Wounds and First Aid Ae: ‘The skin is normally intact. A break or tear in the skin may occ, following an accident. The result is a wound. The deeper the woung the more likely itis to get infected as it cannot be properly cleaned. the appearance of the wound and its likelihood of infection depend on whay causes the wound. Aims of the firstaider when dealing with wounds are 1. To stop the bleeding. 2. To prevent infection. Injury to the skin may be caused by the following: a. Acutwitha sharp instrument, e.g. knife, glass, stone, etc. b. Ablowwith a blunt instrument, e.g. stick, stone, etc. c. A broken bone whose sharp pierces the skin from inside, usually when open fracture occurs. 3. The degree of injury to the skin ranges from an abrasion to a deep wound. ABRASIONS An abrasion or gauze is a scraping away of the superficial layer of the skin. Abrasions are actually very superficial cuts in the skin. Signs * Superficial scraping of the skin + Slight bleeding, Treatment 1. Wash the site with clean boiled water and soap. . Remove any girt or other foreign matter, . Wash with antiseptic lotion and apply gentian violet (GV) pai" . Apply clean gauze covered with cotton wool padding 4" bandage.118 Section ii First id in Emergency Situations Note; * Do notdisturb the blood clots * Do not remove any glass unless itis easily wiped away * Asits removal may open up a large blood vessel 4. Treat for shock. 5. If the wound is large and will require suturing, apply a dry dressing and transfer the patient to hospital after applying 4 firm bandage to control the bleeding. Put the arm in a sling oy immobilize the leg. 6. All punctured wounds of the chest and abdomen after first aiq should be referred to the doctor. Ifthe wound is small and one can deal with it. Proceed as follows 1. Sitor lay the patient down. 2. Handle the injured part gently. 3. Clean the wound with soap and boiled water. Always clean away from not towards the wound. Remove foreign matter. 4. Stop the bleeding using direct pressure. 5. Ifthe wound is small, apply antibiotic ointment and cover with aclean dry dressing. 6. If the edges of the wound need approximation use adhesive plaster to bring them together. Apply a dry sterile dressing. CONTUSED WOUND Contused wound can be caused by a fall or a blow with a blunt object which splits the skin and bruises the surrounding tissues. In a contused wound, the risk of damage to underlying structures (e.g fracture) should be considered, With a bruise, damaged blood vessels leak blood into the tissues although the skin remains unbroken Symptoms and Signs + Pain and swelling in the affected area + Bluish-purple discoloration at site of injury + Pattern bruising in which outlines of the casualty’s clothing a? seen in the bruise. This is a potentially dangerous sign as it 2 indicate damage to internal organs. First Aid Measures Aims blood flow by cooling and gentle compression.an pressure Antibiotic Ointment ANd ap 1eed approxima M ation use sg t. Apply a dry sterile ds, by a fall or a blow wits ruises the surroundingts= age to underlying srs ha bruise, damaged te the skin remains unr jared ‘ injury Vso 6 OF he CO es fly dane" nua” ns. / ob ait a st on ov Treatment Raise and support ee in| t comfortable. ; ee icael compress to the injured area to restrict bleeding duce swelling. i i ri doubt about the severity of the injury, seek medical aid. jured part in the position the casualty GUNSHOT WOUND Gunshot wound is caused when a missile strikes the body at high speed and can result in serious internal injury. There will be a wound, where a missile enters the body and often a much larger exit wound, Internal organs, tissues and blood vessels may be damaged during the missile passage through the body. In addition to external bleeding there may be internal bleeding. EYE WOUNDS All eye injuries are potentially serious. Even superficial grazes can lead to scarring of the surface of the eye (cornea) on infection, with possible deterioration of eye sight and even permanent blindness. ‘The eye can be cut or bruised by direct flows, broken spectacles, or sharp, clipped fragments of metallic materials, girt or glass, which fly into it (for treatment of foreign bodies in the eye, refer Chapter 12, topic on ‘foreign body in the eye’). Symptoms and Signs Partial or total loss of vision of the affected eye, even with no visible injury Painful, blood shot eye, possibly with a visible wound of eyeball or eyelid Loss of blood or clear fluid from the eye wound, possibly with flattening of the normal round contour of the eyeball as the contents leak,120 Section i: First Aid in Emergency Situations Treatment a, Lay the casualty down on his/her back. Sup and keep it as still as possible, embedded foreign bodies, 2. Ask the casualty to close his/her with an eye pad ora sterile dressi adhesive plaster. 