard to buy. So if you can oblige me—and some other inquiring firemen of our company—in your very fine “College Notes” department, I will be greatly obliged. Thanking you in advance, I am,

Yours very truly,

FIRST AID.

Fig. 1—Vessels of Head and Neck A, Carotid Artery, ascending behind muscle to ear and giving off branches; B, to lips and nose: C, back of head; D, along cheek; F, behind ear and continuing vertically; F, temporal artery front of ear to top of head J. jugular vein, emerging from skull just below lobe of ear. Indicating letters placed close to points where pressure may be applied. Dotted lines show where artery runs deep and can only be reached with difficulty.

Dec. 24, 1918.

Answer: Of course we will oblige you. In fact, we are only tOO glad to do all in ourr power to assist any member of the fire service in all ways in our power. That is what this department is for, and what it is designed to do. We will not go into the subject of the general circulation, the various forms of blood vessels and the nature of the hemorrhage (bleeding) that proclaims from whence the blood comesthat was treated in the answer to “A Fireman” in the December 4 issue. But there is one thing to remember. There is no bleeding on the surface of the human body, which cannot he arrested by firm pressure on the wound. In nearly every instance, even if you have forgottenor do not know the exact course of the artery, digital (finger) pressure on the wound will temporarily stop the flow of blood. Of course, this is only useful until the course of the blood-vessel is located properly and the artery itself is compressed, preferably by a tourniquet, as described in the previous answer. Reference to the illustration, Fig. 1, and to the key beneath it will show the articular circulation of the head and neck, and the proper places to apply pressure to control the bleeding from a wound from those parts of the person. Fig. 2 illustrates the upper part of the human body, its circulation and the different methods of stopping hemorrhages from the arteries. When the purified blood returns from the lungs, it enters the left upper chamber (auricle) and is squeezed into the lower (ventricle), which in turn contracting on its contents, forces the blood into the arteries. The main vessel carrying the fluid is the aorta, a tube of about the diameter of the bow! of an ordinary pipe. From this main, branches are given off, one to each arm, one to each side of the neck, and, downward, one to each leg. The branches for the head and arms come out through the narrow upper opening of the thorax, those for the arms taking a bend over the flat first rib. Here, then, is a bony point against which it can be compressed. Bleeding from the axillary artery can be thus controlled. Cut away the clothing from neck and shoulders. Then drive the thumb down hard—very hard— into the root of the neck, just above the collarbone, and immediately behind the sterno-mastoid muscle you can see running from the breastbone to ear. (See Fig. 2-A.) Another method, in case of bleeding directly from the axilla (armpit) is to take a ball—as a tennis ball—and wrapping it in a handkerchief, press it hard into the armpit, closing the arm down over it. This, however, should be done with great circumspection as there are several very delicate nerves and blood-vessels in this cavity that can easily be ruptured with careless handling. B. C. and D. (Fig. 2) illustrate methods of compressing the facial and scalp arteries. From the armpit the arm artery runs down the inner side of the arm, and becomes the brachial artery. The course follows the direction of your inner coat seam. The best way to press this blood-vessel is shown at F and also at E, the latter method of compression (E) from the front being suggested for use in case the patient is an exceedingly muscular subject. The artery lies in the inner groove of the biceps muscle. Place the palm of the hand against the hack of the arm and dispose the finger-tips along the seam or groove, the pressure being made against the shaft of the humerus (upper arm bone). There is one more “golden rule” to be followed in all cases of bleeding—always elevate the part. This follows the exact principle that causes a stream that is powerful at the first or second story of a high building to become a mere dribble at the tenth or fifteenth. The force of the pump—for that is what the heart is—is expended largely in overcoming the gravity of the column of water or blood, as the case may be. A third of our golden rules is: In all arterial bleeding, always apply pressure over a bone between the heart and the wound.

Fig. 2.—Arrest of Arterial Bleeding in Head, Neck, and Upper Extremities The position of heart and main arteries shown by dotted lines. Bones of shoulder joint and upper ribs (cut across) shown in outline.

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