Wounds

Wounds

- By Dermot Holmes

Wounds

A wound is usually when a persons skin is cut, torn, punctured, pierced or broken for example. It is physical trauma, this trauma may cause bleeding, pain and irritation. It usually will hurt, how much it does depends on the deepness, size and what type of wound it is. Bleeding is caused by damaged arteries, blood will flow heavier if one is damaged. Effective action should be sought to help save the life. Any small cuts or bleeds will usually slow down fairly quickly through clotting, body clotting is a defensive mechanism where white blood cells build up around the area to form a scab or dry blood. Larger cuts need assistance and outside intervention.

Wounds

There are many types of wounds, wounds can include:

• Incision Wounds – These are when the skin is cut open by a clean-sharp object such as a knife or razor.

• Lacerations – are caused by blunt force trauma, they are odd tears to the skin. Usually trauma that has hit a bone surround by soft tissue.

• Abrasions (also known as grazes) – skin that is scraped off, may be caused by skin friction with a rough surface from sliding or falling. These wounds are on the top layer of skin.

• Punctures – skin punctured by an object• Penetration – A knife or sharp object entering the body• Gunshot – there may be two sides to this wound, exit and entry of that of a bullet

penetration the skin. • Crushing Injuries – when extreme amounts of force are applied over an extended period

of time.• Avulsions – a partially removed piece of skin or flesh, a flap of.• Embedded Object – a foreign object embedded into the skin• Amputation – Severed body part

Wounds

Closed Wounds (do not usually break the skin) include:• Bruises (or Contusions) – the tissue underneath the skin is damaged in this case, usually

by blunt force trauma. These usually are just left to heal as they are not very damaging to the body.

• Hematomas (Bloody Tumours) - when a blood vessel is damaged it may cause blood to collect under the skin. As with bruises are left to heal by their self although can take longer.

Wounds

A Stitched up incision Small Laceration Puncture Wound

Avulsion where skin has been removed

Finger after amputation

Management Techniques. Signs. Symptoms

- External Bleeding

Minor Wounds:- Superficial- Less than two and a half centimetre surface area- Bleeding stops quickly- E.g.. Abrasions, incisions, puncture wounds, avulsions etcManagement:- wash, clean water- Antiseptic or sterile saline to clean- Sterile gauze to clean- Cover, sterile dressingSeeking Medical Attention:- Worry over seriousness of wound- Hard to clean- Infection- Stitches needed- A tetanus shot may be neededConsiderations:- Large Abrasions: infected easily, be especially careful when cleaning and covering- Avulsions: Do not remove flap unless very small, move flap to original position before covering.

Major Wounds:- Large surface area- Constant bleeding or a lot of blood- E.g. Lacerations, Incisions, Large Avulsions, Deep Punctures, Imbedded Objects, Amputations etcManagement:- Primary Survey- Direct pressure to wound- If able, squeeze edges- Elevation of site- Cover with pad, secure, ensure pad stays put- Still, reassurance, immobilisation- Monitor vital signs- Always call ambulance if unsure or seek medical attention- If possible provide supplemental oxygenConsiderations:- Apply second pad if bleeding goes through first pad, keep both pads on- If bleeding continues reapply a second pad, if still bleeding it may be because first pad is not positioned

well.- If these have not worked, and it is a life-threatening bleeding a constrictive bandage may be used.- For deep punctures, medical attention should be sought straight away as internal organs may be affected.

Be careful of this as there may be very little bleeding and can be deceiving.- Infection at high risk

Management Techniques. Signs. Symptoms

- External Bleeding

Embedded Objects:- Foreign Object in skin- May be deep- Doesn’t necessarily have to be bleedingManagement:- Leave object in place, removing may cause more damage or bleeding- Apply pressure, ring bandage, place around object then adding pressure- Elevation- Cover wound, do not apply direct pressure to object

Amputations:- Loss of limb- Severed body parts- BleedingManagement (To the Stump)- As major wounds, primary survey, direct pressure, elevation, ambulance etc.Management (Severed Part):- Part put in sealed container/plastic bag, this is to be placed in another container or bag of icy water- Ensure part doesn’t contact the water- Urgent medical assistanceConsiderations:- Trauma may result- Good first aid and management may save a limb, advanced technology can successfully reattach parts so it is

important this is done quickly and correctly.

Management Techniques. Signs. Symptoms

- Embedded Objects & Amputations

What to look for:- Trauma- Medical History- Shock, symptoms/signs- Affected area, tenderness, pain, swelling- Blood, in vomit, urine, or coughing upManagement:- Always call ambulance- Primary survey- Lay victim, elevate legs if possible- Keep still- Reassurance- Maintain body temp- Supplemental oxygen- Monitor vital signs- Secondary survey

Management Techniques. Signs. Symptoms

- Internal Bleeding

What to look for:- Suspected crushing by object- Trapped under heavy object- Kidney failureManagement:- If person has been trapped for longer than an hour, do not remove object until medical

assistance arrives- Only remove straight away- Always call ambulance- Victim in comfortable position- Don’t use tourniquet- Monitor vital signs and condition

Management Techniques. Signs. Symptoms

- Crush Injuries

Scalp Wounds:- Heavy bleeding- Can be associated injuries- Concussion caused from head trauma- Dizziness, short term memory loss, nausea, headaches, blurred vision, vomiting, Management:- Medical attention- Observe vital signs- Treat as wound

Management Techniques. Signs. Symptoms

- Head & Facial Injuries

Things To Look For/considerations:- Could be bleeding within skull- Could cause brain damage- Clear fluid which surround bran, known as cerebrospinal fluid may leak, may be from ears or nose- Unconsciousness- Headache, visual problems, numbness, nausea, paralysis, vomiting, convulsion- Bruising, around ears or eyes- Pupils are responding slowly or unequal- Breathing patterns not normal or totally stoppedManagement (Responsive):- Medical Assistance- Keep still- Reassurance- If discharge occurs, cover ears lightly with sterile pad, make sure the ear isn’t blocked by this as the ear

needs to be allowed to drain- Supplemental oxygenManagement (Unresponsive):- Primary Survey- Call ambulance- Supplemental Oxygen

Management Techniques. Signs. Symptoms

- Fracture Skull/ Cerebral Compression

Bibliography

www resources:

Children’s Hospital San Diego http://www.chsd.org/images/medtips/bb_arm2_rd.jpg (2008) (online) (retrieved 3/9/08)

First Aid/Internal Bleeding http://en.wikibooks.org/wiki/First_Aid/External_Bleeding (2007) (online) (retrieved 1/9/08)

Healing research http://www.healingsearch.com/Nepal/Bruises.jpg (2006) (online) (retrieved 3/9/08)

Open Access Journal Of Plastic Surgery http://www.eplasty.com/ (2008) (online) (retrieved 1/9/08)

The National Labour Committee http://www.nlcnet.org/admin/media/images/China/2005_Disney/HungHing_Worker_Finger_Injury3.jpg (2006) (online) (retrieved 3/9/08)

Ostomy Wound Management http://o-wm.com/ (2008) (online) (retrieved 1/9/08)

Patient Safety in Surgery http://www.pssjournal.com/content/figures/1754-9493-2-12-2.gif (2008) (online) (retrieved 3/9/08)

Royal Life Saving http://www.royallifesaving.com.au/www/html/187-nsw-website-home-page.asp (2008) (online) (retrieved 1/9/08)

Wikipedia http://en.wikipedia.org/wiki/Wounds (2008) (online) (retrieved 1/9/08)

Wounds http://woundsresearch.com/ (2008) (online) (retrieved 1/9/08)

Books: Royal Life Saving: The Royal Life Saving Society Australia. First Aid – Written By John Lippmann & David Natoli 2006

2 unit Personal Development, Health &Physical Education Preliminary Course 2008, First Aid. – Aple Publishing (2008)