Wound: Encyclopedia - Wound

Wound

A wound is type of physical trauma wherein the skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound).

Before any medical or paramedical evaluation, a wound is considered as minor when:

• it is superficial (a "flesh wound");
• it is away from natural orifices;
• there is only a minor bleeding;
• it was not caused by a tool or an animal.

Any other wound should be considered as severe. If there is any doubt, a wound should be considered as severe. "Severe" does not necessarily means that it endangers life, but it must at least be seen by a physician. In the case of severe open wounds, there is a risk of blood loss (which could lead to shock), and an increased chance of infection due to bacteria entering a wound that is exposed to air. Due to the risk of infection, wounds should be kept clean, and closed if possible until professional help is available.

Closed wounds can be just as dangerous as open wounds depending on their severity. A concussion is an extremely dire closed wound, and requires emergency medical attention.

Wound - Types of wound

Wound - Open

Open wounds can be classified into a number of different types, according to the object that caused the wound. The types of open wound are:

• Incisions - caused by a clean, sharp-edged object such as a knife, a razor or a glass splinter.
• Lacerations - rough, irregular wounds caused by crushing or ripping forces.
• Abrasions (grazes) - a superficial wound in which the topmost layers of the skin are scraped off, often caused by a sliding fall onto a rough surface.
• Puncture wounds - caused by an object puncturing the skin, such as a nail or needle.
• Penetration wounds - caused by an object such as a knife entering the body.
• Gunshot wounds - caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit.

All stab wounds and gunshot wounds should be considered major wounds.

Wound - Closed

Closed wounds have far fewer categories, but are just as dangerous as open wounds. They are:

• Contusions - (more commonly known as a bruise) - caused by blunt force trauma that damages tissues under the skin
• Hematoma - (also called a blood tumor) - caused by damage to a blood vessel that in turn causes blood to collect under the skin
• Crushing Injuries- caused by a great or extreme amount of force applied over a long period of time

Wound - First aid

Wound - Minor Open Wounds small cuts and grazes

Minor cuts and grazes are easily treated at home. The priority with minor wounds is to reduce the risk of infection.

1. The cause of the wound should be removed, or the casualty should be moved away and the dangerous area marked.
2. Wash your hands thoroughly with soap and water, dry them, and put on disposable gloves if available
3. Wash the wound gently with clean, potable water (alternatively a sterile saline solution may be used), and clean the surrounding area with mild soap and water.
4. Pat the wound dry with a clean gauze swab or similar clean, non-fluffy material.
5. Cover the wound with a dressing (for small cuts a sticking plaster is ideal). The wound should not be left open to the air.
6. If the bleeding does not stop, if there is a special risk of infection, or if the wound does not begin to heal within 48 hours, advise the injured person to seek medical attention.
7. Ask whether the casualty has been vaccinated against tetanus. If the injured person has never been immunised, or if he or she is unsure if the the course of vaccinations was completed, or if the last injection was more than ten years ago, advise the casualty to seek medical advice.

Wound - Severe/Major Open Wound

The priority with major wounds is to prevent further blood loss. Treat the casualty to control the bleeding, prevent shock, and call for help as soon as possible.

1. Emergency medical servicess should be called.
2. Disposable gloves should be used. The casualty's clothing should be removed to expose the wound.
3. Get the casualty to raise the wound above the level of the heart (if the wound is in a limb) and, if there is no object embedded in the wound, apply direct pressure to the area with their own hand.
4. Help the casualty to lie down (on a blanket or carpet to protect them from the cold). If shock is suspected, raise the casualty's legs and support them on a chair or similar.
5. A sterile dressing should be applied (or if none is available, an improvised dressing made from a clean towel or cloth). The dressing should be secured with a bandage that is tight enough to maintain pressure on the wound (but not so tight as to impair circulation beyond the wound).
6. If blood seeps through the first dressing, a second dressing should be applied on top of the first. If blood seeps through the second dressing, both dressings should be removed and a fresh one applied, with sufficient pressure applied.
7. The injured part should be supported in a raised position - a leg supported on a chair, or an arm rested across the chest (so that it is above the level of the heart).

Wound - If an object is embedded in a wound

If there is an object (for example, broken glass) embedded in the wound, or an open fracture where a broken bone sticks through the skin, pressure should not be applied over the object or the object removed. Treat as follows:

1. Put on disposable gloves, if available, to protect yourself from infection.
2. Press firmly on either side of the embedded object to push the edges of the wound together.
3. If the wound is in a limb, raise and support the limb above the level of the heart.
4. Help the casualty to lie down (on a blanket or carpet to protect them from the cold). If you suspect that shock may develop, raise the casualty's legs and support them on a chair or similar.
5. Build up padding on either side of the object (using dressing pads, rolled-up bandages, or similar), so that you are able to bandage over the object without pressing on it.
6. Summon an ambulance, if you have not sent someone to do so already (alternatively if the wound is minor, the wound is not bleeding heavily, and the casualty is comfortable, arrange to transport the casualty to hospital by another means). Monitor the casualty's condition until help arrives.

Wound - Minor Closed Wounds contusions

Ice (not applied directly to the skin as it causes frostbite) applied to the skin should ease any pain or swelling. Note that pain and swelling should be minor. If it is not medical attention should be sought to make sure that the wound is not more serious.

Wound - Major Closed Wounds hematoma and crushing injuries

1. Ice - put ice on the wound (recommended in instances of 20 minutes on, 20 minutes off) Direct contact of ice with the skin is discouraged, as this may cause ice burns or abrasions. Wrapping the ice in a towel prevents this.
2. Compress - use a pressure dressing or manual compression to slow or stop bleeding (internal)
3. Elevate - if the injury is a limb, elevate injured tissue above the heart. This will help to keep the swelling down, which decreases pain.
4. Splint - If necessary, splint above and below the wound to slow or stop bleeding and to reduce pain.

Always be alert for shock in major closed wound patients. This can result from internal bleeding, so be sure to evaluate them for such.

A concussion is a an injury to the brain, often resulting from a blow to the head, that can cause temporary disorientation, memory loss, or unconsciousness. If you or someone else has had a blunt force trauma to the head, seek medical attention immediately, because a concussion is a likely possibility, especially if they exhibit any of the signs listed previously.

Wound - Wound healing

See wound healing for a complete description

Categories: First aid | Medical emergencies | Traumatology

Adapted from the Wikipedia article "Wound", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki