1. FIRST AID AND EMERGENCY CARE LECTURE 6 WOUND AND WOUND CARE

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

3. CLASSIFICATION OF SOFT TISSUE DAMAGE 1. Open wounds  An open wound is a break in the skin or the mucous membrane. Types of open wounds  Abrasions: Wounds usually results when the skin is scraped against a hard surface.  Incisions: Body tissue cut on knives or sharp objects

4.  Lacerations: Irregular or blunt breaking or tearing of soft tissues  Punctures: Produced by an object piercing skin layers  Avulsions: Tissue is forcibly separated or torn from the victim's body.

5. 2. Closed wound  Involves injury to the underlying tissues without a break in the skin or a mucous membrane. MATERIAL FOR WOUND CARE  Dressing- also called a compress, mostly it is sterile gauze pads mainly to control bleeding  Bandage- Any material used to hold a dressing in place, need not to be sterile. Adhering

6. GENERAL PRINCIPLES OF EMERGENCY CARE FOR OPEN WOUNDS 1. Expose the wound 2. Clean the wound surface with normal salin 3. Control bleeding 4. Prevent contamination (infection) 5. Gauze dressing 6. Bandage the dressing in place 7. Keep the patient lying still 8. Reassure the patient

7. Emergency Care for Minor Lacerated or Incised Wounds 1. Most incisions and lacerations can be managed by bandaging and dressing in place 2. A butterfly bandage is applied over the wound 3. Fix the butterfly bandage onto the skin 4. A gauze dressing is bandaged over the butterfly strip

8. Emergency Care for Impaled (Pierce) Objects 1. Do not remove the impaled object 2. Expose the wound area 3. Control profuse bleeding by direct hand pressure if possible 4. Stabilize the impaled object with a bulky dressing 5. Provide oxygen at high concentration 6. Reassure and keep the patient at rest 7. Carefully transport the patient ASAP

9. Causes of traumatic wounds Causes of woundDistribution of patients Blunt object42 Sharp object34 Glass13 Wood4 Bite6 Human1 Dog3 Others5

10. Distribution of traumatic wounds Location of WoundDistribution of Patients Head and Neck51 Trunk2 Upper Extremities34 Lower Extremities13

11. Evaluation History 1. Mechanism of injury 2. Time of injury 3. General medical condition 4. Allergies 5. Tetanus status

12. Exam 1. Size 2. Location 3. Contaminants 4. Neurovascular 5. Tendons

13. UNIVERSAL PRECAUTIONS 1. Wash hands carefully 2. Use protective barriers such as Gloves/ gowns/ masks/ eyewear 3. Keep clean environment

14. X LOCAL ANESTHESIA There are two main groups of local anesthesia A- Esters 1. Cocaine 2. Procaine (Novocain) 3. Benzocaine (Cetacaine) 4. Tetracaine (Pontocaine) 5. Chloroprocaine (Nesacaine)

15. X A- Amides 1. Lidocaine (Xylocaine) 2. Mepivacaine (Polocaine, Carbocaine) 3. Bupivacaine (Marcaine) 4. Etidocaine (Duranest) 5. Prilocaine

16. Skin and Wound preparation 1. Hair removal: remove all the hair around the wound skin 2. Disinfecting the skin: use solutions such as Normal Saline, Povidine-Iodine 10% and 1%, Chlorhexidine 1% and 0.1%, Hydrogen Peroxide, and Hexachlorophene 3. Irrigate wound with sterile (clean) water

17. 4. Some wounds which are contaminated with soil, dust, devitalized tissue, and clotted blood need soaking first 5. Covered with gauze and left undisturbed for 4 to 5 days 6. If the wound is uninfected at the end of the waiting period, it is closed with sutures or skin tapes

18. Points to remember 1. An ‘ideal agent’ does not exist – either tissue toxic or poorly bacteriostatic 2. Simple scrub water around wound should be sufficient 3. No studies have demonstrated the impact of cleaning intact skin on infection rate, however it is important to decrease bacterial load to minimize ongoing wound contamination.

19. 4. Avoid mechanical scrubbing unless heavily contaminated (increase inflammation in animal data)

20. Tetanus  More than 250,000 cases annually worldwide with 50% mortality  100 cases annually in USA  About 10% in patients with minor wound or chronic skin lesion  In 20% of cases, no wound implicated  2/3 of cases in patients over age 50

21. Prophylactic Antibiotics Indications 1. Bite wounds 2. Contaminated or devitalized wounds 3. High risk sites e.g. Foot 4. Immunocompromised 5. Risk for infective endocarditis

22. 6. Intraoral through lacerations 7. Deep puncture wounds 8. Extensive soft tissue injury Prophylactic Antibiotics 1. Amoxicillin, Clavulin 2. Keflex 3. Erythromycin  recommended course is 3 to 5 days