1. BASIC WOUND RECOGNITION
and first aid management
This short course will teach you how to recognise and manage wounds. It is not a first aid course and therefore not a substitute for practical skills. However, it will give you valuable basic information about the nature of wounds; their differences, potential for complications and the management required to control bleeding and to ensure that the best possible healing takes place.
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2. BASIC WOUND RECOGNITION
What is a wound?
A wound is a type of injury in which skin is broken, or where blunt force trauma causes internal injuries that bleed but the skin remains intact. In essence, a wound is any injury that bleeds or has the potential to bleed.
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3. BASIC WOUND RECOGNITION
What types of wound are there? A
Abrasion
The best way to remember the different TYPES of wound, is to memorise this simple mnemonic: C
Contusion L
Laceration I
Incision P
Puncture S
Shot
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4. Commonly known as a graze
Abrasion
Picture of an abrasion
Commonly known as a graze
Video: treating an abrasion
Non-clean wound
Very little or no bleeding
Heals quickly
Should be cleaned to prevent infection
A wound caused by superficial damage to the skin, no deeper than the epidermis. Bleeding, if present, is minimal. Mild abrasions, also known as grazes or scrapes, do not scar or bleed, but deep abrasions may lead to the formation of scar tissue. A more traumatic abrasion that removes all layers of skin is called an avulsion.
Abrasion injuries most commonly occur when exposed skin comes into moving contact with a rough surface, causing a grinding or rubbing away of the upper layers of the epidermis.
Tx:
Look at the wound to determine size and depth of skin damage
Clean the wound with water
Apply a sterile gauze pad or dressing
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5. Commonly known as a bruise
Contusion
Commonly known as a bruise
Video: treating a contusion - RICE
Bleeding takes place inside the body
Swelling may take place
Discoloration of the skin may occur
There may be pain around the affected area
No external infection risk
A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin (be it bumping against something or hitting yourself with a hammer). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis.
Tx:
R I C E
If internal injury suspected, refer to A&E or call an ambulance.
Contusions on cavities are serious and indicate possible internal organ trauma
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6. Recognisable as ragged
Laceration
Recognisable as ragged
Video: treating a laceration
Non-clean wound
High risk of infection if not cleaned
May not bleed profusely
Heals quickly in minor cases
Caused by uneven edges and protrusions
e.g. Barbed wire, animal claws
Heavy blunt trauma can also cause lacerations
Are ragged, irregular tear-like wounds. The term laceration is commonly misused in reference to incisions.
Laceration are usually painful but tend not to bleed profusely because the ragged tissue slows blood flow from vessels and control, such as clotting, can take effect much more rapidly. Lacerations may also leave permanent scars on the skin, but this depends on the person, their age, the depth and nature of the laceration itself and how well it was treated.
Infection is a big concern with lacerations, because blood flow may be slow and germs can embed into the wound much more readily as a result. It is also very likely that the object that caused the laceration was not clean and will have carried germs directly into the wound.
Tx:
Look at the wound to determine it’s size and depth
Look for EFO
Clean the wound with water if bleeding is minimal
Dress the wound to control bleeding
Elevate the limb if appropriate to reduce bleeding further
Refer to A&E or call an ambulance if necessary
Manage for shock if the wound is large and there is serious bleeding
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7. Recognisable as sliced
Incision
Recognisable as sliced
Video: treating a incision
Clean wound
May bleed profusely
Takes longer to heal than a laceration
Caused by sharp, even edges
e.g. Knife, razor blade, paper edge
Incisions are usually painful and often bleed profusely because the sliced tissue allows bloods to escape from vessels for longer before control, such as clotting begins to take effect. Incisions may also leave permanent scars on the skin, but this depends on the person, their age, the part of the body affected, the depth and nature of the incision itself and how well it was treated.
Tx:
Look at the wound to determine it’s size and depth
Look for EFO
Clean the wound with water if bleeding is minimal
Dress the wound to control bleeding
Elevate the limb if appropriate to reduce bleeding further
Refer to A&E or call an ambulance if necessary
Manage for shock if the wound is large and there is serious bleeding
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8. Also called a stab wound
Puncture
Also called a stab wound
Video: treating a puncture
Can be penetrating or perforating
May bleed profusely, internally and externally
Very high risk of infection
May involve damage to major blood vessels and organs
More than one wound if perforating
May involve an embedded foreign object
A puncture wound is caused by an object piercing the skin and creating a hole. Some punctures are just on the surface. Others can be very deep, depending on the source and cause.
A puncture wound does not usually result in excessive bleeding. Puncture wounds often close fairly quickly on their own. Infection is a major risk with puncture wounds and so cleaning, and sometimes antibiotic treatment, is necessary.
Tx:
First, check to see that nothing is left in the wound. Check to see if the object that caused the wound is intact. If a piece is missing, it may be stuck in the wound.
Allow the wound to bleed freely, but if bleeding is heavy or squirting out, apply pressure until it stops. If bleeding won’t stop, you will need emergency care.
Stop the bleeding: Minor puncture wounds and cuts usually stop bleeding on their own. If not, apply gentle pressure with a clean cloth or bandage. If the blood spurts or continues after several minutes of pressure, emergency care is necessary.
Clean the wound: First, wash your hands. If your hands are not clean, you may spread bacteria into the wound. Cleanse the wound. Wash with water. You can use a mild soap such as Ivory if the wound is very dirty. If dirt or debris remains in the wound, clean a pair of tweezers with alcohol and remove the dirt. If you cannot get the dirt or debris out, contact your doctor.
Protect the wound: An antibiotic ointment can be used. Apply a thin layer over the wound. This will help coat and protect the wound. Large amounts of ointment are not helpful because they can attract bacteria. Apply the ointment with a clean swab or gauze. Do not apply directly from the tube in order to avoid contamination of the tube. Ointments can be applied up to 3 times a day, but you should always clean the wound before applying ointment.
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9. Also called a ballistic wound
Gun Shot
Picture of a gunshot
Also called a ballistic wound
Video: treating a gunshot
Can be penetrating or perforating
May bleed profusely, internally and externally
Very high risk of infection
May involve damage to major blood vessels and organs
Larger exit wound if perforating
A gunshot wound involves penetration of the body by a bullet, commonly marked by a small entrance wound and a larger exit wound. The wound is usually accompanied by damage to blood vessels, bones, and other tissues. There is a high risk of infection caused by exposure of the wound to the external environment and debris carried inside the body by the bullet. Additional complications depend on the part of the body wounded.
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