Manual for Noncommissioned Officers and Privates of Infantry of the Army of the United States, 1917 Part 57

[Ill.u.s.tration: FIG. 2.]

When a large artery is cut the blood gushes out in spurts every time the heart beats. In this case it is necessary to stop the flow of blood by pressing upon the hose somewhere between the heart and the leak.

If the leak is in the arm or hand, apply pressure as in figure 1.

If the leak is in the leg, apply pressure as in figure 2.

If the leak is in the shoulder or armpit, apply pressure as in figure 3.

The reason for this is that at the places indicated the arteries may be pressed against a bone more easily than at any other places.

Another way of applying pressure (by means of a tourniquet) is shown in figure 4. Place a pad of tightly rolled cloth or paper, or any suitable object, over the artery. Tie a bandage loosely about the limb and then insert your bayonet, or a stick, and twist up the bandage until the pressure of the pad on the artery stops the leak. Twist the bandage slowly and stop as soon as the blood ceases to flow, in order not to bruise the flesh or muscles unnecessarily.

[Ill.u.s.tration: FIG. 3.]

A tourniquet may cause pain and swelling of the limb, and it left on too long may cause the limb to die. Therefore, about every half hour or so, loosen the bandage very carefully, but if the bleeding continues pressure must be applied again. In this case apply the pressure with the thumb for five or ten minutes, as this cuts off only the main artery and leaves some of the smaller arteries and the veins free to restore some of the circulation. When a tourniquet is painful, it is too tight and should be carefully loosened a little.

It the leg or arm is held upright, this also helps to reduce the bleeding in these parts, because the heart then has to pump the blood uphill.

A broken bone is called a fracture. The great danger in the case of a fracture is that the sharp, jagged edges of the bones may stick through the flesh and skin, or tear and bruise the arteries, veins, and muscles. If the skin is not broken, a fracture is not so serious, as no germs can get in. Therefore never move a person with a broken bone until the fracture has been so fixed that the broken ends of the bone can not move.

[Ill.u.s.tration: FIG. 4.--Improvised tourniquet.]

If the leg or arm is broken, straighten the limb gently and if necessary pull upon the end firmly to get the bones in place.

Then bind the limb firmly to a splint to hold it in place. A splint may be made of any straight, stiff material--a s.h.i.+ngle or piece of board, a bayonet, a rifle, a straight branch of a tree, etc. Whatever material you use must be well padded on the side next to the limb. Be careful never to place the bandages over the fracture, but always above and below. (Figs. 5, 6, 7, 8.)

Many surgeons think that the method of binding a broken leg to the well one, and of binding the arm to the body, is the best plan in the field as being the quickest and one that serves the immediate purpose.

[Ill.u.s.tration: FIG. 5.]

[Ill.u.s.tration: FIG. 6.]

With wounds about the body the chest and abdomen you must not meddle except to protect them when possible without much handling with the materials of the packet.

FAINTING, SHOCK, HEAT EXHAUSTION.

The symptoms of fainting, shock, and heat exhaustion are very similar. The face is pale, the skin cool and moist, the pulse is weak, and generally the patient is unconscious. Keep the patient quiet, resting on his back, with his head low. Loosen the clothing, but keep the patient warm, and give stimulants (whisky, hot coffee, tea, etc.).

SUNSTROKE.

In the case of sunstroke the face is flushed, the skin is dry and very hot, and the pulse is full and strong. In this case place the patient in a cool spot, remove the clothing, and make every effort to lessen the heat in the body by cold applications to the head and surface generally. Do not, under any circ.u.mstances, give any stimulants or hot drinks.

[Ill.u.s.tration: FIG. 7.]

[Ill.u.s.tration: FIG. 8.]

FREEZING AND FROSTBITE.

The part frozen, which looks white or bluish white, and is cold, should be very slowly raised in temperature by brisk but careful rubbing in a cool place and never near a fire. Stimulants are to be given cautiously when the patient can swallow, and followed by small amounts of warm liquid nourishment. The object is to restore the circulation of the blood and the natural warmth gradually and not violently. Care and patience are necessary to do this.

RESUSITATION OF THE APPARENTLY DROWNED.

In the instruction of the Army in First Aid the method of resuscitation of the apparently drowned, as described by "Schaefer,"

will be taught instead of the "Sylvester Method," heretofore used. The Schaefer method of artificial respiration is also applicable in cases of electric shock, asphyxiation by gas, and of the failure of respiration following concussion of the brain.

