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 .