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

• Abrasion– Top layer of skin removed– Little or no blood loss– Painful

© American Academy of Orthopaedic Surgeons.

Types of Open Wounds

• Laceration– Cut with jagged,

irregular edges– Tearing away of skin

tissue• Incision

– Smooth edges

© Scott Camazine/Alamy.

© American Academy of Orthopaedic Surgeons.

Types of Open Wounds

• Puncture– Deep, narrow– High risk of infection

• Avulsion– Flap of skin torn loose

• Amputation– Cutting or tearing off of

body part

© American Academy of Orthopaedic Surgeons.

© American Academy of Orthopaedic Surgeons.

Care for Open Wounds

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

• Expose the wound.• Control bleeding with direct pressure.

Cleaning a Wound

• Scrub hands with soap and water.

• Clean wound.– For shallow wound:

• Wash with soap and water.

• Flush with clean water under pressure.

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Cleaning a Wound

• 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.

• If bleeding restarts, apply direct pressure.

Covering a Wound

• Dressing: applied over a wound to control bleeding and prevent contamination− Should be sterile or as clean as possible

• Bandage: holds dressing in place– Need not be sterile

Covering a Wound

• If the wound is small, apply thin layer of antibiotic ointment.

• Cover with a sterile dressing.• Do not pull off 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 wounds– Visible bone, joint, muscle, fat, or tendon– Wound entering joint or body cavity– “Fight bite”

• Wounds needing sutures– Best placed within 6 to 8 hours

• Anyone who has not had a tetanus vaccination within 10 years– 5 years in the case of a dirty wound

When to Seek Medical Care

Risk of Infection

• Wounds with foreign material• Ragged or crushed tissue• Injury to underlying nerves, tendons, joints • Bite wounds• Hand and foot wounds• Puncture wounds or wounds that cannot

drain

Infected Wound: What to Look For

• 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

© Dr. P. Marazzi/Photo Researchers, Inc.

Infected Wound: What to Do

• Soak wound in warm water, or apply warm, wet packs over infected wound.

• Apply antibiotic ointment.• Change dressings several times per day.• Give pain medication.• Seek medical care if the infection persists

or worsens.

Tetanus

• 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

• 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 and Avulsions

• In many cases, an amputated extremity can be successfully reattached.

• Avulsions most often involve ears, fingers, and hands.– Can bleed heavily

Types of Amputations

• Clean− Clean-cut, complete

• Crushing− Crushed or mashed off

• Degloving– Skin is peeled off.

© Chuck Stewart, MD.

Amputations: What to Do

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• Call 9-1-1.• Control bleeding and treat

for shock.• Care for the part:

– Wrap in a wet sterile gauze or a clean cloth.

– Put in a waterproof container of ice.

– Send to the medical facility.

Avulsions: What to Do

• Gently move the skin back to normal position.

• Cover with sterile or clean dressing and apply pressure.

• If bleeding continues, apply tourniquet or hemostatic dressing, if available.

Blisters

• A collection of fluid in a bubble under the outer layer of skin

• Caused by repeated rubbing of the skin

• Treatable and preventable

© Maximillian Weinzierl/Alamy.

Blisters: What to Do

• Hot spot– Relieve pressure by applying:

• Blister bandage• Surgical tape• Elastic tape

– Trim and round edges of tape.• Blister that is closed and not very painful

– Use the most appropriate method discussed.

Blisters: What to Do

• Blister that is closed and very painful– Clean blister and needle with alcohol pad.– Make several small holes at base of blister

with needle.

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Blisters: What to Do

• Blister that is closed and very painful (cont’d)– Apply paper tape and cover with elastic or

adhesive tape.• Trim and round edges of tape.

– Watch for signs of infection.

Blisters: What to Do

• Blister that is very painful and open or torn– Trim off dead skin.– Place blister pad over raw skin; cover with

paper tape.– Cover with elastic or adhesive tape.

• Round edges of tape.– Watch for signs of infection.

Impaled (Embedded) Objects

• Embedded objects should be stabilized to prevent internal damage.

© American Academy of Orthopaedic Surgeons.

Sliver (Splinter): What to Do

• Remove with tweezers.• Wash the area with soap and water.• Apply antibiotic ointment.• Apply adhesive bandage.

Large Impaled Object: What to Do

• Stabilize object.• If bleeding, apply direct pressure around

base of object.• If necessary, reduce length or weight of

object by cutting or breaking it.• Call 9-1-1.

Impaled Object in Cheek: What to Do

• If you are more than 1 hour from medical help, consider removing it.– To remove object:

• Place two fingers next to object.• Gently pull it in the direction from which it entered.

– If it cannot be removed easily:• Leave it in place.• Secure with bulky dressings.

Impaled Object in Cheek: What to Do

• Control the bleeding.– After removing object, place dressings over

wound inside mouth.– Place dressing over outside of wound.

Impaled Object in Eye: What to Do

• Do not exert pressure on eyeball.• 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.• Call 9-1-1.

Cactus Spines: What to Do

• 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

– Adhesive, duct, or cellophane tape

Fishhooks: What to Do

• Tape fishhook in place.• If barb has not penetrated skin:

– Remove by “backing out.”– Treat as puncture wound.– Seek care for tetanus.

• If barb has entered skin:– Transport person.– If far from medical care, remove hook with

pliers or string-jerk method.

© Tosh Brown/Alamy.

Fishhooks: What to Do

• Pliers method– Apply an ice pack or

hard pressure.– Push further in until it

emerges through skin.– Cut off barb with pliers

and push hook back out through entry.

© Jones & Bartlett Learning.

Fishhooks: What to Do

• 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

© Jones & Bartlett Learning.

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

Closed Wounds: What to Do

• 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

• Long or deep and needs stitches• Over a joint• Animal or human bite• Impairs function of eye, eyelid, or lip• All layers of skin removed• Caused by a metal object or a puncture

wound• Over possible broken bone

Wounds Requiring Medical Care

• Deep, jagged, or gaping open• Involves damage to underlying bones,

joints, or tendons• Foreign material embedded• Cuts that show signs of infection• Cuts that include issues with movement or

sensation, or increased pain

Wounds Requiring Medical Care

• 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 or partial amputation

 

Sutures (Stitches)

• Within 6 to 8 hours of injury• Benefits

– Faster healing– Reduced infection and scarring

• Wound does not require sutures if:– Cut edges of skin fall together.– Cut is shallow.

 

Gunshot Wounds

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

• Bullet causes injury by:– Laceration and crushing– Shock waves and temporary cavitation

 

Gunshot Wounds: What to Look For

• Penetrating wound—entry only• Perforating wound—entry and exit points

 

© American Academy of Orthopaedic Surgeons.© American Academy of Orthopaedic Surgeons.

Gunshot Wounds: What to Do

• Monitor person’s breathing.• Expose the wound(s).• Control bleeding with direct pressure.• Apply dry, sterile dressings and bandage.• Treat person for shock; keep calm.• Seek immediate medical care.

 

Legal Implications of Gunshot Wounds

• 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.