1. Surgical Emergency

2. Any abnormal break of the skin or the body surfaces is known as wound.
Open wounds allow blood to be lost from the body & germs to enter.
If the bleeding is internal, the wound is closed. This is most easily recognized by bruising, indicating damage to blood vessels just beneath the skin.

3. First aid priorities
Control blood loss by applying pressure & raising the injured part.
Take steps to minimize shock, which can result from severe blood loss.
Cover any open wound with a dressing to protect it from infection & promote natural healing.
Pay attention to hygiene, so that no spread of infection between the casualty & yourself.

4. 1- Bleeding Thus, the first aider must aim to control severe bleeding.
Bleeding is a loss of blood from the blood vessels.
Severe or continued bleeding may lead to collapse and death.
Thus, the first aider must aim to control severe bleeding.

5. Wounds that are relatively small and involve only slight bleeding.
I- External Bleeding:
a) Minor Bleeding:
Wounds that are relatively small and involve only slight bleeding.
It may be accompanied with pain at the site of the wound.
Management:
Wash your hands with soap and water.
Gently wash wound with soap and water.
Place sterile gauze over the wound and apply pressure to stop bleeding.

6. If blood soaks through the gauze replace with new gauze.
If possible elevate the injury above the heart.
When bleeding stops apply an antibacterial ointment.
Cover wound with bandage to reduce chances of infection.

8. B) Major or Severe Bleeding
If the damaged blood vessel is too large or the blood is flowing too fast to clot.
Bleeding may become life threatening, especially in children and infants whose blood volume is much smaller than an adult's.

9. Management:
If you have time wash your hands and put on synthetic gloves.
Have the person lie down. This will decrease the person's blood pressure and heart rate, and, therefore, decrease the bleeding.
If possible elevate the lower body higher than the head. This reduces the chance of shock.
Raise the injury above the heart to slow the bleeding as it will eliminate the effects of gravity pulling blood "down" and out of the body.

10. Lightly remove any dirt or debris
Lightly remove any dirt or debris. DO NOT remove any embedded objects or probe the wound.
Using a sterile dressing apply pressure to the wound. Use a cloth, towel or even your hand if gauze is not available.
Hold continual pressure on the wound for at least 20 minutes.
Resist the urge to lift up the gauze and check to see if the wound has stopped bleeding.

12. Indirect pressure
Direct pressure at the bleeding point can be impossible to apply or insufficient to stop bleeding. In these cases, indirect pressure can be applied to a pressure point above the bleeding artery, where the main artery runs close to a bone.
First identify the artery by feeling for pulsation, then apply pressure until the blood supply to the limb is greatly reduced. .

13. If the bleeding did not stop:
DO NOT remove pressure or the gauze. Instead add more gauze or material on top of it.
If the bleeding will not stop you can apply direct pressure to the artery delivering blood to the wound. The major pressure points are:
For the Arm: The inside of the arm just above the elbow below the armpit.
For the Leg: At the top of the thigh.
For the face: in front of the ears

14. Squeeze the main artery against the bone in these parts of the body
Squeeze the main artery against the bone in these parts of the body. Use flat fingers on the artery and continue to apply pressure to the wound with your other hand.

16. DO NOT apply a tourniquet, it may result in tissue damage or even gangrene.

17. II- Internal Bleeding:
Bleeding within the body cavities may follow injury, such as fracture or penetrating wound, but also can occur spontaneously as from stomach ulcer.
Internal bleeding is serious, even if blood is not split from the body, it is still lost from the circulation & shock can develop. Accumulated blood can also exert damaging pressure on organs as lungs or brain.

18. Signs of internal bleeding:
Evidence of internal bleeding from some organs may be seen by the first aider.
“Suspect internal bleeding if following injury, signs of shock develop without obvious blood loss.”
Signs of internal bleeding:
Bleeding from ear, nose, rectum or vagina.
Coughing up blood or blood found in vomit.
Abdominal pain, tenderness, rigidity or spasm in the abdomen.
Bruising on neck, abdomen or chest

19. Any wound that has penetrated the chest, skull or the abdomen.
Fractures.
Pain and tenderness at the affected area, swelling and tension may be felt.
Signs of shock (Cold, pale skin. weakness. anxiety. shallow breathing or thirst).

20. Management
Seek medical aid urgently or arrange to transport the victim to the hospital
lay the casualty down and raise the legs
loosen tight clothing and give nothing by mouth
Check breathing rate, pulse, and level of responsiveness
If the casualty is unconscious, open the airway and check breathing.
Keep casualty covered.

