L13 - Open Wounds

Soft tissue

Includes the layers of the skin, fat and muscle

List the three layers of skin

1. Epidermis: provides a barrier to bacteria another organisms that can cause infection

2. Dermis: contains nerves, sweat glands, oil glands and blood vessels

3. Hypodermis: (subcutaneous layer): located beneath the epidermis and dermis, and contains adipose (fat), blood vessels, and connective tissue

Wound

A physical injury involving the soft tissue 

Describe the difference between a closed and open wound

• Closed wound

  • Has no superficial tissue damage

  • Simplest closed wound is a “bruise” also called a “contusion”

• Open wound

  • An open wound has a break in the surface of the skin 

  • Infection is a primary concern with open wounds

Signs and Symptoms of shock due to internal bleeding

1. Skin that feels cool and looks pale or bluish

2. An altered level of consciousness

3. A rapid, weak heartbeat

4. Excessive thirst

5. Tender, swollen or rigid areas of the body, such as the abdomen

6. Bruising over the injured area

7. Rapid breathing

8. Vomiting blood or coughing up blood

9. An injured extremity that is blue or extremely pale, swollen, and rigid

Care for Closed Wounds (if minor)

• If minor, apply ice to the injured area 

1. Make a cold pack by filling a sealable plastic bag with a mixture of water and ice, and apply it to the injured area for about 20 minutes. If an ice and water mixture is not available, use a bag of frozen vegetables or a chemical cold pack as an alternative. Do not place a chemical cold pack directly on the bare skin- it can burn it. Place a thin towel as a barrier between the cold pack and the bare skin.

2. Remove the cold pack and wait 20 minutes before reapplying a new cold pack

3. If the person is not able to tolerate a 20 minute application limit application to 10 minutes

4. Elevating the injured part may help to reduce swelling; however, do not elevate the injured part if doing so causes more pain or you suspect a dislocation or fracture

Care for Closed Wounds (if severe)

• Call 9-1-1 and treat for shock 

1. A person complains of severe pain or cannot move a body without pain

2. You think the fourth that caused the injury was great enough to cause serious damage

3. An injured extremity is blue or extremely pale

4. The persons abdomen is tender and distended

5. The person is being blood or coughing up blood

6. The person shows signs and symptoms of shock or becomes confused, drowsy, or unresponsive

List six main types of open wounds

1. Abrasion

2. Laceration

3. Avulsion

4. Amputation

5. Puncture

6. Crush wound

List the care for all types of open wounds

1. A major open wound may have severe bleeding, deep or extensive destruction of tissue, or a deeply embedded or impaled object 

2. Call 9-1-1 

3. Put on gloves 

4. Control for any severe external bleeding first 

5. Cover the open wound with a sterile non-stick pad to lessen the chances of infection (covering the wound helps so the victim doesn’t have to look at it, lessening psychogenic shock) 

6. Be prepare to treat for shock

List the signs and symptoms of an infected wound

1. Increased pain, swelling, redness or warmth and the area around the wound

2. Red streaks extending from the area around the wound

3. Pus (a thick yellow or green fluid) draining from the wound

4. Fever

Describe how to prevent infection in an open wound

1. Dressings: pads placed directly on the wound to absorb blood and other fluids and prevent infection

   • Commonly ranging from 2 to 4 inches square

2. Bandage: any material that is used to wrap or cover any part of the body → used to hold dressings in place, to apply pressure to control bleeding, to protect a wound from dirt and infection, and to provide support to an injured limb or body part

3. Pressure bandage: Any bandage applied snugly to create pressure on a wound or an injury

4. Roller bandage (or roller gauze) is usually made of gauze or gauze-like material

Abrasion

• Most common type of open wound

• Characterized by skin that has been rubbed or scraped away, such as often occurs when a child falls and scrapes their hands or knees on a rough surface road

• Care for an Abrasion 

  1. Put on gloves

  2. Since there is very little bleeding, there is no need for direct pressure

  3. Wash the wound thoroughly with regular soap and water and gently scrub the area to remove any dirt, small rocks, or debris that is caught in the wound. * Note: this hurts! A lot. But it is the most important part. Any debris left in the wound can lead to infection later, so make sure to clean the wound thoroughly

  4. Dry the wound with clean, sterile gauze

  5. Cover the wound with a layer of antibiotic ointment (neosporin, triple antibiotic, bacitracin, polysporin) as long as there are no known allergies (some people are allergic to antibiotic ointment)

  6. Cover the wound with a non-stick, sterile dressing and secure. (a bandaid works if it is big enough, but sometimes abrasions can be large, think "turf burn")

  7. Wash your hands

Laceration

• A cut which may have either jagged or smooth edges

• Lacerations usually bleed freely and, depending on the structures involved, can bleed heavily

• Lacerations are not always painful because damaged nerves cannot transmit pain signals to the brain

• Lacerations can easily become infected if not cared for properly

• Care for a laceration depends on the extent of the cut

  1. Control for any bleeding

  2. Cover the wound

  3. Refer to the doctor

Avulsion

• Serious injury in which a portion of the skin and sometimes other soft tissue is partially or completely torn away

• A partially avulsed piece of skin may remain attached but hangs like a flap

• Bleeding is usually significant because of avulsions often involve deeper soft tissue layers.

• Care for an Avulsion 

  1. The primary concern for a first aider should be minimizing the risk of infection while the victim is transported to the hospital

  2. Cover the avulsed tissue with a sterile, non-stick pad and cover with spiral gauze, paying careful attention to securing the gauze, but not applying unnecessary pressure over the wound (don't wrap tightly like you would for a severe bleed)

Amputation

• Although damage to the tissue is severe when a body part is severed, bleeding may not be as bad as you might expect

• Care for Amputation 

  1. Call 9-1-1.

  2. Put on disposable gloves.

  3. Provide care for the open wound as described in "specific care for major open wounds".

  4. Wrap the severed body part in sterile gauze or any clean material, such as a washcloth. Moisten the cloth with sterile saline (if available), if not use dry sterile gauze as shown in the picture below.

  5. Place the wrapped part in a sealable plastic bag or container. Label it with the persons name and time and date it was placed in the bag

  6. Keep the bag cool by placing it in a larger bag or container of ice- not on ice alone and not on dry ice

  7. Make sure the bag or container is transported to the medical facility by EMS personnel with the injured person

Puncture

• Results when the skin is pierced with a pointed object, such as a nail, a piece of glass, a splinter or a knife, gunshot

• Because the skin usually closes around the penetrating object, external bleeding is generally not severe

• Internal bleeding can be severe if the penetrating object damages major blood vessels or internal organs

• Embedded object: object that remains in the wound

• Care for Puncture Wounds

  1.  Call 9-1-1

  2. Cover the open wounds with sterile non-stick pads and refer

Crush Wound

• A crush injury is the result of a body part, usually and extremity, being subjected to a high degree of pressure, in most cases after being compressed between two heavy objects

• This type of injury may result in serious damage to underlying tissues and cause bleeding, bruising, fracture, laceration, and compartment syndrome, which is swelling and an increase in pressure within a limited space that presses on and compromises blood vessels, nerves and tendons that run through that space

• In severe crush injuries to the torso, internal organs may rupture. 

• Crush injuries can be open or closed. 

• Care for Amputation 

•  Crush Injury 

  1. Call 9-1-1 and cover the wound with a sterile, non-stick dressing