FIRST AID AND
EMERGENCY CARE
LECTURE 6
WOUND AND WOUND CARE
DEFINITIONS
Wounds:
A wound is a break in the continuity of the
tissues of the body either internal or external.
CLASSIFICATION OF SOFT TISSUE
DAMAGE
1. Open wounds

An open wound is a break in the skin or the
mucous membrane.
Types of open wounds
 Abrasions: Wounds usually results when the
skin is scraped against a hard surface.
 Incisions: Body tissue cut on knives or sharp
objects



Lacerations: Irregular or blunt breaking or
tearing of soft tissues
Punctures: Produced by an object piercing skin
layers
Avulsions: Tissue is forcibly separated or torn
from the victim's body.
2. Closed wound

Involves injury to the underlying tissues without
a break in the skin or a mucous membrane.
MATERIAL FOR WOUND CARE
 Dressing- also called a compress, mostly it is
sterile gauze pads mainly to control bleeding
 Bandage- Any material used to hold a dressing
in place, need not to be sterile. Adhering
GENERAL PRINCIPLES OF EMERGENCY
CARE FOR OPEN WOUNDS
1. Expose the wound
2. Clean the wound surface with normal salin
3. Control bleeding
4. Prevent contamination (infection)
5. Gauze dressing
6. Bandage the dressing in place
7. Keep the patient lying still
8. Reassure the patient
Emergency Care for Minor Lacerated
or Incised Wounds
1. Most incisions and lacerations can be
managed by bandaging and dressing in place
2. A butterfly bandage is applied over the wound
3. Fix the butterfly bandage onto the skin
4. A gauze dressing is bandaged over the
butterfly strip
Emergency Care for Impaled (Pierce) Objects
1. Do not remove the impaled object
2. Expose the wound area
3. Control profuse bleeding by direct hand
4.
5.
6.
7.
pressure if possible
Stabilize the impaled object with a bulky
dressing
Provide oxygen at high concentration
Reassure and keep the patient at rest
Carefully transport the patient ASAP
Causes of traumatic wounds
Causes of wound
Blunt object
Sharp object
Glass
Wood
Bite
Human
Dog
Others
Distribution of patients
42
34
13
4
6
1
3
5
Distribution of traumatic wounds
Location of Wound
Head and Neck
Trunk
Upper Extremities
Lower Extremities
Distribution of Patients
51
2
34
13
Evaluation
History
1. Mechanism of injury
2. Time of injury
3. General medical condition
4. Allergies
5. Tetanus status
Exam
1. Size
2. Location
3. Contaminants
4. Neurovascular
5. Tendons
UNIVERSAL PRECAUTIONS
1. Wash hands carefully
2. Use protective barriers such as Gloves/ gowns/
masks/ eyewear
3. Keep clean environment
X LOCAL ANESTHESIA
There are two main groups of local anesthesia
A- Esters
1. Cocaine
2. Procaine (Novocain)
3. Benzocaine (Cetacaine)
4. Tetracaine (Pontocaine)
5. Chloroprocaine (Nesacaine)
X A- Amides
1. Lidocaine (Xylocaine)
2. Mepivacaine (Polocaine, Carbocaine)
3. Bupivacaine (Marcaine)
4. Etidocaine (Duranest)
5. Prilocaine
Skin and Wound preparation
1. Hair removal: remove all the hair around the
wound skin
2. Disinfecting the skin: use solutions such as
Normal Saline, Povidine-Iodine 10% and 1%,
Chlorhexidine 1% and 0.1%, Hydrogen
Peroxide, and Hexachlorophene
3. Irrigate wound with sterile (clean) water
4. Some wounds which are contaminated with
soil, dust, devitalized tissue, and clotted blood
need soaking first
5. Covered with gauze and left undisturbed for 4
to 5 days
6. If the wound is uninfected at the end of the
waiting period, it is closed with sutures or skin
tapes
Points to remember
1. An ‘ideal agent’ does not exist – either tissue
toxic or poorly bacteriostatic
2. Simple scrub water around wound should be
sufficient
3. No studies have demonstrated the impact of
cleaning intact skin on infection rate, however
it is important to decrease bacterial load to
minimize ongoing wound contamination.
4. Avoid mechanical scrubbing unless heavily
contaminated (increase inflammation in animal
data)
Tetanus





More than 250,000 cases annually worldwide
with 50% mortality
100 cases annually in USA
About 10% in patients with minor wound or
chronic skin lesion
In 20% of cases, no wound implicated
2/3 of cases in patients over age 50
Prophylactic Antibiotics
Indications
1. Bite wounds
2. Contaminated or devitalized wounds
3. High risk sites e.g. Foot
4. Immunocompromised
5. Risk for infective endocarditis
6. Intraoral through lacerations
7. Deep puncture wounds
8. Extensive soft tissue injury
Prophylactic Antibiotics
1. Amoxicillin, Clavulin
2. Keflex
3. Erythromycin

recommended course is 3 to 5 days