Signs and symptoms:-

• Face and lips become pale.
  
• Skin is cold and clammy.
  
• casualty feels faint or dizzy.
  
• Breathing becomes shallow.
  
• Pulse is rapid, becoming weaker.
  

1. Direct pressure you should apply pressure directly on a wound immediately.
   
2. Indirect pressure you should apply pressure on the artery which supplies the area.
   
3. elevation.
   

Internal bleeding has probably occurred if any of the following signs appear.

1. Coughing with foamy, red blood.
   
2. Vomiting with red or brown coffee ground material.
   
3. bowel movements containing red or black tar-like material.
   
4. red or brown urine.
   

Important - read first :-
Do not give the person anything to eat or drink, as surgery may be necessary. Conserve body heat by covering the person lightly. A blanket should be placed underneath him if the ground is cold. but do not overheat the person.

Wounds
A wound is a break in the continuity of the tissues of the body, either external or internal.

Classification of wounds.

1. Open is a break in the skin or the mucous membrane.
2. Closed involves injury to underlying tissues without a break in the skin or a mucous membrane.

1. Incised or clean cut cased by a sharp instrument such as a knife or razor. They may bleed profusely.
2. Lacerated, caused by such things as machinery or barbed wire. The edges of the wound are torn and irregular. dirt is more likely to be present.
3. Contused or bruised : caused by a blunt instrument, falling against a hard surface or by crushing.
4. Punctured: caused by a sharp pointed instrument such as a dagger or needle. These wound have small opening but may be deep.
5. Gunshot wounds, a small entry may be associated with extensive internal injuries and with a large exit wound.

1. Expose the wound and check for the presence of foreign bodies. Apply direct pressure to control bleeding by pressing with fingers or palm of hand. If the wound is large, squeeze the edges together.
2. Lay the casualty down. If the wound is on Limb and you don't suspect a fracture, raise and support it.
3. If the injury is on a limb and direct pressure is ineffective, apply indirect pressure to the main artery which supplies the limb.
   DO NOT Apply indirect pressure for any longer than 15 minutes nor apply a tourniquet.
4. Place a sterile, un-medicated dressing over the wound. Making sure that it extends well beyond the edges of the secure with a bandage. Tie bandage firmly enough to control bleeding but not so tight as to cut off circulation. Immobilize the injured part. If no suitable dressing is available, place a piece of gauze over the wound, cover it with a pad of cotton wool and bandage firmly. An improvised dressing can be made from any suitable material like a clean shirt.
5. If bleeding continues, apply further dressing or pads on top of the original ones and bandage firmly.
6. Remove to hospital immediately.

Treatment :-

1. support the casualty in a sitting position with his head slightly forward.
2. Instruct him to breathe through his mouth.
3. Tell him to pinch firmly the soft part of his nose for about ten minutes.
4. Loosen clothing about neck and chest.
5. Warn him not to blow his nose for some hours.
6. Don't disturb the clot.

Amputation:
Recent advances in surgery have made the reattachment of amputated limbs, fingers and toes possible. the chances of a good result are greater the sooner the casualty and the severed part are removed to hospital always place the severed part in a suitable container to protect it. Inform the immediately so that the hospital can prepare for the specialist surgery required.

AIM:-

Control bleeding and remove casualty to hospital as soon as possible with the severed part.

Treatment :-

1. Control bleeding using direct pressure, take great care not to damage the stump.
2. Place the severed part in a clean plastic bag to keep it clean and prevent it drying out. If possible put the bag in container of ice. However, the bag must be wrapped in suitable material to prevent the severed part touching the ice.  Note:- Mark the package clearly with the casualty's name and the time the amputation occurred.
3. Remove to hospital immediately.