Management of minor acute wounds

1. Asses the wound

2. Clean the wound

3. Stop the bleeding

4. Apply dressing

5. Healing

6. Refer if necessary

• prevent infection

• Restore tissue health

Immediate aims

• type of wound

• Colour

• Depth

• Shape

• Size

• Exduate amount

• Location

• Wounds have different phases

• Remember patient factors

• Consider ease, cost, patient satisfaction

Wound assessment

• before and when changing dressing

• With warm, sterile water

• No antiseptics if clean

• If forgein matter - use diluted antiseptic - wash after 3-4 mins

• Use a warmer solution to maintain optimum temp on a wound

• Can use chlorhexidine gluconate

Clean the wound

• before dressing

• Apply pressure with bandage or clean handkerchief

• At least 10 mins

• Raise wound if possible

• If cloth becomes bloody then add cloth on top

Stop the bleeding

• depends on type of wound

• Moist wound healing

Apply dressing

• thinking beyond inflammatory phase

Healing

• Ibleeding from a wound does not stop after 10 minutes of firm direct pressure,

• Wounds with foreign debris that cannot be washed out have a higher risk of infection, which is a serious bacterial infection

• if a wound is causing severe pain, the patient has a fever, or there is numbness/loss of movement which could indicate nerve or tendon damage

• Signs of an infected acute minor wound include: increased pain, redness, swelling, warmth, pus, fever, and lack of healing.

when to refer someone

• Abrasions are minor wound grazes where the outer layer of the epidermis (skin) is broken or ripped away, often from falls or accidents

• commonly occur on thin, bony areas of the body.

grazes/abrasions

• gently trail the wound with a clean object to dislodge any foreign matter, but avoid scrubbing the wound surface

• Use antiseptics only if necessary for a dirty wound, and stop any bleeding.

• Use paper tape around the edges of the wound to hold the skin in place and prevent water from getting in.

• a temporary measure for minor wounds only need to be covered for a while. Nonadherent pads with a fixation sheet or film dressings can be used as an island dressing.

• Use a nonadherent pad with paper tape as a dressing for minor wounds that are moist and exudating

• change every few days

grazes/abrasions management

• Moist wound healing is important for minimizing scarring in minor wounds like grazes.

• Leaving the wound open to dry out and form a scab is not as much of a problem, the scab will eventually drop off and the wound will heal.

• good sign of healing is when the skin looks very red and pink,

• Expect some exudate or oozing under the dressing, especially with film dressings.

• Monitor for signs of infection like heat, redness, swelling, and pain.

graze/abrasion healing

• if a wound is very dirty and simple washing cannot dislodge the foreign debris,

• require a good clean wash and possibly local anesthesia.

• he wound is severe enough to expose the fatty layers, it is a sign that the wound is too deep

Referring grazes

• Sharp object wounds

• deep or shallow

• amount of bleeding

• can affects nerves and bones

Incisions:

• irregular or jagged tears in the skin

• gaping wounds

• caused by blunt trauma

• heavy bleeding

• infections can be problem

Lacerations

• Careful cleaning

• Pressure control - gentle pressure and elevation

• Appropriate dressing - minor - closure strips to hold edges together

• need secondary dressing or absorbent pad or net bandage

• Monitor healing

cut management

• on the face

• embedded or dirty

• hard to control bleeding

• loss of sensation or movement

• pain or breathing

• if need stitches - larger than a cm

• infected look

refering cut

• frail or older person

• ageing skin

• due to friction

• Medication effects

skin tears

• Gentle cleaning

• Non-adherent dressings

• Moist healing environment

• preserve a the skin flap

• apply with hydrogel if dry

• cover with form dressing - 5 to 7 days

• repeat until healed

• cover with wound contact layer

skin tear management

• wear longer slevees or pants

• apply a mosituring agent

• avoid use of drying or pH

prevention of skin tears

• damage skin cells

• depth of tissue

• superficial, partial thickness, full thickness

• caused by sunburns, chemcials

burns

• epidermis affected

• looks pink or red

• no immediate burns

• may peel

• painful

• not prone to infection

• sunburn

minor burns

• enitre epidermis layer destroyed

• mottled appearance

• 2-4 weeks to heal

• immediate blistering

• copious tissue fluids

partial thickness burns

• enitre epidermis and subcutaneous tissue

• skin grating

• scarring inevitable

• whititish leathery or cherry brown or blackish

• no blister

full thickness burns

• caused by acids

• more serious

• irrigated with cool water

• remove clothing if in contact with substance

• always refer

• eye burns - prolonged irritation

chemical burns

• effective within 1-3 hours

• remove all items of clothing near the burn

• remove constrictive things

• cool the area - water running - avoid ice water

• cover with a wet cloth

• keep patient warm

• apply amorphous hydrogel

• dont apply any lotion, creams or ointments

first aid for thermal burns

• airway involved

• burn on face, hands

• size of 10c on child

• size of 20c on adult

• very young or old

• high voltage electrical

• cant improve in 7 days

refer burns

• children - 5% - surface area

• dont include the actual burn itself in surface area

• assess again in 48 hours - to see its progress

• adults - 10% of surface area

emergency burns

• adults - paracetamol - 500 -1000mg every 4-6 hrs to a max of 4g per day

• ibuprofen - 200-400mg tds-qid prn (max 1.2g daily)

oral analgesia in burns - adults

• paracetamol - 15mg/kg every 4-6 hours

• ibuprofen - 5-10mg/kg tds-qid prn (max 400mg)

oral analgesia - children

• size and location

• if small dont obstruct dressing, leave alone

• sterile fluid, entry to bacteria

• obstructuing dressing and puncture and release serous fluid

blister

• watch for signs of local infection

• watch for any new blistering that indicates the wound is deepening

• go to hospital immediately

• seek medical attention if the burn is not healing

• protect from sun

• use water-based irritants

burn management fluids

• Povidone iodine - 0.05%

least damaging antiseptic