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An open wound is

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a break in the skin's surface resulting in external bleeding. It may allow bacteria to enter the body, causing an infection.

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Abrasion

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Top layer of skin is removed. b. There is little or no bleeding. c. Painful because nerve endings are damaged. d. Debris may be present. e. The condition is serious if it is over a large area or becomes embedded with foreign matter.

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Laceration

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A cut with jagged, irregular edges b. Caused by tearing away of skin tissue

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Incision

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a. Smooth edges b. Amount of bleeding depends on: i. Depth ii. Location iii. Size

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Puncture

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Deep, narrow b. Small entrance c. High risk of infection

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Avulsion

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a. A flap of skin is torn loose and hanging or completely removed from body. b. May bleed heavily c. The flap should be laid flat and realigned if it is still attached

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Amputation

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Cutting or tearing off of a body part (finger, toe, hand, arm, etc.)

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Care for open wounds

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Protect yourself against disease. a. Wear exam gloves. b. If no gloves, improvise with other materials.Layers of gauze or clean cloth ii. Waterproof materials—plastic bag, plastic wrap c. If no materials are available, have victim apply pressure to the wound him- or herself. d. Use bare hands as a last resort. 2. Find the source of the bleeding. a. Expose the wound by removing or cutting clothing. 3. Control bleeding by applying direct pressure.

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Wounds with a low risk of infection should be cleaned.

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Scrub hands with soap and water, and wear exam gloves, if available. 2. Expose the wound. 3. Clean the wound. a. For a shallow wound: i. Wash inside the wound with soap and water. ii. Flush with clean running water under pressure (i.e., from a faucet) to carry out dirty particles. b. For a wound with higher infection risk (animal bite, puncture): i. Clean the wound. ii. Seek medical care for additional wound cleaning. 4. Use tweezers to remove any remaining embedded debris. 5. Apply direct pressure to control bleeding.

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Cover the wound.

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1. If small, cover with thin layer of antibiotic ointment. 2. Cover wound with sterile dressing. a. Do not close gaping or dirty wounds with tape or butterfly bandages. 3. Do NOT pull off a sticky or blood-soaked dressing. a. If you must remove, soak in warm water to make removal easier. 4. Change dressing if it gets wet or dirty.

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Dressings and bandages are two different kinds of first aid supplies

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two different kinds of first aid supplies

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Dressings

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Applied over a wound to control bleeding and prevent contamination

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bandages

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Holds dressing in place

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Seek medical care for high-risk wounds

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Embedded foreign material 2. Bites 3. Puncture wounds 4. Ragged wounds 5. Edges of skin do not come together 6. Visible bone, joint, muscle, fat, or tendonWound entering a joint or body cavity 8. "Fight bite" a. Wound over knuckle b. Caused by punching a person in the teeth c. Needs a tetanus vaccination

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Signs of infection include

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Swelling and redness b. Sensation of warmth c. Throbbing pain d. Pus discharge e. Fever f. Swelling of lymph nodes g. Red streaks leading from the wound toward the heart i. Spreading infection that could cause death

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Risk of wound infection is higher for

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Wounds with foreign material (debris) b. Ragged or crushed tissue c. Injury to an underlying bone, joint, or tendon d. Bite wounds (human or animal) e. Hand and foot wounds f. Puncture wounds or other wounds that cannot drain

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Home care of wound infection

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a. Keep area clean. b. Soak wound or apply warm, wet packs. c. Elevate. d. Apply antibiotic ointment. e. Change dressings daily. f. Seek medical care if the infection persists or worsens.

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Tetanus Also called lockjaw

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Caused by a toxin-producing bacterium. a. Toxin travels to nervous system. b. Toxin causes contraction of some muscle groups. i. Jaw No known antidote for toxin.

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Tetanus bacteria can occur on:

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Rusty objects b. Soil c. Street dust d. Organic fertilizer e. Pet feces

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Tetanus can be prevented

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with vaccinations and boosters every 5 to 10 years

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Tetanus booster guidelines

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Wound victim who has never been immunized b. No booster in past 10 years c. Dirty wound and no booster in past 5 years d. Shots must be given within 72 hours of injury

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Guillotine amputation

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a. Clean-cut, complete detachment

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Crushing amputation

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a. Extremity is crushed or mashed off

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3. Degloving a.

