Chapter 9 - Open wounds

open wound

• a break in the skin’s surface resulting in external bleeding

• may allow bacteria to enter the body

Types of wounds

• Abrasion

• Laceration

• Incision

• Avulsion

• Amputation

Abrasion/ Road rash

• top layer of skin removed

• Little to no blood loss

• Painful

Laceration

• cut with jagged, irregular edges

• tearing away of skin tissue

incision

smooth edges

Puncture

• deep, narrow

• High risk of infection

Avulsion

flap of skin torn loose

Amputation

cutting or tearing off body part

Care for open wounds

• Protect yourself from disease (medical exam gloves, etc)

• Expose the wound

• Control bleeding with direct pressure

Cleaning a wound

• Scrub hands with soap and water

• Clean would

For shallow wound

• Wash with soap and water

• Flush with clean water under pressure

• For wound with higher infection risk: clean wound, seek medical care for additional cleaning

• Use tweezers to remove remainsg embedded debris

• If bleeding restarts, apply pressure

Covering a wound

Dressing: applied over a wound to control bleeding and prevent contamination

Bandage: holds dressing in place (need not be sterile)

If the wound is large

DO NOT close gaping or dirty wounds with tape or butterfly bandages

covering a wound (pt 2)

• DO NOT pull of dressing that has become stuck

• If you must remove, soak in warm water

• Change wet or dirty dressings

When to seek medical care (High risk wounds)

• Embedded foreign material

• Animal and human bites

• Puncture wounds

• Ragged, large, or deep woundsVisible bone, joint, muscle, fat, or tendon

• Wound entering joint or body cavity

• “Fight bite’

Wounds needing sutures

• Best placed within 6-8 hours

When to seek medical care (pt 2)

• Anyone who has not had a tetanus vaccination within 10 years

• 5 years in the case of a dirty wound

Risk of infection

• Wounds with dirty, foreign material debris

• Ragged or crushed tissue

• Injrury to underlying nerves, tendons, joints

• Bite wounds

• Hand and foot wounds

• Puncture wounds or wounds that cannot drain

Embedded objects

• Embedded objects should be stabilized to prevent internal damage

Silver (Splinter) What to do

• Remove with tweezers

• wash area with soap and water

• apply antibiotic treatment

• apply adhesive bandages

Large Impaled object: what to do

• Stabilize object

• If bleeding, apply direct pressure around base of object

• If necessary, reduce length or wright of object by cutting it.

• Call 911

Impaled object in cheek

• If you are more than 1 hour of medical help, consider removing it

Impaled object in cheek (pt 2)

To remove it

• Place two fingers next to the object

• Gently pull it out in the direction from which it entered

If cannot be removed easily

• Leave it in place

• Secure with bulky dressings

Control the bleeding

• After removing object, place dressings over the wound inside the mouth

• Place dressing over outside of wound

Impaled object in the eye: what to do

• Do not exert pressure on the eyeball

• Stabilize object

• If long: use bulky dressing and place paper cup or cone over eye

• If short: surround eye with ring pad in place with roller bandage

• Cover undamaged eye

• Call 911

Cactus spines: what to do

Removal methods: 1) tweezers, 2) Glue or rubber cement 3) Apply thin layer 4) Allow to dry and roll up dried glue 5) Combination of tweezers and glue most effective

• Adhesive, duct, or cellophane tape

Fishhooks: what to do

• Tape fishhooks in place

• If barb has not penetrated skin: remove by “backing out”, Treat as puncture wound, seek care for tetanus

If barb has not entered skin

• Transport person

• If far from medical care, remove hook with pliers or string-jerk method

Closed wounds

• Caused by strike with blunt objects

• Skin is not broken, but tissue and blood vessels are crushed

Types of closed wounds

• Bruises and contrusions (bruises)

• Hematomas

• Crush injuries

Closed wounds: what to do

• Apply an ice pack

• Injured limb

-aapply elastic bandage for compression

-splint limb

• Check for fractures

• Elevate extremity above heart level

Sutures (stitches)

• Within 24 hours of injury

• Benefits

-faster healing

-Reduced infection and scarring

• Wound does not require sutures if

-Cut edges off of skin all together

-Cut is shallow

Gunshot wounds

• At the scene of the shooter: run, hide, fight

Bullet causes injury by

• Laceration and crushing

• Shock waves and temporary cavitation

Penetrating wound

entry only

Perforating wound en

entry and exit points

Gunshot wounds: what to do

• Call 911 immediately

• Monitor person’s breathing

• Expose the wound(s)

• Control bleeding with direct pressure

• Apply dry, sterile, dressings and bandage

• Treat the person for shock: keep calm

Legal implications for gunshot wounds

• Keep accurate record of observations

• Do not touch or move anything

• Preserve evidence, such as shells or casings

• Do not touch or move anything unless necessary

• All gunshot wounds must be reported to the police