3. Advise the casualty to kee} movement will cause the injured eye to move. If Necessary bandage both eyes to prevent unnecessary movement, Reassy : the casualty before blindfolding, a 4. Arrange transportation to hospital, maintaining the treatmen; Position. POTt his/her Do not attempt to temo’ injured eye and Bently coy ing. Secure it wit habandaye! BE oy P his/her sound eye stil becatise WOUND TOTHE PALM OF HAND Wounds in the palm can occur, when a person handles broken glas or sharp tools or falls on to sharp objects. Such wounds may bleed Profusely and can be accompanied by fractures. If the wound is deep, the nerves and tendons in the hand may be damaged. Symptoms and Signs + Pain at the site of the wound + Bleeding may be profuse + Loss of sensation and mov. ement in the fingers and hand, ifthe underlying nerves and tendons are severed, First Aid Measures Aims Control bleeding and arrange immediate transportation to hospital with ‘out attempting to remove any embedded foreign bodies. Treatment 1. To control bleeding, place a sterile dressing or gauze anda clean pad over the wound and apply direct pressure with fingers ee Chapter 6, topic on ‘controlling blood loss and direct pressure) or thumbs or by casualty if able. Ifno dressing or padis availal a use an improvised dressing (e.g. a clean handkerchief, a fres!122 Section i Fist Aid in Emergency Situations __ INFECTED WOUNDS All open wounds will be contaminated by germs, which either, from the cause of the injury, from the air or from the first aiggr breath or fingers. Some particles of dirt may be carried away fror, = damaged tissue by bleeding. Any harmful germs, which remains bs usually destroyed by the white cells in the blood, and wound the, stays clean and healthy. | Normal first aid for wounds includes prevention of infection | However, any wound, which has not begun to heal properly afi, about 48 hours, may be infected because dirt, dead tisstue, foreign | bodies and/or bacteria may still be present. If infection develops it can have serious consequences. It may enter in the blood system | and subsequently spread to other parts of the body, permanently destroying tissue and occasionally leading to death. Symptoms and Signs = Increasing pain and soreness in the wound « Increased surrounding parts with a feeling of heat + Pus may ooze from the wound «Fever, sweating, thirst, shivering and lethargy, if the infections severe + Swelling and tenderness in the glands, in the neck, armpits or groin » Faint read trails may be seen on the surface of the inside of the arms or legs leading towards lymph glands. First Aid Measures Aim Seek medical aid. Treatment 1. Dress wound with a prepared sterile dressing or simila! preferably sterile, material and secure witha bandage: 2. Elevate the injured part and immobilize especially, if swollen. 3. Seek medical aid. eas cleal124 Section Ik First Aid in Emergency Situations First Aid Measures Aims Ease breathing by immediately sealing the wound, immediate transportation to hospital. Attange Treatment 1. Immediately seal open wound with palm or the Casualty’s jg possible. aes 2. Place the casualty in a half-sitting position with his/h and shoulders supported; turn the body towards the side so the sound lung is upper most. . Pressure the casualty. . Gently cover the wounds with a sterile dressing as soon 2s possible. . If possible, form an airtight seal by covering the dressing with a plastic sheet or metal foil. Secure and seal the edges of the dressing with layers of adhesive tape, strapping and/or bandage . Support the arm on the injured side in an elevation sling and make the casualty as comfortable as possible. wo Checkbreathing rate (refer Chapter4, topicon ‘breathing’), pulse (refer Chapter 14, topic on ‘pulse’) and level of responsiveness (refer Chapter 1, topic on ‘level of responsiveness’) at 10-minute intervals. Look for evidence of internal bleeding (refer Chapier 6, topic on ‘external bleeding’). . If the casualty becomes unconscious, open airway and check breathing. Complete ABC of resuscitation (refer Chapter 4, topic on ‘respiratory resuscitation’), if requires and place in the recovery position with his/her uninjured side upper most. 9. Arrange urgent transportation to hospital, Transport as a stretcher case, maintaining the treatment position. If a foreign body is present (refer Chapter 12, ‘Foreign Body Injuries and First Aid’) give first aid as for foreign body. ler heaq injured 9 ABDOMINAL WOUNDS Wounds of the abdominal wall may be caused by sharp instruments or by missiles. A deep wound of the abdominal wall is serious not only