First Aid Wounds

1. Chapter 9
Wounds

2. Open Wounds
• A break in the skin’s surface resulting in
external bleeding
• May allow bacteria to enter the body,
causing an infection

3. Types of Open Wounds
• Abrasion
– Top layer of skin removed
– Little or no blood loss
– Painful
© American Academy of Orthopaedic Surgeons.

4. Types of Open Wounds
• Laceration
– Cut with jagged,
irregular edges
– Tearing away of skin
tissue
• Incision
– Smooth edges
© Scott Camazine/Alamy.
© American Academy of Orthopaedic Surgeons.

5. Types of Open Wounds
• Puncture
– Deep, narrow
– High risk of infection
• Avulsion
– Flap of skin torn loose
• Amputation
– Cutting or tearing off of
body part
© American Academy of Orthopaedic Surgeons.
© American Academy of Orthopaedic Surgeons.

6. Care for Open Wounds
• Protect yourself from disease (exam
gloves, etc.).
• Expose the wound.
• Control bleeding with direct pressure.

7. Cleaning a Wound
• Scrub hands with
soap and water.
• Clean wound.
– For shallow wound:
• Wash with soap and
water.
• Flush with clean
water under pressure.
© Jones & Bartlett Learning.

8. Cleaning a Wound
• Clean wound (cont’d).
− For wound with higher infection risk:
• Clean wound.
• Seek medical care for additional cleaning.
• Use tweezers to remove remaining
embedded debris.
• If bleeding restarts, apply direct pressure.

9. Covering a Wound
• Dressing: applied over a wound to control
bleeding and prevent contamination
− Should be sterile or as clean as possible
• Bandage: holds dressing in place
– Need not be sterile

10. Covering a Wound
• If the wound is small, apply thin layer of
antibiotic ointment.
• Cover with a sterile dressing.
• Do not pull off dressing that has become
stuck.
– If you must remove, soak in warm water.
• Change wet or dirty dressings.

11. When to Seek Medical Care
• High risk wounds
– Embedded foreign material
– Animal and human bites
– Puncture wounds
– Ragged, large, or deep wounds
– Visible bone, joint, muscle, fat, or tendon
– Wound entering joint or body cavity
– “Fight bite”

12. • Wounds needing sutures
– Best placed within 6 to 8 hours
• Anyone who has not had a tetanus
vaccination within 10 years
– 5 years in the case of a dirty wound
When to Seek Medical Care

13. Risk of Infection
• Wounds with foreign material
• Ragged or crushed tissue
• Injury to underlying nerves, tendons, joints
• Bite wounds
• Hand and foot wounds
• Puncture wounds or wounds that cannot
drain

14. Infected Wound:
What to Look For
• Swelling and redness around the wound
• Sensation of warmth
• Throbbing pain
• Pus discharge
• Fever
• Swelling of lymph nodes
• Red streaks leading from wound toward
heart
© Dr. P. Marazzi/Photo Researchers, Inc.

15. Infected Wound: What to Do
• Soak wound in warm water, or apply
warm, wet packs over infected wound.
• Apply antibiotic ointment.
• Change dressings several times per day.
• Give pain medication.
• Seek medical care if the infection persists
or worsens.

16. Tetanus
• Caused by toxin-producing bacterium
• Travels to nervous system
• Causes muscle contraction (lockjaw)
• No known antidote to toxin
• Tetanus vaccine and boosters can prevent
the disease.

17. Tetanus
• Seek vaccine and/or booster if:
– Never immunized
– No tetanus booster in past 10 years
– Dirty, contaminated wound and no booster in
past 5 years
• Must receive within 72 hours

18. Amputations and Avulsions
• In many cases, an amputated extremity
can be successfully reattached.
• Avulsions most often involve ears, fingers,
and hands.
– Can bleed heavily

19. Types of Amputations
• Clean
− Clean-cut, complete
• Crushing
− Crushed or mashed off
• Degloving
– Skin is peeled off.
© Chuck Stewart, MD.

20. Amputations: What to Do
© Jones & Bartlett Learning.
• Call 9-1-1.
• Control bleeding and treat
for shock.
• Care for the part:
– Wrap in a wet sterile gauze
or a clean cloth.
– Put in a waterproof
container of ice.
– Send to the medical facility.

21. Avulsions: What to Do
• Gently move the skin back to normal
position.
• Cover with sterile or clean dressing and
apply pressure.
• If bleeding continues, apply tourniquet or
hemostatic dressing, if available.

22. Blisters
• A collection of fluid in a
bubble under the outer
layer of skin
• Caused by repeated
rubbing of the skin
• Treatable and
preventable
© Maximillian Weinzierl/Alamy.

23. Blisters: What to Do
• Hot spot
– Relieve pressure by applying:
• Blister bandage
• Surgical tape
• Elastic tape
– Trim and round edges of tape.
• Blister that is closed and not very painful
– Use the most appropriate method discussed.

24. Blisters: What to Do
• Blister that is closed and very painful
– Clean blister and needle with alcohol pad.
– Make several small holes at base of blister
with needle.
© Jones & Bartlett Learning.

