DOCSLIB.ORG

WOUND MANAGEMENT TYPES of WOUND • Contusion – Bruising Or

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
WOUND MANAGEMENT TYPES of WOUND • Contusion – Bruising Or WOUND MANAGEMENT TYPES OF WOUND • Contusion – bruising or haemorrhage. Caused by a blow from something blunt • Abrasion – caused by skin being scraped along a hard surface • Incision – clean cut/surgical. Skin, soft tissues and muscle may be severed • Laceration – jagged edges e.g. from teeth, claws, barbed wire. • Puncture – small entry. May have some internal damage and can become infected • Tear/Avulsion – skin and soft tissue partially or completely torn away • Cavity – chronic, open wound ASSESSING A WOUND HISTORY: A detailed, thorough history is essential for assessing the extent of injury and for organising appropriate wound management. • When did the injury occur? The longer the wound has been present, the more likely an infection will occur after closure • Where did the injury occur? What are the potential contaminants? E.g. saliva, pus, faeces, soil • How did the injury occur? Must assess any potential damage to deeper structures EXAMINATION: Important questions to consider during examination of a wound • Is there loss of function in the injured part? • Are important underlying structures involved e.g. nerves, major vessels, ligaments, bones? • What is the level of contamination? • Are any foreign bodies present? • What is the viability of the injured parts? Are any parts missing? ASSESSMENT: • Swelling • Pain • Surrounding skin colour (redness suggests infection) WOUND MANAGEMENT All open wounds need some sort of covering to help control bleeding, to prevent infection, and to reduce pain. Infection can be minimised by washing hands before and after management, wearing clean gloves, avoiding coughing, sneezing or talking while managing wound, handling the wound only when necessary to control severe bleeding and by using sterile or clean dressings. MINOR WOUNDS 1. Clean the wound thoroughly with gauze soaked in saline or cooled, boiled water 2. Apply a non-stick dressing MAJOR WOUNDS 1. Follow DRABC 2. Control bleeding – apply firm direct pressure, elevate bleeding part, apply pad over wound 3. Clean the wound as best as possible 4. Apply a sterile or clean dressing 5. Seek medical aid SPECIFIC WOUNDS: • Haematoma – follow RICE o REST the casualty and injured part o ICEPACKS wrapped in wet cloth applied to injury for 15 mins every 2hr for 24 hrs o COMPRESSION BANDAGES should be firmly applied to extend well beyond injury o ELEVATE the injured part • Abrasion/incision/laceration o Cleanse wound thoroughly with sterile gauze soaked in sterile water or cooled boiled water o Apply non-adherent dressing • Tear/avulsion o Return skin to original position if possible o Apply pressure to wound using a dressing and a pad to control any bleeding o Bandage • Embedded object: o DO NOT remove the foreign object o Control bleeding by applying pressure to surrounding area (not on foreign object) o Place a ring pad around the object and bandage over the padding o Call 000 • Penetrating wounds o Control bleeding by applying direct pressure around the wound o Keep wound as clean as possible – DO NOT try to pick out any embedded foreign material o Apply a clean or sterile dressing o Rest the injured person in a comfortable position o Call 000 • Bleeding from the scalp o Follow DRABC o If you suspect a fracture, control bleeding with gentle pressure around wound o If there appears to be no fracture, control bleeding with firm direct pressure o If casualty’s condition permits, sitting up may help control bleeding o Monitor casualty’s condition • Snake and Spider bite o DO NOT wash venom off skin or cut/suck venom out or try to catch the snake/spider o DO NOT use a constrictive bandage e.g. arterial tourniquet o Check breathing and pulse → follow DRABC o Calm casualty o Apply pressure immobilisation bandage Apply a firm roller bandage starting just above fingers/toes and moving up limb as far as can be reached Bandage needs to be firm but not too tight – check circulation o Immobilise casualty Apply a splint to immobilise bitten limb If possible, ensure casualty does not move o NB – Red Back Spiders – apply icepack to bitten area and seek medical aid WOUND DRESSING The main aims of wound dressing are to control bleeding and protect the wound from infection. General principles for applying dressings: • Wash hands before putting on clean disposable gloves • Use sterile dressing that extends about 2cm past the edges of the wound • Do not touch the surface that will contact the wound • If the wound is minor, clean with sterile or clean water before applying the dressing • Replace at least once a day any dressing which becomes wet or soiled • Wash hands after removing gloves TYPES OF DRESSING • Adhesive dressings – Generally used for minor wounds • Non – adherent dressings - used with any injury but are especially useful for burns and abrasions where the injury is to the surface of the skin and it is important to prevent blood and fluids sticking to the dressing. • Combine and BPC dressings – these combine a bandage and pad dressings in one unit and are used for large or deep wounds. Because they are made of layers of gauze and cotton wool, their bulk is useful for controlling bleeding and for absorbing discharge • Bandages –any material used to wrap or cover a wound. Bandages are used to keep dressings in place, to control bleeding, protect a wound from infection, give support and pain relief, to restrict movement and minimise swelling and to immobilise limbs REFERENCES: • The McGraw Hill Companies, Inc (2008) “Current Diagnosis & Treatment: Emergency Medicine” 6th Edition • St. John Ambulance Australia (1998) “Australian First Aid” 3rd Edition .
Load more

Recommended publications
  • Recognizing When a Child's Injury Or Illness Is Caused by Abuse
    U.S. Department of Justice Office of Justice Programs Office of Juvenile Justice and Delinquency Prevention Recognizing When a Child’s Injury or Illness Is Caused by Abuse PORTABLE GUIDE TO INVESTIGATING CHILD ABUSE U.S. Department of Justice Office of Justice Programs 810 Seventh Street NW. Washington, DC 20531 Eric H. Holder, Jr. Attorney General Karol V. Mason Assistant Attorney General Robert L. Listenbee Administrator Office of Juvenile Justice and Delinquency Prevention Office of Justice Programs Innovation • Partnerships • Safer Neighborhoods www.ojp.usdoj.gov Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov The Office of Juvenile Justice and Delinquency Prevention is a component of the Office of Justice Programs, which also includes the Bureau of Justice Assistance; the Bureau of Justice Statistics; the National Institute of Justice; the Office for Victims of Crime; and the Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking. Recognizing When a Child’s Injury or Illness Is Caused by Abuse PORTABLE GUIDE TO INVESTIGATING CHILD ABUSE NCJ 243908 JULY 2014 Contents Could This Be Child Abuse? ..............................................................................................1 Caretaker Assessment ......................................................................................................2 Injury Assessment ............................................................................................................4 Ruling Out a Natural Phenomenon or Medical Conditions
    [Show full text]
  • Protocols for Injuries to the Eye Corneal Abrasion I
    PROTOCOLS FOR INJURIES TO THE EYE CORNEAL ABRASION I. BACKGROUND A corneal abrasion is usually caused by a foreign body or other object striking the eye. This results in a disruption of the corneal epithelium. II. DIAGNOSTIC CRITERIA A. Pertinent History and Physical Findings Patients complain of pain and blurred vision. Photophobia may also be present. Symptoms may not occur for several hours following an injury. B. Appropriate Diagnostic Tests and Examinations Comprehensive examination by an ophthalmologist to rule out a foreign body under the lids, embedded in the cornea or sclera, or penetrating into the eye. The comprehensive examination should include a determination of visual acuity, a slit lamp examination and a dilated fundus examination when indicated. III. TREATMENT A. Outpatient Treatment Topical antibiotics, cycloplegics, and pressure patch at the discretion of the physician. Analgesics may be indicated for severe pain. B. Duration of Treatment May require daily visits until cornea sufficiently healed, usually within twenty-four to seventy-two hours but may be longer with more extensive injuries. In uncomplicated cases, return to work anticipated within one to two days. The duration of disability may be longer if significant iritis is present. IV. ANTICIPATED OUTCOME Full recovery. CORNEAL FOREIGN BODY I. BACKGROUND A corneal foreign body most often occurs when striking metal on metal or striking stone. Auto body workers and machinists are the greatest risk for a corneal foreign body. Hot metal may perforate the cornea and enter the eye. Foreign bodies may be contaminated and pose a risk for corneal ulcers. II. DIAGNOSTIC CRITERIA A. Pertinent History and Physical Findings The onset of pain occurs either immediately after the injury or within the first twenty-four hours.
