Chapter 9 Wounds

Open Wounds A break in the skin’s surface resulting in external bleeding May allow bacteria to enter the body, causing an infection

Types of Open Wounds (1 of 3) Abrasion Top layer of skin is removed. Little or no bleeding Painful

Types of Open Wounds (2 of 3) Laceration Cut with jagged, irregular edges Tearing away of skin tissue Incision Smooth edges © SHOUT/Alamy Images

Types of Open Wounds (3 of 3) Puncture Deep, narrow High risk of infection Avulsion Flap of skin torn loose Amputation Cutting or tearing off of body part

Care for Open Wounds Protect yourself from disease (exam gloves, etc.). Expose the wound. Control bleeding with direct pressure.

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. End punc

Wound Cleaning (2 of 2) Clean wound (cont’d). 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.

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.

Seek Medical Care for High-Risk Wounds Wounds with embedded material Bites Puncture wounds Ragged wounds, or wounds where skin edges do not come together Visible nerve, joint, muscle, fat, or tendon Wound entering joint or body cavity

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

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.

Care for Infected Wounds (2 of 2) Apply antibiotic ointment. Change dressings daily. Seek medical help if infection persists or becomes worse.

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.

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

Amputations Guillotine Crushing Degloving Clean-cut, complete Crushed or mashed off Degloving Skin is peeled off. © Chuck Stewart, MD

Care for Amputations Control bleeding. Treat for shock. Recover amputated part and take to hospital. Wrap part in gauze, place in waterproof bag, and keep cool.

Care for Blisters (1 of 3) Fluid “bubble” caused by repeated rubbing For red “hot spot” blisters: Snugly apply tape. Or make pad from several layers of moleskin or molefoam. © Maximillian Weinzier/Alamy Images

Care for Blisters (2 of 3) 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.

Care for Blisters (3 of 3) For open or very painful blister: Clean with soap and water. Drain fluid. Apply pad with opening. Apply antibiotic ointment and secure with tape.

Care for Impaled (Embedded) Objects Do not remove object. Stabilize object. Control bleeding. May shorten object to ease transport After stabilizing

Care for Impaled Objects in Cheek Remove object if it extends through cheek. Straddle with two fingers. Gently pull in direction of entry. Place dressings: Between cheek and teeth On outside of cheek

Care for Impaled Objects in Eye Do NOT exert pressure on eye. Stabilize object. If long: use bulky dressing and place paper cup or cone over eye. If short: surround eye with ring pad held in place with roller bandage. Cover undamaged eye. Seek immediate medical attention.

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.

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.

Care for Fishhooks (1 of 2) Pliers method Apply cold or hard pressure. Push hook in shallow curve. Cut off barb with pliers and push hook through entry. Treat for tetanus.

Care for Fishhooks (2 of 2) String-jerk method Loop fishing line over curve of hook. Stabilize and apply pressure. Press down on shank and eye; jerk line out. Movement parallel to skin’s surface

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

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.

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

Wounds Requiring Medical Care (2 of 3) 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 puncture wound

Wounds Requiring Medical Care (3 of 3) 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

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.

Gunshot Wounds Bullet causes injury by: Penetrating—entry only Laceration and crushing Shock waves and temporary cavitation Penetrating—entry only Perforating—entry and exit wound

Care for Gunshot Wounds Monitor victim’s 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.

Legal Aspects Keep accurate record of observations. Preserve evidence, such as shells or casings. Do not touch or move anything unless it is necessary. All gunshot wounds must be reported to police.