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a. Skin is peeled off.

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Care for amputations

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Control bleeding with direct pressure. a. Apply dry dressing or bulky cloths. b. Follow precautions against diseases. c. May require a tourniquet 2. Treat for shock. 3. Find the amputated part and take it with the victim to the hospital. a. In some cases, you may ask others to recover the part while victim is being transported. 4. Pack and care for amputated part. a. Do NOT clean. b. Wrap in dry, sterile gauze or clean cloth. c. Place in plastic bag or waterproof containerd. Place bag or container on bed of ice. i. Keep cool, not frozen. 5. Seek immediate medical care

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Blisters

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Tissue remains stationary as stress is put on the skin's surface. a. Seperates skin into two layers b. Space fills with fluid

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Care for friction blister

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depends on size and location

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For painful, red "hot spot

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Snugly apply tape. b. Or make a pad from several layers of moleskin or molefoam. i. Cut hole in pad for blister.

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Closed blister on foot, not painful

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Tape with duct tape or waterproof adhesive. i. Should remain there for several days ii. If replacement is needed, there is the risk of the blister tearing

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Blister's roof should only be removed when infection is present. i.

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Area should be washed with soap. ii. Protective bandage should be used for 10 to 14 days. iii. Consider removal if partially torn blister may result in larger open wound. (a) Use scissors sterilized with rubbing alcoho

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Open or very painful blister on foot

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Clean with soap and water. b. Drain fluid from blister. i. Pierce small holes at base with sterilized needle. ii. Press fluid out. iii. Do not remove roof unless it is torn or there is infection. c. Apply pad with opening for blister. d. Apply antibiotic ointment and secure covering with tape.

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Care for impaled objects

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Expose the wound. 2. Do not move or remove object. a. Cheeks are the exception. 3. Stabilize the object. a. Use bulky dressings or clean cloths. b. Secure the object to reduce motion. 4. Control bleeding. a. Apply pressure on dressing around the object. b. Do not press on object. c. Do not press on wound along a cutting edge. 5. Shorten the object: a. Only when necessary for transport b. Only after stabilizing

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Care for impaled object in cheek

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Remove the object if: a. Object extends through cheek, inside mouth b. Victim is > 1 hour from medical care. 2. To remove object: a. Straddle with two fingers on either side. b. Gently pull with other hand. c. Pull in the direction of entry. d. If it cannot be removed easily, leave in place and secure. 3. Placing dressings over wound. a. Between cheek and teeth b. On outside of cheek

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Care for impaled object in eye

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Stabilize the object. a. For long, protruding objects: i. Use bulky dressing or clean cloth. ii. Place a paper cup or cone over eye to prevent bumping. b. For short objects: i. Surround eye with ring pad. ii. Hold pad in place with roller bandageCover the undamaged eye. i. This prevents sympathetic movements of injured eye. ii. Reassure victim, who cannot see. 3. Seek immediate medical care

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Care for slivers

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1. Can cause pain, irritation, and infection 2. Sometimes called splinters. 3. Removal: a. May need to reposition sliver with end of sterile needle. b. Remove with tweezers. c. Clean with soap and water. d. Apply adhesive bandage

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Care for cactus spines

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Removal is tedious because spines: a. occur in groups. b. are difficult to see. c. evolved to resist removal.

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Removal methods:

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a. Tweezers b. Glue or rubber cement i. Apply in thin layer. ii. Allow to dry > 30 minutes. iii. Roll up dried glue from margins, slowly. iv. May apply a single layer of gauze while damp to help remove. c. Combination of tweezers and glue is most effective. d. Do NOT use superglue.

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Care for fishhooks 1.

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Tape fishhook in place. 2. Do not try to remove if: a. Injury to eye or underlying blood vessel or nerve may occur. b. Victim is uncooperative. 3. If barb has NOT penetrated skin: a. Remove by "backing out." b. Treat as a puncture wound. c. Seek care for tetanus. 4. If barb has entered skin: a. If medical care is near, transport victim.