Being under water for four of five minutes is generally fatal, but an effort to revive the apparently drowned should always be made, unless it is known that the body has been under water for a very long time. The attempt to revive the patient should not be delayed for the purpose of removing his clothes or placing him in the ambulance. Begin the procedure as soon as he is out of the water, on the sh.o.r.e or in the boat. The first and most important thing is to start artificial respiration without delay.

The Schaefer method is preferred because it can be carried out by one person without a.s.sistance, and because its procedure is not exhausting to the operator, thus permitting him, if required, to continue it for one or two hours. When it is known that a person has been under water for but a few minutes continue the artificial respiration for at least one and a half to two hours before considering the case hopeless. Once the patient has begun to breathe watch carefully to see that he does not stop again. Should the breathing be very faint, or should he stop breathing, a.s.sist him again with artificial respiration. After he starts breathing do not lift him nor permit him to stand until the breathing has become full and regular.

As soon as the patient is removed from the water, turn him face to the ground, clasp your hands under his waist, and raise the body so any water may drain out of the air pa.s.sages while the head remains low. (Figure 9.)

[Ill.u.s.tration: FIG. 9.--Schaefer method of artificial respiration.

Inspiration.]

[Ill.u.s.tration: FIG. 10.--Schaefer method of artificial respiration.

Expiration.]

The patient is laid on his stomach, arms extended from his body beyond his head, face turned to one side so that the mouth and nose do not touch the ground. This position causes the tongue to fall forward of its own weight and so prevents its falling back into the air pa.s.sages. Turning the head to one side prevents the face coming into contact with mud or water during the operation.

This position also facilitates the removal from the mouth of foreign bodies, such as tobacco, chewing gum, false teeth, etc., and favors the expulsion of mucus, blood, vomitus, serum, or any liquid that may be in the air pa.s.sages.

The operator kneels, straddles one or both of the patient's thighs, and faces his head. Locating the lowest rib, the operator, with his thumbs nearly parallel to his fingers, places his hands so that the little finger curls over the twelfth rib. If the hands are on the pelvic bones the object of the work is defeated; hence the bones of the pelvis are first located in order to avoid them.

The hands must be free from the pelvis and resting on the lowest rib. By operating on the bare back it is easier to locate the lower ribs and avoid the pelvis. The nearer the ends of the ribs the hands are placed without sliding off the better. The hands are thus removed from the spine, the fingers being nearly out of sight.

The fingers help some, but the chief pressure is exerted by the heels (thenar and hypothenar eminences) of the hands, with the weight coming straight from the shoulders. It is a waste of energy to bend the arms at the elbows and shove in from the sides, because the muscles of the back are stronger than the muscles of the arms.

The operator's arms are held straight, and his weight is brought from his shoulders by bringing his body and shoulders forward.

This weight is gradually increased until at the end of the three seconds of vertical pressure upon the lower ribs of the patient the force is felt to be heavy enough to compress the parts; then the weight is suddenly removed. If there is danger of not returning the hands to the right position again, they can remain lightly in place; but it is usually better to remove the hands entirely.

If the operator is light and the patient an overweight adult, he can utilize over 80 per cent of his weight by raising his knees from the ground and supporting himself entirely on his toes and the heels of his hands, the latter properly placed on the ends of the floating ribs of the patient. In this manner he can work as effectively as a heavy man.

A light feather or a piece of absorbent cotton drawn out thin and held near the nose by some one will indicate by its movements whether or not there is a current of air going and coming with each forced expiration and spontaneous inspiration.

The natural rate of breathing is 12 to 15 times per minute. The rate of operation should not exceed this. The lungs must be thoroughly emptied by three seconds of pressure, then refilling takes care of itself. Pressure and release of pressure--one complete respiration--occupies about five seconds. If the operator is alone, he can be guided in each act by his own deep, regular respiration or by counting or by his watch lying by his side.

If comrades are present, he can be advised by them.

The duration of the efforts as artificial respiration should ordinarily exceed an hour; indefinitely longer if there are any evidences of returning animation, by way of breathing, speaking, or movements. There are liable to be evidences of life within 25 minutes in patients who will recover from electric shock, but where there is doubt the patient should be given the benefit of the doubt. In drowning, especially, recoveries are on record after two hours or more of unconsciousness; hence, the Schaefer method, being easy of operation, is more likely to be persisted in.

Aromatic spirits of ammonia may be poured on a handkerchief and held continuously within 3 inches of the face and nose. If other ammonia preparations are used, they should be diluted or held farther away. Try it on your own nose first.

When the operator is a heavy man it is necessary to caution him not to bring force too violently upon the ribs, as one of them might be broken.

Do not attempt to give liquids of any kind to the patient while unconscious. Apply warm blankets and hot-water bottles as soon as they can be obtained.