Stopping external bleeding from a penetrating skull wound

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Clinical situation:  

While driving your car, you saw an accident on the road. A victim is sitting next to a broken car standing on the side of the road, calling for help. The victim has a wound to his head with bleeding from it. The scene is safe. A vehicle first aid kit is available for your use. 
Stop the bleeding.

Equipment for the practical skill:

• simulator;
• vehicle first aid kit.

The procedure for performing a practical skill:

• Call for help:
  • ask an eyewitness to call an ambulance and report an accident with a victim;
  • ask the bystander to assist you in providing first aid.
• Make sure the scene is safe.
• Identify a type of the external bleeding:
  • visualize the wound;
  • verify the bleeding;
  • choose a way to stop the bleeding.
• Since the victim is conscious, obtain informed consent to the procedure:
  • give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure;
  • explain what you are going to do;
  • ask the patient to consent to procedure.
• Take from the first aid kit protective gloves and put on it.
• Place a multi-layer pad on the wound:
  • take a comfortable position for this manipulation, if it’s possible, use the help of an assistant;
  • take from the first aid kit an individual sterile medical dressing package and open it: if there is no package, take 2-5 sterile  gauze pads 10x10 cm and stack them on top of each other to form a multi-layer gauze pad;
  • сover the wound with this pad avoiding a pressure of fingers on the wound.
• Place the compressive bandage (option: "Cap" bandage):
  • take a sterile bandage of the individual sterile medical dressing package or a sterile bandage from the first aid kit;
  • cut (tear off) a piece of bandage 50-75 cm long;
  • place it in the transverse direction on the crown of the head above the multi-layer gauze pad so that the ends descend vertically down in front of the auricles;
  • ask an assistant to hold them in a taut position (sometimes the patient himself does this);

• carry out the first horizontal moves on top of this bandage around the head so that their lower edge goes over the eyebrows, over the auricles and over the occiput;

• having reached the vertical tie on one side, wrap the bandage around it (a loop is made) and then on the forehead area somewhat in an oblique direction, covering half the circular course;

• having reached the opposite tie, make a loop again and again lead in an oblique direction to the occipital region, half covering the underlying passage, etc;

•  so each time, throwing the bandage over a vertical tape, lead it more and more obliquely until they cover the entire.

• Tie ends of the bandage under the chin.

• If blood soaks through the multi-layer pad, put another one on top and apply "Cap" bandage again.
• Help the casualty lie down with his or her head and shoulders slightly raised.
• Monitor vital signs – level of response, breathing, and pulse – while waiting for help.