Cut the gauze or muslin with the boiled scissors into strips about 18 inches long and narrow enough to go into the wound easily and place these strips back in the pan. Remove the dressing from the wound and work the narrow strips into the wound by means of the closed points of the scissors, the stick or the forceps (fig. 163). A small metallic screw driver makes an excellent packing instrument. The gauze is pushed firmly into the bottom of the wound first and the wound gradually filled from the bottom up. Considerable pressure must be used to pack the wound effectively. If the wound is somewhat cone-shaped the gauze may be packed firmly into the opening and then held in place by a bandage properly applied. Sterile packing can be allowed to remain undisturbed for 24 to 48 hours. Before starting in to remove it, sterilize the hands and have sterile instruments and materials ready for repacking in case hemor ́rhage recurs. Have a tourniquet at hand also. Take the packing out slowly and gently. If serious bleeding follows the removal of the packing, apply the tourniquet and repack. If the wound does not bleed, swab with tincture of iodine and dress with sterile gauze. EMERGENCY PACKING. Whenever circumstances permit the above procedure should be faithfully carried out before packing a wound. Even in camps or remote districts pans and a fire can generally be obtained and the bleeding controlled by a temporary tourniquet while the necessary articles are being boiled. However, if it is impossible to secure sterile materials, use the cleanest things obtainable. Strips torn from a clean handkerchief, towel, napkin, or the sleeve of a shirt can be forced into a wound with a narrow stick, a buttonhook, a long wire nail, or a pencil. It is better to run the risk of infecting a wound than to allow a man to bleed to death. Such packing, however, should be removed as soon as sterile material can be obtained and the wound repacked if bleeding starts in afresh. ARTERIAL HEMORRHAGE. Blood from arteries comes in spurts or a fine jet and is bright red. Treatment. Very small bleeding arteries can often be controlled by pressure and slightly larger ones by packing, but as a general rule, if the artery is of any size and in an extremity, it will be best to apply a tourniquet immediately. TOURNIQUETS. Tourniquets are appliances used to check hemorrhage by compressing the arteries somewhere between the heart and the wound. It is well known that the flow of water through a soft tube, such as the tubing used on a fountain syringe, can be easily stopped by FIG. 167.-Inelastic tourniquet applied to FIG. 168.-Emergency tourniquet twisted up by the hand. main artery of thigh. Note compress over main artery under tourniquet. Stick is prevented from untwisting by necktie above the knee. pinching the rubber between the fingers. Hemorrhage from a wound can be controlled in the same manner by pressing the main artery with the fingers or a pad against the bone which lies underneath or by making constriction around the limb by a very tight band. There are two varieties of tourniquets. In hospitals and on ambulances a strong rubber band about 3 feet long, with chains and FIG. 159.-Stopping bleeding. (Courtesy of the American Red Cross.) hooks on the ends for fastening, is generally used for this purpose. This is known as an elastic tourniquet, and is very convenient, because it can be quickly applied by anyone and controls hemorrhage very effectively (fig. 165). In first-aid work it may be often necessary to improvise a tourniquet. For this purpose a handkerchief, necktie, towel, or any piece of material of sufficient strength, which can be knotted around the limb and twisted up with a stick, is frequently used. These are known as inelastic tourniquets, and when using them it is advisable, when time and circumstances permit, to place a pad over the main artery so as to make pressure on it directly (fig. 167). PROVISIONAL TOURNIQUETS. In an emergency when an artery of considerable size has been opened the helper should immediately take a handkerchief, necktie, towel, or even a wide strip torn from the shirt of the patient, and tie it around the arm or leg which is wounded, placing the knot so that the encircling band is slightly larger than the circumference of the part. Adjust the band so that it is several inches from the wound and between the wound and the heart. Grasp the band firmly in the palm of the hand and turn the hand around, thus tightening and twisting the tourniquet (fig. 168). This will instantly stop the flow of blood and give the helper a chance to collect his wits and decide on his further course of action. He holds the tourniquet thus tightened until a stick, ruler, screw driver, a long pair of scissors, chair rung, or any similar article has been obtained and then slips this instrument into the loop in place of his hand and uses it to twist up the tourniquet. The band is tightened by twisting the stick, or whatever is used as a lever, just enough to stop the bleeding and no more. All tourniquets are very painful, and as great leverage is secured by means of the stick special care must be exercised in tightening them, as serious damage may be inflicted on the nerves and structures beneath by too great pressure. Always watch the wound, and the moment the hemorrhage ceases stop turning the lever. When just the right amount of pressure has been applied, fasten the stick in the proper position by a handkerchief or strip of some material, looped first around it and then passed around the part (fig. 173). The bleeding is now controlled for the present, and further procedure will depend upon how soon medical aid can be obtained. 1. If the accident has happened in a city or town and medical help will certainly be available within an hour, nothing further need be done except to send for a doctor and make the patient as comfortable as possible in the interval. Proper measures should be taken to protect the wound from the entrance of bacteria, as already described. 2. If it will probably require two or three hours to secure a physician, the helper should endeavor to improvise some sort of an elastic tourniquet to replace the nonstretching band which was applied at first. Elastic tourniquets are very much better than the inelastic ones, because they do less damage to the tissues and are less painful. The inner tube of a bicycle tire makes an excellent tourniquet; also a strip about 1 inch wide and 4 or 5 feet long cut from the inner tube of an automobile tire. Practically all automobilists carry these spare tubes, |