The bodys response to injury¶
When you are healthy and run for the cattle, you start breathing rapidly and deeply, and also your heartbeats are faster and stronger. Why? To increase your strength, the body needs more oxygen. It is exactly the same for the mine victim. Nerve signals from the injury make the victim try to get more oxygen. This response comes immediately after the injury.
There is a great need to get more oxygen into the body:
- The breathing rate (RR) increases. The patient takes more breaths/minute. Your own RR when reading this is probably around 15-20 breaths each minute. If the mine victim has lost a lot of blood or he has a chest injury, the RR may increase to 30-40 breaths each minute.
- Each breath is deeper. The lungs act as a suction pump. The motor for this pump is the diaphragm. After injury the movement of the diaphragm increases. It goes deeper into the abdomen to suck air in. (You can see the abdomen expand.) And it rises further upward into the chest cavity to push air out.
Examination
Does he have enough oxygene?
Talk to him. If he talks back and his words make sense, his brain is working well. This means that at the moment he has enough oxygen in the blood. But it is possible that the oxygen in his blood is slowly decreasing. So keep on talking with him while you examine him and talk to him all the way to the hospital.
The signs of too little oxygen in the blood: Breathing is rapid, more than 30 breaths each minute (adults). The victim is pale, sweating, and restless. As the supply of oxygen in the blood gets lower and lower, he becomes confused, says crazy things, pushes you away, or pulls out the IV lines. He is in danger! You have to find out how to get more oxygen into the blood now:
- Is the airway open? If not, do something! If it is open, carry on with step
- Is the breathing good? If not, do something! If it is good, carry on with step 3
- Stop the bleeding, give IV infusions.
Is the airway open?
With complete airway block the victim is dead within 5 minutes.
- If the victim talks to you with a normal voice, his airway is OK.
- Tongue block. If his voice is strange, his breathing is noisy, or he does not talk back, tilt his head by the chin and place your ear to his mouth. If you cannot hear or feel his warm breaths in your ear, he is dead or dying: Start CPR now! If the breathing sounds became clearer when you tilted his head, it means he had a tongue block in the throat. You removed the block by tilting the head. Excellent! Keep his head tilted.
- Airway block. If the breathing sounds are still noisy with the head tilted, there may be something inside his airway. Remove it by sweeping your finger inside the mouth to clear it. Then suck out mucus, vomit, blood, and dirt from the airway if you have a suction apparatus.
- Prevent airway block. It is good if he had a gag reflex or coughed when you sucked the airway. If he did not gag or cough, he may be unconscious. Place all unconscious victims in the recovery position.
Is he breathing well?
Less than 25 breaths each minute, and his breaths are deep: You can see the belly expand when he sucks air in. This means that the lungs are working well, and the reason for low blood oxygen is probably blood loss. 30 breaths or more each minute, but panting like a dog with shallow breaths. There can be four reasons for this:
- Pain makes the breathing shallow. Give IV ketamine for pain relief and see if the breathing gets slower and deeper.
- The lung pump is damaged because he has a chest injury. The chest wall muscles contract in convulsions, the chest cage becomes “stiff ” – and the breathing is shallow. Give IV ketamine for pain relief. If the breathing is still poor, he probably needs a chest tube drain.
- The lung pump is locked because he has injuries to the abdomen. Fluid and gas have inflated the stomach and “locked” the diaphragm. Let him sit or half-sit. Put in a stomach tube to deflate the stomach.
- The diaphragm is not working any more: If the blood oxygen is very low, the diaphragm becomes soft. The victim is breathing only by lifting his chest. For each breath in you can see the belly move in, for each breath out the belly expands. This is the opposite of normal breathing movements! Hollowing out of the upper part of the belly for in-breaths is a sign of very low blood oxygen. The victim is close to dying. Be ready to start CPR.
The oxygen supply system can only work if all three parts work. If the airway is OK and his breathing is OK, but he is getting worse, the victim is probably losing blood. If the airway is OK and the heart rate is OK (less than 100 beats each minute), but he is getting worse, the victim has a breathing problem.