Wounds

A wound occurs when the integrity of any tissue is compromised (e.g. skin breaks, muscle tears, burns, or bone fractures). A wound may be caused by an act, such as a gunshot, fall, or surgical procedure; by an infectious disease; or by an underlying condition.

Types and causes of wounds are wide ranging, and health care professionals have several different ways of classifying them. They may be chronic, such as the skin ulcers caused by diabetes mellitus, or acute, such as a gunshot woundor animal bite. Wounds may also be referred to as open, in which the skin has been compromised and underlying tissues are exposed, or closed, in which the skin has not been compromised, but trauma to underlying structures has occurred (e.g. a bruised rib or cerebral contusion). Emergency personnel and first-aid workers generally place acute wounds in one of eight categories:

  • Abrasions. Also called scrapes, they occur when the skin is rubbed away by friction against another rough surface (e.g. rope burns and skinned knees).
  • Avulsions. Occur when an entire structure or part of it is forcibly pulled away, such as the loss of a permanent tooth or an ear lobe. Explosions,gunshots, and animal bites may cause avulsions.
  • Contusions. Also called bruises, these are the result of a forceful trauma that injures an internal structure without breaking the skin. Blows to the chest, abdomen, or headwith a blunt instrument (e.g. a football or a fist) can cause contusions.
  • Crush wounds. Occur when a heavy object falls onto a person, splittingthe skin and shattering or tearing underlying structures.
  • Cuts. Slicing wounds made with a sharp instrument, leaving even edges. They may be as minimal as a paper cut or as significant as a surgical incision.
  • Lacerations. Also called tears, these are separating wounds that produce ragged edges. They are produced by a tremendous force against the body, either from aninternal source as in childbirth, or from an external source like a punch.
  • Missile wounds. Also called velocity wounds, they are caused by an object entering the body at a high speed, typically a bullet.
  • Punctures.Deep, narrow wounds produced by sharp objects such as nails, knives, and broken glass.

Acute wounds have a wide range of causes. Often, they are the unintentional results of motor vehicle accidents, falls, mishandling of sharp objects, or sports-related injury. Wounds may also be an intentional result of violence involving assault with weapons, including fists, knives, or guns.

The general symptoms of a wound are localized pain and bleeding.

Treatment of wounds involves stopping any bleeding, then cleaning and dressing the wound to prevent infection. Additional medical attention may be required if the effects of the wound have compromised the body's ability to functioneffectively.

Most bleeding may be stopped by direct pressure. Direct pressure is applied by placing a clean cloth or dressing over the wound and pressing the palm of the hand over the entire area. This limits local bleeding without disrupting asignificant portion of the circulation. The cloth absorbs blood and allows clot formation; the clot should not be disturbed, so if blood soaks through the cloth, another cloth should be placed directly on top rather than replacingthe original cloth.

If the wound is on an arm or leg that does not appear to have a broken bone,the wound should be elevated to a height above the person's heart while direct pressure is applied. Elevating the wound allows gravity to slow down the flow of blood to that area.

Once the bleeding has been stopped, cleaning and dressing the wound is important for preventing infection. Although the flowing blood flushes debris fromthe wound, running water should also be used to rinse away dirt. Embedded particles such as wood slivers and glass splinters, if not too deep, may be removed with a needle or pair of tweezers that has been sterilized in rubbing alcohol or in the heat of a flame. Once the wound has been cleared of foreign material and washed, it should be gently blotted dry, with care not to disturbthe blood clot. An antibiotic ointment may be applied. The wound should thenbe covered with a clean dressing and bandaged to hold the dressing in place.

Additional medical attention is necessary in several instances. Wounds whichpenetrate the muscle beneath the skin should be cleaned and treated by a doctor. Such a wound may require stitches to keep it closed during healing. Somedeep wounds which do not extend to the underlying muscle may only require butterfly bandages to keep them closed during healing. Wounds to the face and neck, even small ones, should always be examined and treated by a doctor to preserve sensory function and minimize scarring. Deep wounds to the hands and wrists should be examined for nerve and tendon damage. Puncture wounds may require a tetanus shot to prevent serious infection. Animal bites should always be examined and the possibility of rabies infection determined.

Wounds which develop signs of infection should also be brought to a doctor'sattention. Signs of infection are swelling, redness, tenderness, throbbing pain, localized warmth, fever, swollen lymph glands, the presence of pus eitherin the wound or draining from it, and red streaks spreading away from the wound.

With even as little as one quart of blood lost, a person may lose consciousness and go into traumatic shock. Because this is life-threatening, emergency medical assistance should be called immediately. If the person stops breathing, artificial respiration (also called mouth-to-mouth resuscitation or rescuebreathing) should be administered. In the absence of a pulse, cardiopulmonaryresuscitation (CPR) must be performed. Once the person is breathing unassisted, the bleeding may be attended to.

Without the complication of infection, most wounds heal well with time. Depending on the depth and size of the wound, it may or may not leave a visible scar.

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