Penetrating Trauma

In this lesson, we'll go over the treatment options for penetrating injuries like gunshot wounds, knife stabbings, or any other type of similar penetrating trauma.

Penetrating injuries can often be life-threatening and will usually require immediate treatment. Knowing how to assess and provide first aid for these injuries can make a critical difference in the outcome of the victim. 

In this lesson, we will guide you through the assessment phase and initial treatment of penetrating injuries.

First Aid Steps for Penetrating Trauma Injuries

As always, the first thing you want to do is ensure that the scene is safe. Carefully assess the scene for any ongoing danger and ensure your safety and the safety of others before approaching the injured person.

If there is an active threat, prioritize your safety and seek a safe location before providing aid. Your safety and the safety of others is always the most important step. Once you have determined that the scene is safe, follow the steps below.

• Step 1: Call 911 for help. If you cannot call emergency services yourself, ask someone else at the scene to do this, providing others are in the vicinity, as you may have your hands full with the victim.
• Step 2: Provide accurate details to emergency services about the situation, including your location and the nature of the injury. Calling for professional medical help is crucial for the injured person's survival. Also, remaining calm, if possible, will help to ensure the proper communication of vital information
• Step 3: Control the bleeding by applying direct pressure to the wound using a clean cloth, a sterile dressing, or even your gloved hand.

• Step 4: Maintain pressure until medical professionals take over. If the object causing the penetration is still in the wound, don't remove it, as it may be acting as a plug to control the bleeding.

If you believe there is a possibility that the penetrating item such as a bullet, knife, or other item may have gone through the body, check to see if there is a wound where the object came out. With bullets especially, the exit wound is usually larger than the entry wound.

• Step 5: Once the bleeding has been controlled, help the victim get into a comfortable position, preferably lying flat on the ground if possible. Then, cover the injured person with a blanket or any available material to help maintain their body heat. This can reduce the risk of hypothermia, help with the clotting process, and provide comfort to the victim.
• Step 6: Lastly, provide reassurance. Keep the injured person calm and reassure them that help is on the way. It's important not to lie to them or give them false hope. Minimizing their movement to avoid exacerbating the injury, keeping them calm, and reassuring them that you are taking good care of them can all aid in their recovery.

It's important to resist the urge to probe or irrigate the wound. Your focus should be on controlling bleeding, keeping them warm, providing comfort and reassurance, and waiting for professional medical help to arrive.

Remember, in most cases, maintaining the victim’s airway, breathing, and circulation will be the most important steps in a critical penetrating trauma emergency, as cardiac arrest may become an additional threat.

These are the basic steps for providing the initial care for a penetrating injury. Once emergency medical services arrive, they'll take over and provide the appropriate medical treatment.

A Word About Cardiac Arrests Associated with Penetrating Traumas

According to the American Heart Association, basic and advanced life support for the trauma patient are fundamentally the same as that for the patient with a primary cardiac arrest, with a focus on support of the airway, breathing, and circulation.

Cardiopulmonary deterioration associated with trauma has several possible causes including:

• Hypoxia secondary to respiratory arrest, airway obstruction, large open pneumothorax, tracheobronchial injury, or thoracoabdominal injury
• Injury to vital structures, such as the heart, aorta, or pulmonary arteries
• Severe head injury with secondary cardiovascular collapse
• Underlying medical problems or other conditions that led to the injury, such as sudden cardiac arrest
• Diminished cardiac output or pulseless arrest from tension pneumothorax or pericardial tamponade
• Extreme blood loss leading to hypovolemia and diminished delivery of oxygen

Even with a rapid and effective out-of-hospital response, victims with out-of-hospital cardiac arrest due to trauma rarely survive. Those patients with the best outcome from trauma arrest generally are young, have treatable penetrating injuries, have received early endotracheal intubation, and undergo prompt transport to a trauma care facility.

Remembering your CPR training during a penetrating trauma injury could be vital for whomever you're administering first aid to should they fall victim to a cardiac arrest. It pays to be prepared.