    [Show full text]
  • Skin Injuries – Can We Determine Timing and Mechanism?
    Skin injuries – can we determine timing and mechanism? Jo Tully VFPMS Seminar 2016 What skin injuries do we need to consider? • Bruising • Commonest accidental and inflicted skin injury • Basic principles that can be applied when formulating opinion • Abrasions • Lacerations }we need to be able to tell the difference • Incisions • Stabs/chops • Bite marks – animal v human / inflicted v ‘accidental’ v self-inflicted Our role…. We are often/usually/always asked…………….. • “What type of injury is it?” • “When did this injury occur?” • “How did this injury occur?” • “Was this injury inflicted or accidental?” • IS THIS CHILD ABUSE? • To be able to answer these questions (if we can) we need knowledge of • Anatomy/physiology/healing - injury interpretation • Forces • Mechanisms in relation to development, plausibility • Current evidence Bruising – can we really tell which bruises are caused by abuse? Definitions – bruising • BLUNT FORCE TRAUMA • Bruise =bleeding beneath intact skin due to BFT • Contusion = bruise in deeper tissues • Haematoma - extravasated blood filling a cavity (or potential space). Usually associated with swelling • Petechiae =Pinpoint sized (0.1-2mm) hemorrhages into the skin due to acute rise in venous pressure • medical causes • direct forces • indirect forces Medical Direct Indirect causes mechanical mechanical forces forces Factors affecting development and appearance of a bruise • Properties of impacting object or surface • Force of impact • Duration of impact • Site - properties of body region impacted (blood supply,
    [Show full text]
  • Medical Term for Scrape
    Medical Term For Scrape protozoologicalIncomprehensible Mack Willmott federalized fraction fermentation some decimeter and tickle after hishyphenated rusticator Thornie revengingly overtasks and owlishly. perforce. Zedekiah Lecherous and andbeseeched grippier. his focussing lobes challengingly or contritely after Mayor knee and previews angelically, unmasking Ttw is for scrape may require stitches to medications and support a knee sprains heal closed wounds such as terms at harvard medical history does not. This medical terms for scraping can be. Ancient Chinese medical treatment leaves lasting impressions. Lifting the cloth, gauze, or bandage to check on the wound may cause additional bleeding, so it is important to continue to maintain firm pressure over the abrasion. Many people with their expertise in cross section is the risk for teaching hospital but all are a scrape for their location. Please stand by, while we are checking your browser. It helps prepare the tooth for this procedure and can also be used on the root of a tooth is needed. Abrasion this grant the medical term for scraped skin This happens when an injury scrapes off the particular layer of talking skin A person may say the he. How to scrape for scrapes and ice pack or treatment may be avoided in terms as a term for dentures that gives back to treat a lawyer. Antibiotics For Wound Infection PlushCare. Gua sha Scraping of low is able to relieve pain more ease. Awareness of your surroundings and paying close trip to in you need doing my help manual the likelihood of an accidental scrape, plane, or injury. Please consult your health care provider with any questions or concerns you may have regarding your condition.
    [Show full text]
  • Wound Classification
    Wound Classification Presented by Dr. Karen Zulkowski, D.N.S., RN Montana State University Welcome! Thank you for joining this webinar about how to assess and measure a wound. 2 A Little About Myself… • Associate professor at Montana State University • Executive editor of the Journal of the World Council of Enterstomal Therapists (JWCET) and WCET International Ostomy Guidelines (2014) • Editorial board member of Ostomy Wound Management and Advances in Skin and Wound Care • Legal consultant • Former NPUAP board member 3 Today We Will Talk About • How to assess a wound • How to measure a wound Please make a note of your questions. Your Quality Improvement (QI) Specialists will follow up with you after this webinar to address them. 4 Assessing and Measuring Wounds • You completed a skin assessment and found a wound. • Now you need to determine what type of wound you found. • If it is a pressure ulcer, you need to determine the stage. 5 Assessing and Measuring Wounds This is important because— • Each type of wound has a different etiology. • Treatment may be very different. However— • Not all wounds are clear cut. • The cause may be multifactoral. 6 Types of Wounds • Vascular (arterial, venous, and mixed) • Neuropathic (diabetic) • Moisture-associated dermatitis • Skin tear • Pressure ulcer 7 Mixed Etiologies Many wounds have mixed etiologies. • There may be both venous and arterial insufficiency. • There may be diabetes and pressure characteristics. 8 Moisture-Associated Skin Damage • Also called perineal dermatitis, diaper rash, incontinence-associated dermatitis (often confused with pressure ulcers) • An inflammation of the skin in the perineal area, on and between the buttocks, into the skin folds, and down the inner thighs • Scaling of the skin with papule and vesicle formation: – These may open, with “weeping” of the skin, which exacerbates skin damage.
