Chapter 9Wounds

Open Wounds • A break in the skin’s surface

resulting in external bleeding • May allow bacteria to enter the

body, causing an infection

Types of Open Wounds (1 of 3)

• Abrasion• Top layer of skin

is removed.• Little or no

bleeding• Painful

Types of Open Wounds (2 of 3)

• Laceration• Cut with jagged,

irregular edges• Tearing away of

skin tissue• Incision

• Smooth edges

© SHOUT/Alamy Images

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

Care for Open Wounds

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

• Expose the wound. • Control bleeding with direct

pressure.

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.

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.

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.

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

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

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.

Care for Infected Wounds (2 of 2)

• Apply antibiotic ointment. • Change dressings daily. • Seek medical help if infection

persists or becomes worse.

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.

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

Amputations

• Guillotine• Clean-cut, complete

• Crushing• Crushed or mashed

off• Degloving

• Skin is peeled off. © Chuck Stewart, MD

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.

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

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.

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.

Care for Impaled (Embedded) Objects

• Do not remove object.

• Stabilize object.• Control bleeding.• May shorten

object to ease transport• After stabilizing

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

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.

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.

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.

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.

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

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

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.

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

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

Wounds Requiring Medical Care (3 of 3)

• Call 9-1-1 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

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.

Gunshot Wounds

• Bullet causes injury by:• Laceration and crushing • Shock waves and

temporary cavitation • Penetrating—entry only• Perforating—entry and

exit wound

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.

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.