1 Dr. Samer Sara
What is a wound? An injury to the skin and some times other deeper soft tissues. Types: Open wounds: Skin is torn or cut, often leads to bleeding. Closed wounds: Skin is not affected and injury exists in the hypodermis (beneath the skin). 2
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Types of open wounds Abrasions Lacerations Punctures Avulsion Amputation 4
Abrasions: The top layers of skin are scraped off. Skinned elbow and knee are common in children. It s painful but not serious. Bleeding is limited to capillary that stops by itself. Foreign material may present and cause infection. 5
lacerations (cut): Frequently penetrate the skin and damage the underlying tissues. Are either: smooth cut with straight edges called : incision, such those caused by knives. rough cuts. may cause lifethreatening bleeding. 6
Punctures: occur when sharp objects penetrate the skin and deeper tissues. May be gunshot. more likely to trap foreign material increasing the risk of infection. 7
Avulsions: area of skin or outer soft tissue torn partially from the body. 8
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Amputations: Complete cutting or tearing off of all part of an extremity (finger-foot). The amputated party could be reattached. 10
11 Cleaning Wounds
o The priority is to control bleeding with direct pressure or other means. o Don t remove dressing to clean the wound (may disturb clotted blood and restart bleeding). o Otherwise the first step in minor wound care is to clean the wound. o Wash your hands first and wear gloves if available. 12
o Remove clothing, avoid contact with wound. o Gently wash the wound with soap and running water (irrigation)for at least 5 minutes, Or until no foreign matter apparent. o If necessary use sterile gauze to remove any dirt. o Carefully dry the wound. o Apply a sterile dressing and bandage. 13
Alert... Don t try to clean a major wound after bleeding control. Don t put antibiotic ointment except in shallow wounds. Don t use alcohol, or iodine Avoid breathing and blowing on the wound. Don t attempt to remove clothing stuck to a wound. Don t scrub a wound. 14
Wound Infections May occur in any open wound. Could be local, or pathogens may inter circulation causing systemic disease. Blood borne diseases may be transmitted from one person to another through un open wound. Pathogens may be transmitted into a wound by any substance that comes into contact with the wound, or even by pathogens in the air. 15
Some wounds are at greatest risk : A. Wounds resulting from bites. B. Puncture wounds. C. Wounds contaminated with dirt. 16
Signs and symptoms of local infection : Wound is red,swollen, and worm. Pain Pus fever 17
Tetanus Is called lockjaw because a stiff neck and jaw are early symptoms. Tetanus bacteria is found in soil and on skin surface. It enters the body through wounds. Tetanus immunization is included in routine childhood vaccination. Adults need a booster every 10 years. A tetanus shot must be given within 72 hours after being wounded. 18
Dressing and Bandaging Wounds Wash hands and wear gloves. Choose dressing larger than the wound. Carefully lay the dressing on the wound. If blood seeps through, do not remove dressing but add more dressing on it. Apply a bandage to hold dressing in place. 19
Guidelines for using Bandage Apply the bandage firmly but not so tightly that it cuts off circulation. Don t cover fingers and toes unless injured. Be sure bandage is secure enough that dressing will not move. Wrap a bandage from the bottom of the limb upward to avoid cutting the circulation. 20
When to seek medical attention o Bleeding not easily controlled. o Deep or large wound. o Significant wounds on the face. o Signs and symptoms of infection. o Animal or human bite. o Puncture wounds. o Any wound you are unsure about. o Wounds may require stitches. 21
22 Special Wounds
closed wounds: 1-Raise the area of the wound. 2-Put ice or cold water on the affected area. 3-check the victim if he has any other injuries. 23
puncture wounds: Remove any small objects Gently press the area to control bleeding. Don t put any medicine. wash the wound with running water. Dress the wound and seek medical attention. 24
Impaled objects: Leave an impaled object in it s place and use bulky dressing to keep it from moving. Control bleeding by applying direct pressure at the side of the object. Dress the wound around the object. Support the object while bandaging it in place. 25
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Avulsion & Amputation: Wrap the severed part in a dry sterile dressing but don t wash it. Place the part in a plastic bag and seal it. Place the sealed bag in another bag or container with ice. Don t let the part in touch with ice. Make sure the severed part is given to the EMS. 28
Crush injuries& crush syndrome Crush injury: Injury that occurs because of pressure from a heavy object onto a body part. Crush syndrome: The shock-like state following release of the body part after a prolonged period of compression. 29
Causes: Natural disasters such as earthquakes. War. Buildings collapse as a result of explosion. Industrial incidents (mining). Road traffic accidents. Patients own body weight, after stroke or intoxication. 30
Most commonly in traumatic crush, the legs are affected, and less frequently the arms. Crush injury of the head and torso significant enough to cause the syndrome is incompatible with life due to the internal organ damage. 31
Compressive force leads to vascular compromise with collapse of blood vessels, nerves and muscle cells. Muscles can withstand approx. 4 hours without blood flow before cell death occurs. loss of blood to supply muscle tissue produces toxins from muscle metabolism without oxygen. the cell releases potassium and other toxic substances such as myoglobin, phosphate and urate into the circulation. 32
hyperkalemia (may precipitate cardiac arrest). metabolic acidosis. acute renal failure: due to myoglobolinuria. 33
Management Before one hour Liberate victim asap. Elevate limb if possible. Control bleeding. Deal with fractures, dislocations. Put victim in shock position. Call 110. Call 110. After one hour Don t liberate victim if not controlled with tourniquet. Treat any other injuries. Reassure victim and rest with him. 34
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