21. III- Bleeding from some particular regions:
a) Bleeding from the Head
Bleeding from the head is usually caused by a blow.
The scalp in particular has a rich blood supply and even a small wound can bleed heavily.
Bleeding may be profuse & will make the injury appear worse than it is.
However a scalp wound may be part of a more serious underlying injury such as skull fracture.

22. Staining of the eye socket, Pain, and a knock or cavity in the skull
A - Skull fracture
Signs:
Staining of the eye socket, Pain, and a knock or cavity in the skull
Straw-colour fluid coming from one or both ears
Casualty becomes increasingly drowsy and unresponsive over a period of time.

23. Dizziness, blurred vision or nausea Headache
B - Concussion
Pale skin
Dizziness, blurred vision or nausea
Headache
Brief or partial loss of consciousness

24. First Aid Management:
Treatment should include taking full details of what happened and checking for signs of head injury, such as skull fracture or concussion.
Help the injured person to sit or lie down.
Check for any signs of head injury.
Using a sterile bandage, apply direct pressure to the wound to stop the bleeding.

25. Cover the wound with a sterile dressing or a clean pad
Cover the wound with a sterile dressing or a clean pad. Tie this in place with a bandage.
Take or send the casualty to hospital as soon as possible.
If the casualty becomes unconscious, monitor and maintain airway and breathing and be prepared to resuscitate as necessary.

26. Bleeding is often severe as the palm has a rich blood supply.
B - Bleeding from the Palm:
The palm of the hand is commonly cut while cutting objects or through a fall.
Bleeding is often severe as the palm has a rich blood supply.
There are many tendons and nerves in the hand, and wounds to the palm may be accompanied by loss of movement or feeling in the fingers.

27. First Aid Management:
Help the casualty to sit or lie down. Apply direct pressure to the wound and raise the arm.
lf the person has had a fall, take care to rule out a broken arm before raising the arm.
Place a sterile dressing or clean pad in the hand and ask the casualty to grip her fingers over it. Bandage the fingers so that they are clenched over the pad. Leave the thumb exposed.

28. lf there is an embedded object in the wound, treat the hand flat and bandage around the object.
lf tendon damage means that the fingers cannot be clenched, bandage the wound with the hand flat.
Treat for shock if necessary. Keep the casualty warm, at rest and reassure him or her.
Support the arm in an elevation sling and take or send the casualty to hospital

29. C) Bleeding from the Nose:
The nose is a very vascular area of the body that contains many arterioles (tiny blood vessels) that can bleed easily.
Nosebleeds occur more frequently in the winter when heated indoor air can dry the membranes of the nose. 
Also, air moving through the nose can also dry out the membranes and can form crusts. These crusts bleed when irritated by rubbing, picking, or blowing the nose.
Occasionally, nosebleeds may indicate other disorders such as bleeding disorders, high blood pressure, or hardening of the arteries.

30. Nosebleeds most commonly occur when blood vessels inside the nostrils are ruptured by a blow to the nose or as a result of sneezing, picking or blowing the nose.
Infection as a cold or flu makes the blood vessels in the nose more fragile.
Nosebleeds may also occur as a result of high blood pressure.

31. Nosebleeds can be dangerous if the casualty loses a lot of blood.
If a nosebleed follows a head injury, the blood may appear thin & watery.

32. First Aid management:
Have the patient tilt their head forward. Tilting the head backwards can cause blood to go down the throat
Pinch the soft part of the nose just below the bone. Instruct the patient to breathe through their mouth
Apply pressure for 10 minutes
Seek medical help if...
You cannot stop the bleeding in 15 to 20 minutes
If the patient becomes dizzy or disoriented
If the patient has begun new medication recently
If they have frequent nose bleeds or bruise easily

34. D- Bleeding from the Gums:
A progressive disease affecting oral cavity characterized by chronic bleeding of gums that may lead to tooth loss. 
Causes:
Poor oral hygiene or inadequate plaque removal.
Oral trauma (like toothbrush abrasion) or inflammation (infection).
Vitamin C / K deficiency.
Hot food.
Leukemia.
Pregnancy. 

35. First Aid Management:
Apply pressure using ice-pack. 
Mouth rinse using pinch of salt in warm water (twice a day to reduce swelling).
Take vitamin supplements if necessary.
Consult a dentist if bleeding continues.
Avoid: Taking aspirin, cigarette smoking, or using hard brush.