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Chapter 9

Wounds

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Open Wounds

A break in the skins surface

resulting in external bleeding

May allow bacteria to enter the

body, causing an infection

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Types of Open Wounds (1 of 3)

Abrasion

Top layer of skin

is removed. Little or no

bleeding

Painful

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Laceration

Cut with jagged,

irregular edges Tearing away of

skin tissue

Incision

Smooth edges

SHOUT/Alamy Images

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Puncture

Deep, narrow

High risk of infection

Avulsion Flap of skin torn

loose

Amputation Cutting or tearing off

of body part

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Care for Open Wounds

Protect yourself from disease

(exam gloves, etc.).

Expose the wound. Control bleeding with direct

pressure.

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Wound Cleaning (1 of 2)

Scrub hands with

soap and water.

Clean wound. For shallow wound:

Wash with soap

and water.

Flush with clean

water under

pressure.

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Wound Cleaning (2 of 2)

Clean wound (contd).

For wound with higher infection risk:

Clean wound.

Seek medical care for additional cleaning.

Use tweezers to remove remaining

embedded debris.

Apply direct pressure to control

bleeding.

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Covering a Wound

Apply thin layer of antibiotic ointment.

Small wounds only

Cover with a sterile dressing. Do not pull off sticky or blood-soaked

dressing.

Change any wet or dirty dressings.

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Seek Medical Care for High-RiskWounds

Wounds with embedded material

Bites

Puncture wounds Ragged wounds, or wounds where skin

edges do not come together

Visible nerve, joint, muscle, fat, ortendon

Wound entering joint or body cavity

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Signs of Infection

Swelling and redness around the wound Sensation of warmth

Throbbing pain

Pus discharge

Fever

Swelling of lymph nodes Red streaks leading from wound toward

heart

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Care for Infected Wounds (1 of 2)

Keep area clean.

Soak in warm

water or apply

warm, wet packs.

Elevate limb. Dr. P. Marazzi/Photo Researchers, Inc.

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Care for Infected Wounds (2 of 2)

Apply antibiotic ointment.

Change dressings daily.

Seek medical help if infectionpersists or becomes worse.

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Tetanus (1 of 2)

Caused by toxin-producing bacterium

Travels to nervous system

Causes muscle contraction (lockjaw) No known antidote to toxin

Tetanus vaccine and boosters can

prevent the disease.

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Tetanus (2 of 2)

Seek vaccine and/or booster if:

Never immunized

No tetanus booster in past 10 years

Dirty, contaminated wound and no

booster in past 5 years

Must receive within 72 hours

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Amputations

Guillotine

Clean-cut, complete

Crushing

Crushed or mashed

off

Degloving

Skin is peeled off. Chuck Stewart, MD

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Care for Amputations

Control bleeding. Treat for shock.

Recover

amputated partand take tohospital.

Wrap part in

gauze, place inwaterproof bag,and keep cool.

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Care for Blisters (1 of 3)

Fluid bubblecaused by repeatedrubbing

For red hot spotblisters:

Snugly apply tape.

Or make pad fromseveral layers ofmoleskin ormolefoam. Maximillian Weinzier/Alamy Images

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For closed blister:

Tape with duct tape.

Should remain for several days

Only remove roof if infection occurs.

Wash with soap.

Use scissors sterilized with rubbing alcohol.

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For open or very

painful blister:

Clean with soap and

water.

Drain fluid.

Apply pad with

opening. Apply antibiotic

ointment and secure

with tape.

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Care for Impaled (Embedded)Objects

Do not removeobject.

Stabilize object.

Control bleeding.

May shortenobject to ease

transport After stabilizing

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Care for Impaled Objects in Cheek

Remove object if it extends throughcheek.

Straddle with two fingers. Gently pull in direction of entry.

Place dressings:

Between cheek and teeth

On outside of cheek

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Care for Impaled Objects in Eye

Do NOT exert pressure on eye.

Stabilize object.

If long: use bulky dressing and place papercup or cone over eye.

If short: surround eye with ring pad held inplace with roller bandage.

Cover undamagedeye. Seek immediate medical attention.

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Care for Slivers

Can be painful and irritating Removal

Reposition as needed with end of sterile

needle. Remove with tweezers.

Clean with soap and water.

Apply adhesive strip.

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Care for Cactus Spines

Removal methods:

Tweezers

Glue or rubber cement

Apply in thin layer.

Allow to dry and roll up dried glue.

Combination of tweezers and glue most

effective Do NOT use superglue.

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Care for Fishhooks (1 of 2)

Pliers method

Apply cold or hard

pressure.

Push hook inshallow curve.

Cut off barb with

pliers and pushhook through entry.

Treat for tetanus.

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Care for Fishhooks (2 of 2)

String-jerk method

Loop fishing lineover curve of hook.

Stabilize and applypressure.

Press down onshank and eye; jerk

line out. Movement parallel to

skins surface

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Closed Wounds

Caused by strike with blunt object

Skin is not broken, but tissue and

blood vessels are crushed.

Types of closed wounds:

Bruises and contusions

Hematomas

Crush injuries

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Care for Closed Wounds

Apply an ice pack.

Injured limb:

Apply elastic bandage for compression.

Splint limb.

Check for fractures.

Elevate extremity above heart level.

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Wounds Requiring Medical Care(1 of 2)

Still bleeding after 15 minutes of pressure

Long or deep and needs stitches

Over a joint Impairs function of eye, eyelid, or lip

Removes all layers of skin

Animal or human bite

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Involves damage to underlying nerves,

tendons, joints, or bones

Over a possible broken bone

Crushing injury

Object embedded in wound

Caused by a metal object or a puncturewound

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Call 9-1-1 immediately if:

Bleeding does not slow within 15 minutes.

Signs of shock

Cut to neck or chest causes difficulty

breathing.

Deep cut to abdomen, painful

Eyeball cut Amputation

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Sutures (Stitches)

Within 6 to 8 hours of injury Benefits:

Faster healing

Reduce infection and scarring

Wound does not require sutures if:

Cut edges of skin come together.

Cut is shallow.

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Gunshot Wounds

Bullet causes injury by:

Laceration and crushing

Shock waves and

temporary cavitation Penetratingentry only

Perforatingentry and

exit wound

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Care for Gunshot Wounds

Monitor victims breathing.

Expose the wound(s).

Control bleeding with direct pressure. Apply dry, sterile dressings and

bandage.

Treat victim for shock; keep calm. Seek immediate medical care.

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Legal Aspects

Keep accurate record ofobservations.

Preserve evidence, such as shellsor casings.

Do not touch or move anythingunless it is necessary.

All gunshot wounds must bereported to police.

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