because of the external bleeding, but also because the underlying organs may have been punctured or lacerated, leading °Oe nN Fi atid in Emergeney Sitat is 'fp bi art of ‘ ala a. the the intestin ati : ; Protruding intestines: Protrudes from the wound. Do not * Mover with a ote ile touch, : bandage, tile dressing or clean cloth secured wit S Ifthe casu ha alty coughs or vomits, support the wound nd treat the casualty as above, CRUSH INJURIES ae injuries commonly occur in earthquakes, bomb incidents 8 accidents and demolition work. Prolonged crushing & mass of muscles, e.g. in the thigh, leads to shock because of. blood loss into the tissues after the casualty has been freed, Toxic substances released by the damaged muscles are introduced into the casualty’s circulation and may lead to kidney failure. This sequence is known as ‘the Crush Syndrome’. Because of the danger of kidney failure in all cases where a casualty has been trapped for longer than 1 hour, call the emergency services immediately and do not attempt to release him/her. 3. Position al aS in steps Symptoms and Signs * Crushed limb may be tingling or numb * Swollen and hard tissue around injured part because serum (refer Chapter 6, topic on ‘How the body responds to injury?’) has poured into the area f at Bruising and formation of blisters at the site of injury a Crushed or trapped limb will be cool, pale and pulseless, i! arteries are compressed « Symptoms and signs of frac of fracture’) « Symptoms and signs ofs! ture (refer Chapter 9, topic on “types hock (refer Chapter 5, topic on ‘shock’). First Aid Measures Ags i ical Hi e immediate me age to the kidneys; arrang’ Bar Pe nee casualty has been trapped for more than assis' , Treatment iftrapped for less than | hour:e casualty as quickly as possible. * Frevate the limb if the injuries allow to do so. - Control any bleeding and treat any wounds. immobilize any fractures, if present (refer Chapter 9, topic on fractures’). 5, Position as for treatment of shock (refer Chapter 5, topic on ‘shock’) and remove to hospital if necessary. Note: Record time of release and duration of crushing. If trapped for more than 1 hour: 1. Do notattempt to release the casualty. 9, Reassure and make his/her as comfortable as the circumstances permit. 3, Call for medical assistance and emergency services. Release thi eepe ULCERS ‘An ulcer is formed when there is loss of tissue at the surface of the skin. The loss tissue results from an infection, which destroys the cells. Ulcers occur after injury, infection or because of a faulty diet. ‘They also occur in patients suffering from chronic diseases, such as leprosy, syphilis, tuberculosis or filariasis. Types L. Acute ulcer: The ulcer is painful, tender and discharges serum. Later on pus forms and the ulcer has a foul smell. Spreads of dead tissue may be seen. The edges of such an ulcer are swollen. ‘Acute ulcers arise from an infected cut or from a skin infection. 2. Chronic ulcer: It accompanies chronic diseases, malnutrition, underlying bone infection and neglected acute ulcers. These ulcers have a foul smell, their edges are raised and spreading and they are painful. Ifpatient has ulcer, go through the following checklist (Table 7.1)- Table 7.1; Checklist to treat patient with ulcer Loumeareer natin | Dayne ¥* PWeekormenn [constuionstamproms | Wo | [Sowofmainuriion [No | [Depthorutceraton | Supertcal |128 Section II: First Aid in Emergency Situations . Treatment for Acute Ulcer 1, Hot fomentation k 2, Dressing with GV paint. If possible, change twice a day, a, Ifbette ntinued dressings till it heals. b. Ifno better—refer to doctor. Achroniculcer should always be referred to the doctor to exclu, a chronic disease. BOILS A boil is an infection of the skin caused by the germs entering the skin glands. Each boil begins as a small firm, painful swelling and if is neglected, or badly treated it develops into an abscess. Signs and Symptoms A boil is one of the commonest conditions, which one is likely to see in the home. The condition occurs more commonly in children, especially children, who do not bathe frequently and whose skin is dirty. Bad nutrition and diabetes can also lead to boils. The signs and symptoms of a boil are: 1, Swelling. 2. Redness of the affected area. 3. Tenderness of the affected area. 4, Pain, sometimes throbbing pain. These local symptoms may be accompanied by general symptoms mainly: a, Fever, b. Headache. Treatment Apply hot fomentations with magnesium sulfate solution to the affected area, Note 1, If treatment is started early, the process may be stopped and abscess formation prevented. 2. Ifa person who suffers from frequent boils should be seen by 4 doctor to exclude chronic disease, EERE reser