Lesson Outlines
Chapter 9
Lesson 9: Wounds
Lesson Objectives
After completing this lesson, participants should be able to:
 Identify types of open wounds.
 Describe and demonstrate how to care for external bleeding.
 Identify signs of internal bleeding and describe how to care for internal bleeding.
 Describe how to care for a wound to prevent infection.
 Describe how to recognize an infected wound.
 Describe how to care for an amputation.
 Describe how to care for an impaled object.
Points
Open Wounds
 An open wound is a break in the skin’s surface resulting in external bleeding.
 May allow bacteria to enter the body, causing an infection
Types of Open Wounds
 Abrasion: Top layer of skin is removed
 Laceration: Cut skin with jagged edges
 Incisions: Smooth edges and resemble a surgical or paper cut
 Punctures: Usually deep, narrow wounds such as a stab wound from a nail or
knife
 Avulsion: Piece of skin is partially torn away from the body
 Amputation: The cutting or tearing off a body part
Care for Open Wounds
 Protect yourself from disease by wearing medical exam gloves.
 If gloves are not available, use several layers of gauze pads, clean cloths, plastic
wrap or bags, or waterproof material.
 Expose the wound.
 Control bleeding by using direct pressure or other methods as necessary.
 Wash with soap and water
Wound Cleaning
 Shallow wound
o Wash inside the wound with soap and water.
o Flush with clean water.
 Wound with high risk for infection
o Seek medical care for wound cleaning.
o If in remote area, clean wound as best you can.
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o Remove small objects not flushed out with sterile tweezers.
o If bleeding restarts, apply direct pressure over the wound.
Wounds with a high potential for infection:
o Bite wounds
o Very dirty, contaminated wounds
o Crushing, ragged wounds
o Wounds over injured bone, joint, or tendon
o Puncture wounds
Covering a Wound
 Cover with a thin layer of antibiotic ointment.
 Cover the wound with a sterile dressing, but do not close the wound with tape or
butterfly bandages.
 If a wound bleeds after a dressing has been applied and the dressing becomes
stuck, leave it on as long as the wound is healing.
 If a dressing becomes wet or dirty, change it.
When to Seek Medical Care
 High-risk wounds should receive medical care.
o Embedded foreign material
o Animal and human bites
o Puncture wounds
o Ragged wounds
o Large or deep wounds
o Wounds where edges do not come together spontaneously
o Wounds with visible bone, joint, muscle, fat, or tendons
o Wounds that may have entered a joint or body cavity
o “Fight bites”
 Sutures are best placed within 6 to 8 hours after the injury.
 Victims who have not had a tetanus vaccination within 10 years (5 years in the
case of a dirty wound) should seek medical attention within 72 hours to update
tetanus inoculation status.
Signs of Infection
 Swelling and redness around the wound
 A sensation of warmth
 Throbbing pain
 Pus discharge
 Fever
 Swelling of lymph nodes
 One or more red streaks leading from the wound toward the heart (a serious sign
that the infection is spreading and could lead to death)
Care for Infected Wound
 Keep area clean.
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Soak the wound in warm water or apply warm, wet packs.
Elevate the infected portion of the body.
Apply antibiotic ointment.
Change the dressings daily.
Seek medical help if infection persists or becomes worse.
Tetanus
 Also called lockjaw because one symptom is tightening of the jaw muscles.
 Caused by a toxin produced by a bacterium that is found throughout the world.
 Tetanus causes at least 500,000 and perhaps as many as 1 million deaths each
year.
 When tetanus bacterium enters a wound that contains little oxygen, the bacterium
produces a powerful poisonous toxin.
 There is no known antidote to the toxin once it enters the nervous system.
 A tetanus vaccination can completely prevent the disease.
Amputations
 In many cases, an amputated extremity can be successfully replanted (reattached).
 Types of amputations
o Guillotine amputation: clean-cut, complete detachment
o Crushing amputation: extremity is crushed or mashed off
o Degloving: sin is peeled off like a glove
Care for Amputations
 Control the bleeding with direct pressure.
 Treat the victim for shock.
 Recover the amputated part.
 Wrap the part in gauze, place it in a bag, and keep the bag cool.
 Transport the part with the victim.
 Seek medical care immediately.
Blisters
 A blister is a collection of fluid in a “bubble” under the outer layer of skin.
 Repeated rubbing of a small area of the skin will produce a blister.
Care for Blisters
 Try to avoid the risk of infection.
 Minimize the victim’s pain and discomfort.
 Limit the blister’s development.
 Promote a fast recovery.
 If a blister on the foot is open or very painful
 Clean with soap and water.
 Drain all fluid out by making small holes with sterilized needle.
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Apply several layers of moleskin or molefoam.
Apply antibiotic ointment in the hole and cover it securely with tape.
Impaled (Embedded) Objects
 Many kinds of objects can become impaled.
o Pencils
o Screwdrivers
o Knives
o Glass
o Steel rods
o Fence posts
 Proper first aid requires that the impaled object be stabilized because there can be
significant internal damage.
Care for Embedded (Impaled) Objects
 Expose the area.
 Do not remove or move the impaled object.
 Control bleeding.
 Stabilize the object with bulky dressings.
Slivers
 Small slivers of wood, glass, thorns, or metal can be painful and irritating and can
cause infection.
 Usually can be easily removed with tweezers.
 After removal, clean the area with soap and water and apply adhesive strip.
 Cactus spines
o Use a thin layer of white wood-working glue or rubber cement over area
and roll up dried glue to remove spines.
 Fishhooks
o Use pliers with tempered jaws that can cut through a hook.
o The fishline method is another method for removing fishhooks.
Closed Wounds
 A closed wound results when a blunt object strikes the body.
 The skin is not broken, but tissue and blood vessels beneath the skin’s surface are
crushed.
 Three types of closed wounds:
o Bruises and contusions
o Hematoma
o Crush injuries
Wounds That Require Medical Attention
 Medical attention should be sought for the following conditions:
o Uncontrolled bleeding
o Deep incision, laceration that gapes widely, or avulsion
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Large or deep puncture wound
Cuts that damage underlying nerves, tendons, or joints
Cuts over a broken bone
Cuts caused by a crushing injury
Cuts with an object impaled in them
Human or animal bite
Eyelid cut
Slit lip
Internal bleeding
Signs of shock appear
Breathing difficulty due to neck or chest cut
Deep cut to the abdomen
Amputation
Gunshot Wounds
 A bullet causes injury in the following ways:
o Laceration and crushing: when the bullet penetrates the body, it crushes
tissue and forces it apart.
o Shock waves and temporary cavitation: when a bullet penetrates the body,
a shock wave exerts outward pressure from the bullet’s path that creates a
cavity.
 Care for gunshot wounds:
o Initial care is roughly the same as for any other wound.
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