1. Chapter 9
Wounds

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

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

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

5. 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

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

7. 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

8. 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.

9. 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.

10. 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

11. 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

12. 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.

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

14. 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.

15. 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

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

17. 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.

18. 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

19. 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.

20. 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.

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

22. 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

23. 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.

24. 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.

25. 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.

26. 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.

27. 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

28. 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

29. 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.

30. 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

31. 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

32. Wounds Requiring Medical Care (3 of 3)
Call 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

33. 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.

34. 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

35. 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.

36. 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.