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Care for fishhooks 2

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b. If far from medical care, remove hook with pliers method or string-jerk method. 5. Pliers method a. Use extreme care. i. Can produce further severe injury ii. Use pliers that can cut through hook. b. Apply cold or hard pressure around hook. c. Push hook in a shallow curve until point and barb emerge through skin. d. Cut off barb with pliers and push hook back out through entry. e. Treat wound and seek care for tetanus. 6. String-jerk method (better method) a. Loop fishing line over curve of hook. b. Stabilize body part. c. Apply cold or hard pressure around hook. d. Press down on hook's shank and eye with one hand, while jerking line with other. i. Movement should be parallel to skin's surface. e. Treat

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Closed wounds are caused by

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a strike with a blunt object, crushing tissues and vessels under the skin's surface.

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Types of closed wounds

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Bruises and contusions Hematomas Crush injuries

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Bruises and contusions

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a. Blood collects under skin. b. Pain and swelling c. Black-and-blue appearance

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Hematomas

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a. Blood clot under skin b. Lump c. Bluish discoloration

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Crush injuries

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a. Caused by extreme forces b. Can injure vital organs and bones c. Symptoms: i. Discoloration ii. Swelling iii. Pain

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Care for closed wounds

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Apply an ice pack. a. Use for > 20 minutes. b. Place cloth between ice pack and skin. 2. Injured limb: a. Apply elastic bandage for compression. b. Splint limb. 3. Check for fractures. 4. Elevate extremity above heart level. a. Decreases pain and swelling

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Seek medical care for the following wounds and cuts

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a. Bleeding after 15 minutes of applying direct pressure b. Long or deep and need stitches c. Over a joint d. Impair function of a body area such as an eyelid or lip e. All skin layers removed f. Animal or human bite g. May have damaged underlying nerves, tendons, or joints h. Over a possible broken bone i. Associated with a crushing injury j. Have an object embedded k. Caused by a metal object or a puncture wound

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Call 9-1-1 immediately if:

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Bleeding does not slow during first 15 minutes of steady pressure. b. Signs of shock c. Cut to neck or chest causes difficulty breathing. d. Deep cut to abdomen with moderate/severe pain e. Eyeball cut f. Amputation

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Sutures (stitches) should be placed by a physician within

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6 to 8 hours of an injury.

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Wounds that do not require sutures:

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a. Cut edges of skin come together. b. Shallow cuts > 1 inch long 3. Cover wound with sterile gauze rather than closing with bandages or elastic skin closures.

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Laceration and crushing

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Bullet crushes tissue and forces it apart. b. Low-velocity bullets c. Serious if vital organ or major vein is damaged d. Damages only tissues in direct contact with bullet

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Shock waves and temporary cavitation

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a. Shock wave from bullet pushes tissues away, creating a cavity. i. Cavity can be 30 times the diameter of the bullet. b. Negative pressure (vacuum) in cavity draws debris in. c. High-velocity bullets only d. Can damage muscle, nerves, blood vessels, and bone

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Types of gunshot wound

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Penetrating wound,Perforating wound,Other damage

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Penetrating wound

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Bullet entry point b. No exit point

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Perforating wound

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Both entry and exit points b. Exit wound larger than entry wound for high-velocity bullet c. Exit and entry wounds same size for low-velocity bullet d. Entry wound larger than exit wound for close-range gunfire

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Other damage:

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a. Bullet may hit bone. b. Bullet or bone chips may ricochet. c. Split or misshapen bullets do damage over a greater area

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Care for gunshot wounds

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1. Monitor victim's breathing. 2. Expose the wound(s). 3. Control bleeding with direct pressure. 4. Apply dry, sterile dressings and bandage in place. 5. Treat victim for shock. 6. Keep victim calm and quiet. 7. Seek immediate medical care

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Legal aspects

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Keep accurate record of observations. 2. Preserve evidence, such as shells or casings. 3. Do not touch or move anything unless necessary. 4. All gunshot wounds must be reported to police

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