    [Show full text]
  • Gunshot Wounds
    Gunshot Wounds Michael Sirkin, MD Chief, Orthopaedic Trauma Service Assistant Professor, New Jersey Medical School North Jersey Orthopaedic Institute Created March 2004; Reviewed March 2006, August 2010 Ballistics • Most bullets made of lead alloy – High specific gravity • Maximal mass • Less effect of air resistance • Bullet tips – Pointed – Round – Flat – Hollow Ballistics • Low velocity bullets – Made of low melting point lead alloys – If fired from high velocity they melt, 2° to friction • Deform • Change missile ballistics • High velocity bullets – Coated or jacketed with a harder metal – High temperature coating – Less deformity when fired Velocity • Energy = ½ mv2 • Energy increases by the square of the velocity and linearly with the mass • Velocity of missile is the most important factor determining amount of energy and subsequent tissue damage Kinetic Energy of High and Low Velocity Firearms Kinetic Energy of Shotgun Shells Wounding power • Low velocity, less severe – Less than 1000 ft/sec – Less than 230 grams • High velocity, very destructive – Greater than 2000 ft/sec – Weight less than 150 grams • Shotguns, very destructive at close range – About 1200 ft/sec – Weight up to 870 grams Factors that cause tissue damage • Crush and laceration • Secondary missiles • Cavitation • Shock wave Crush and Laceration • Principle mechanism in low velocity gunshot wounds • Material in path is crushed or lacerated • The kinetic energy is dissipated • Increased tissue damage with yaw or tumble – Increased profile – Increased rate of kinetic
    [Show full text]
  • Pressure Ulcer Staging Cards and Skin Inspection Opportunities.Indd
    Pressure Ulcer Staging Pressure Ulcer Staging Suspected Deep Tissue Injury (sDTI): Purple or maroon localized area of discolored Suspected Deep Tissue Injury (sDTI): Purple or maroon localized area of discolored intact skin or blood-fi lled blister due to damage of underlying soft tissue from pressure intact skin or blood-fi lled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, fi rm, mushy, boggy, and/or shear. The area may be preceded by tissue that is painful, fi rm, mushy, boggy, warmer or cooler as compared to adjacent tissue. warmer or cooler as compared to adjacent tissue. Stage 1: Intact skin with non- Stage 1: Intact skin with non- blanchable redness of a localized blanchable redness of a localized area usually over a bony prominence. area usually over a bony prominence. Darkly pigmented skin may not have Darkly pigmented skin may not have visible blanching; its color may differ visible blanching; its color may differ from surrounding area. from surrounding area. Stage 2: Partial thickness loss of Stage 2: Partial thickness loss of dermis presenting as a shallow open dermis presenting as a shallow open ulcer with a red pink wound bed, ulcer with a red pink wound bed, without slough. May also present as without slough. May also present as an intact or open/ruptured serum- an intact or open/ruptured serum- fi lled blister. fi lled blister. Stage 3: Full thickness tissue loss. Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible but Subcutaneous fat may be visible but bone, tendon or muscle are not exposed.
