Spurting Forearm Laceration and a Torn Glove
At 14:10, a 34-year-old press operator sustains a deep laceration to the medial left forearm when a sheet-metal edge slips. Bright red blood spurts with each heartbeat. A coworker is pressing a shop rag over the wound; about 400 mL of blood is on the floor. The patient is pale, anxious, and diaphoretic; radial pulse 120, capillary refill 3 seconds. The press is still running, and the first aid kit is 15 metres away. As you kneel down, you notice a 2-cm tear at the thumb of your right examination glove; you do not see blood on your skin. The kit contains nitrile gloves, gauze, elastic bandage, a commercial tourniquet, saline, and a CPR mask. Another worker offers to 'just tie a belt really tight'.
1. What PPE and exposure-control steps should you take before and immediately after touching the patient?
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Before contact. Stop the press and clear the area so the machine cannot restart. Replace the torn glove with intact nitrile gloves, add eye protection if available, and have the coworker put on gloves before helping. Do not touch blood with the torn glove. After contact. Check your thumb for breaks in the skin; if skin is intact, wash the area with soap and water. If there is any non-intact skin or splash to eyes/mouth, irrigate and report the exposure immediately under the site's bloodborne pathogen policy. Remove contaminated gloves without touching the outside, wash hands, and bag the rag and gloves as contaminated waste. Reasoning. The torn glove is a breach even without visible blood; the priority is to prevent contact before bleeding control, but do not delay life-saving pressure longer than needed to change gloves.
2. Outline your bleeding-control sequence and decide when a tourniquet is indicated.
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Sequence. Apply firm direct pressure with a thick gauze pad directly over the spurting point; hold for at least 5–10 minutes without lifting to check. Add more gauze on top if it soaks through and maintain pressure; apply a pressure bandage if bleeding slows. Elevate the arm if no fracture is suspected. Tourniquet decision. A commercial tourniquet is indicated if bright red bleeding continues uncontrolled after 5–10 minutes of firm direct pressure, if you cannot maintain pressure because of the patient's condition or scene, or if there are multiple casualties. Place it 5–7 cm above the wound, not over a joint, tighten until bleeding stops, and record the time. Do not use the offered belt: it is too narrow and can cause nerve damage. Reasoning. Spurting arterial bleeding can exsanguinate quickly, but direct pressure is first-line; the tourniquet is a rescue measure for uncontrolled bleeding, not an automatic first step.
3. What signs of shock would you monitor, what position and transfer preparation, and what documentation is required?
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Shock monitoring. Watch for worsening pallor, confusion, rising pulse, falling blood pressure, cold clammy skin, and delayed capillary refill. Lay the patient flat, keep him warm, do not give food or drink, and give oxygen if trained and available. Recheck pulse, breathing, and mental status every 5 minutes. Transfer. Call EMS and prepare for transfer with the arm elevated and the pressure bandage/tourniquet visible; do not let him walk. Documentation. Record the mechanism, estimated blood loss, time direct pressure started, tourniquet time if used, vitals, signs of shock, exposure incident, and handover. Reasoning. The patient already has tachycardia and delayed cap refill, so shock prevention and rapid transfer matter as much as the wound itself.