25. Blisters: What to Do
• Blister that is closed and very painful
(cont’d)
– Apply paper tape and cover with elastic or
adhesive tape.
• Trim and round edges of tape.
– Watch for signs of infection.

26. Blisters: What to Do
• Blister that is very painful and open or torn
– Trim off dead skin.
– Place blister pad over raw skin; cover with
paper tape.
– Cover with elastic or adhesive tape.
• Round edges of tape.
– Watch for signs of infection.

27. Impaled (Embedded) Objects
• Embedded objects should be stabilized to
prevent internal damage.
© American Academy of Orthopaedic Surgeons.

28. Sliver (Splinter): What to Do
• Remove with tweezers.
• Wash the area with soap and water.
• Apply antibiotic ointment.
• Apply adhesive bandage.

29. Large Impaled Object:
What to Do
• Stabilize object.
• If bleeding, apply direct pressure around
base of object.
• If necessary, reduce length or weight of
object by cutting or breaking it.
• Call 9-1-1.

30. Impaled Object in Cheek:
What to Do
• If you are more than 1 hour from medical
help, consider removing it.
– To remove object:
• Place two fingers next to object.
• Gently pull it in the direction from which it entered.
– If it cannot be removed easily:
• Leave it in place.
• Secure with bulky dressings.

31. Impaled Object in Cheek:
What to Do
• Control the bleeding.
– After removing object, place dressings over
wound inside mouth.
– Place dressing over outside of wound.

32. Impaled Object in Eye:
What to Do
• Do not exert pressure on eyeball.
• Stabilize object.
– If long: use bulky dressing and place paper
cup or cone over eye.
– If short: surround eye with ring pad held in
place with roller bandage.
• Cover undamaged eye.
• Call 9-1-1.

33. Cactus Spines: What to Do
• Removal methods:
– Tweezers
– Glue or rubber cement
• Apply in thin layer.
• Allow to dry and roll up dried glue.
• Combination of tweezers and glue most effective
– Adhesive, duct, or cellophane tape

34. Fishhooks: What to Do
• Tape fishhook in place.
• If barb has not penetrated skin:
– Remove by “backing out.”
– Treat as puncture wound.
– Seek care for tetanus.
• If barb has entered skin:
– Transport person.
– If far from medical care, remove hook with
pliers or string-jerk method.
© Tosh Brown/Alamy.

35. Fishhooks: What to Do
• Pliers method
– Apply an ice pack or
hard pressure.
– Push further in until it
emerges through skin.
– Cut off barb with pliers
and push hook back out
through entry.
© Jones & Bartlett Learning.

36. Fishhooks: What to Do
• String-jerk method
– Loop fishing line over
curve of hook.
– Stabilize and apply
pressure.
– Press down on shank
and eye; jerk line out.
• Movement parallel to
skin’s surface
© Jones & Bartlett Learning.

37. Closed Wounds
• Caused by strike with blunt object
• Skin is not broken, but tissue and blood
vessels are crushed.
• Types of closed wounds:
– Bruises and contusions
– Hematomas
– Crush injuries

38. Closed Wounds: What to Do
• Apply an ice pack.
• Injured limb
– Apply elastic bandage for compression.
– Splint limb.
• Check for fractures.
• Elevate extremity above heart level.

39. Wounds Requiring Medical Care
• Long or deep and needs stitches
• Over a joint
• Animal or human bite
• Impairs function of eye, eyelid, or lip
• All layers of skin removed
• Caused by a metal object or a puncture
wound
• Over possible broken bone

40. Wounds Requiring Medical Care
• Deep, jagged, or gaping open
• Involves damage to underlying bones,
joints, or tendons
• Foreign material embedded
• Cuts that show signs of infection
• Cuts that include issues with movement or
sensation, or increased pain

41. Wounds Requiring Medical Care
• Call 9-1-1 immediately if:
– Bleeding does not slow within 15 minutes.
– Signs of shock
– Cut to neck or chest causes difficulty
breathing.
– Deep cut to abdomen, painful
– Eyeball cut
– Amputation or partial amputation

42. Sutures (Stitches)
• Within 6 to 8 hours of injury
• Benefits
– Faster healing
– Reduced infection and scarring
• Wound does not require sutures if:
– Cut edges of skin fall together.
– Cut is shallow.

43. Gunshot Wounds
• At the scene of an active shooter: run,
hide, fight
• Bullet causes injury by:
– Laceration and crushing
– Shock waves and temporary cavitation

44. Gunshot Wounds:
What to Look For
• Penetrating wound—entry only
• Perforating wound—entry and exit points
© American Academy of Orthopaedic Surgeons.© American Academy of Orthopaedic Surgeons.

45. Gunshot Wounds: What to Do
• Monitor person’s breathing.
• Expose the wound(s).
• Control bleeding with direct pressure.
• Apply dry, sterile dressings and bandage.
• Treat person for shock; keep calm.
• Seek immediate medical care.

46. Legal Implications of
Gunshot Wounds
• Keep accurate record of observations.
• Preserve evidence, such as shells or
casings.
• Do not touch or move anything unless it is
necessary.
• All gunshot wounds must be reported to
police.