    [Show full text]
  • Penetrating Injury to the Head: Case Reviews K Regunath, S Awang*, S B Siti, M R Premananda, W M Tan, R H Haron**
    CASE REPORT Penetrating Injury to the Head: Case Reviews K Regunath, S Awang*, S B Siti, M R Premananda, W M Tan, R H Haron** *Department of Neurosciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, **Department of Neurosurgery, Hospital Kuala Lumpur the right frontal lobe to a depth of approximately 2.5cm. SUMMARY (Figure 1: A & B) There was no obvious intracranial Penetrating injury to the head is considered a form of severe haemorrhage along the track of injury. The patient was taken traumatic brain injury. Although uncommon, most to the operating theatre and was put under general neurosurgical centres would have experienced treating anaesthesia. The nail was cut proximal to the entry wound patients with such an injury. Despite the presence of well and the piece of wood removed. The entry wound was found written guidelines for managing these cases, surgical to be contaminated with hair and debris. The nail was also treatment requires an individualized approach tailored to rusty. A bicoronal skin incision was fashioned centred on the the situation at hand. We describe a collection of three cases entry wound. A bifrontal craniotomy was fashioned and the of non-missile penetrating head injury which were managed bone flap removed sparing a small island of bone around the in two main Neurosurgical centres within Malaysia and the nail (Figure 1: C&D). Bilateral “U” shaped dural incisions unique management approaches for each of these cases. were made with the base to the midline. The nail was found to have penetrated with dura about 0.5cm from the edge of KEY WORDS: Penetrating head injury, nail related injury, atypical penetrating the sagittal sinus.
    [Show full text]
  • What Everyone Should Know to Stop Bleeding After an Injury
    What Everyone Should Know to Stop Bleeding After an Injury THE HARTFORD CONSENSUS The Joint Committee to Increase Survival from Active Shooter and Intentional Mass Casualty Events was convened by the American College of Surgeons in response to the growing number and severity of these events. The committee met in Hartford Connecticut and has produced a number of documents with rec- ommendations. The documents represent the consensus opinion of a multi-dis- ciplinary committee involving medical groups, the military, the National Security Council, Homeland Security, the FBI, law enforcement, fire rescue, and EMS. These recommendations have become known as the Hartford Consensus. The overarching principle of the Hartford Consensus is that no one should die from uncontrolled bleeding. The Hartford Consensus recommends that all citizens learn to stop bleeding. Further information about the Hartford Consensus and bleeding control can be found on the website: Bleedingcontrol.org 2 SAVE A LIFE: What Everyone Should Know to Stop Bleeding After an Injury Authors: Peter T. Pons, MD, FACEP Lenworth Jacobs, MD, MPH, FACS Acknowledgements: The authors acknowledge the contributions of Michael Cohen and James “Brooks” Hart, CMI to the design of this manual. Some images adapted from Adam Wehrle, EMT-P and NAEMT. © 2017 American College of Surgeons CONTENTS SECTION 1 3 ■ Introduction ■ Primary Principles of Trauma Care Response ■ The ABCs of Bleeding SECTION 2 5 ■ Ensure Your Own Safety SECTION 3 6 ■ A – Alert – call 9-1-1 SECTION 4 7 ■ B – Bleeding – find the bleeding injury SECTION 5 9 ■ C – Compress – apply pressure to stop the bleeding by: ■ Covering the wound with a clean cloth and applying pressure by pushing directly on it with both hands, OR ■Using a tourniquet, OR ■ Packing (stuff) the wound with gauze or a clean cloth and then applying pressure with both hands SECTION 6 13 ■ Summary 2 SECTION 1: INTRODUCTION Welcome to the Stop the Bleed: Bleeding Control for the Injured information booklet.
    [Show full text]
  • Wound Care: the Basics
    Wound Care: The Basics Suzann Williams-Rosenthal, RN, MSN, WOC, GNP Norma Branham, RN, MSN, WOC, GNP University of Virginia May, 2010 What Type of Wound is it? How long has it been there? Acute-generally heal in a couple weeks, but can become chronic: Surgical Trauma Chronic -do not heal by normal repair process-takes weeks to months: Vascular-venous stasis, arterial ulcers Pressure ulcers Diabetic foot ulcers (neuropathic) Chronic Wounds Pressure Ulcer Staging Where is it? Where is it located? Use anatomical location-heel, ankle, sacrum, coccyx, etc. Measurements-in centimeters Length X Width X Depth • Length = greatest length (head to toe) • Width = greatest width (side to side) • Depth = measure by marking the depth with a Q- Tip and then hold to a ruler Wound Characteristics: Describe by percentage of each type of tissue: Granulation tissue: • red, cobblestone appearance (healing, filling in) Necrotic: • Slough-yellow, tan dead tissue (devitalized) • Eschar-black/brown necrotic tissue, can be hard or soft Evaluating additional tissue damage: Undermining Separation of tissue from the surface under the edge of the wound • Describe by clock face with patients head at 12 (“undermining is 1 cm from 12 to 4 o’clock”) Tunneling Channel that runs from the wound edge through to other tissue • “tunneling at 9 o’clock, measuring 3 cm long” Wound Drainage and Odor Exudate Fluid from wound • Document the amount, type and odor • Light, moderate, heavy • Drainage can be clear, sanguineous (bloody), serosanguineous (blood-tinged),
    [Show full text]
  • Immune Thrombocytopenic Purpura in a Twin Girl Revealed by a Traumatic Injury in Parakou (North Benin)
    Immune thrombocytopenic purpura in a twin girl revealed by a traumatic injury in parakou (North Benin) Adedemy JD 1*, Noudamadjo A 1, Kpanidja G 1, Agossou J 1, Agbeille Mohamed F 1, Dovonou CA 2 1 Mother and Child Department, Parakou Teaching Hospital, Republic of Benin, and Faculty of Medicine, University of Parakou West Africa 2 Department of Medicine, Parakou Teaching Hospital, and Faculty of Medicine, University of Parakou, West Africa Abstract Background: ITP seems to be rare but in tropical settings thrombocytopenia is often encountered among children. Objective: Authors through this case report are putting emphasy on the diagnosis and management of ITP in a 4 year old twin girl admitted in the pediatric emergency ward for hematuria and bleeding from various origins seen in the context of a domestic trauma. Results: The various clinical signs have been analyzed to confirm ITP through exclusion of other possible health conditions. The management of ITP depend on the severity of clinical signs and in some cases the situations can be life threatening. In this case report, Blood transfusion and corticosteroids were the main treatment tools. The hospital stay was about 47 days and an ambulatory follow up was conducted for almost 6 months. Conclusion: In the context of various bleeding disorders, hematuria and thrombocytopenia, autoimmune thrombocytopenia in a twin girl was revealed by a domestic trauma. Citation: Adedemy JD, Noudamadjo A, Kpanidja G, Agossou J, Agbeille MF, Dovonou CA (2019) Immune Thrombocytopenic Purpura in a twin girl revealed by a traumatic injury in Parakou (North Benin). Adv Pediatr Res 6:27.
    [Show full text]
  • Wound Healing in Surgery for Trauma a Randomised Controlled Trial Of
    UK WHIST – Wound Healing in Surgery for Trauma A Randomised Controlled Trial of standard wound management versus negative pressure wound therapy in the treatment of adult patients having surgical incisions for major trauma to the lower limb Protocol version 3.0 13 October 2016 Ethical approval MREC approval was obtained on the 16th of February 2016 under reference number 16/WM/0006 Funding This study is funded by the National Institute of Health Research under reference number 14/199/14 Sponsorship The University of Oxford is the sponsor of this study. Registration The study has been registered with the ISRCTN registry under reference number ISRCTN12702354, and on the NIHR Portfolio PID number 20416 Dates Study start date: 01/01/2016 Study end date: 30/04/2023 Protocol Amendments: Amendment Number Date of Amendment Date of Approval Protocol Version 1 02 March 2016 18 March 2016 V2.0 4 18 October 2016 03 November 2016 V3.0 WHIST Protocol PAGE 1 OF 25 V 3.0 | 13Oct 2016 IRAS Project ID 192580 Table of contents TABLE OF CONTENTS .................................................................................................................... 2 ABBREVIATIONS........................................................................................................................... 3 1. CONTACT DETAILS .................................................................................................................... 4 2. SYNOPSIS ................................................................................................................................
    [Show full text]