This article by our friend Andrew J. Jackson at Prepography.com
‘The Art & Study of Self-Reliance’
Andrew’s Note: Today we present the final article in this week’s series on Wound Care from our Military Pedagogy series. These discussions, are from U.S. Army Subcourse MD0576, Wound Care [Approved For Public Release; Distribution is Unlimited]. Today’s article discusses Wound Care for Specific Types of Wounds. It’s important to note that military first aid and field medicine focuses almost entirely on stabilizing patients and moving them rapidly to the rear for further treatment. Needless to say, seek professional medical care immediately in the event of illness or injury and take action yourself only if you have been properly trained.
(1) Description. Friction or scraping causes an abraded wound or an abrasion. This type of wound is superficial. The outer layers of skin or mucous membrane have been damaged or scraped off. A person falling on his knees on a sidewalk will suffer an abrasion.
(2) Treatment. Treat as follows:
(a) Irrigate the wound as previously stated.
(b) Apply antibiotic ointment such as bacitracin.
(c) Cover the wound with a dry, sterile dressing.
(1) Description. A contusion or contused wound occurs as a result of a blow from a blunt instrument, such as a hammer. There is no break in the skin.
(2) Treatment. First apply cold compresses for 12 hours. Pad the affected area and wrap an ace bandage around the area snugly. If the area is on an arm or leg, elevate the arm or leg. Use R.I.C.E.–Rest, Ice, Compression, Elevation.
(1) Description. A wound made by a pointed instrument such as a nail, wire, or knife can result in a puncture or perforation wound. Sometimes a scalpel is used by a doctor to make a puncture wound to promote drainage from tissues. A wound caused by an animal or insect sting, the wound breaking the skin surface and underlying tissues, is also called a puncture wound.
(2) Treatment. These wounds have a higher potential for infection because pathogens and particles of debris have been introduced deep into the tissue. If these wounds are not treated properly, the patients may come for treatment 24 to 48 hours after the injury with complaints of local pain, malaise, and fever. To treat these wounds properly, follow the guidelines given below.
(a) For uncontaminated wounds, irrigate the injured site with normal saline solution. Apply a topical antibiotic such as bacitracin.
(b) For contaminated wounds, have the wound evaluated by the surgeon.
(1) Description. An incision occurs as a result of a cut by a sharp instrument. An example of an incision is a cut made with a scalpel during surgery. In this type of wound, the wound edges are smooth. In a laceration, the tissues are torn apart and remain jagged and irregular. A wound made by the cut of a saw will be a laceration. Although the two types of wounds look and are different, treatment for both is about the same.
(2) Laceration classification. Lacerations can be further classified into four categories: shear lacerations, tension lacerations, compression lacerations, and combination lacerations.
(a) Shear lacerations are caused by sharp objects such as a knife, blades, etc. Little damage is done to the tissues adjacent to the wound. This type of laceration heals rapidly. There is minimal scarring due to the health of the tissues at the edges of the wound.
(b) Tension lacerations are caused when the skin strikes a flat surface and rips. The rip occurs because the impact causes stress on tissues. In this laceration, there is no bone directly below the region of the skin that is struck. Tension lacerations heal with more scarring because of bruising of soft tissue around the laceration. For example, an individual falls on the palms of his hands to break a fall. He may sustain a ragged, linear laceration on the palm of his hand, a tension laceration.
(c) In compression lacerations, tissue is caught between the bone and an external hard surface. Caught in such a manner, the skin bursts. These lacerations heal with the greatest degree of scarring. The reason is that the skin next to the laceration is injured. An individual walking along a sidewalk trips and falls. In the fall, his forehead hits the pavement. He will likely have a compression laceration.
(d) Combination lacerations are as the name suggests, a combination of different types of lacerations. Imagine this. A person hits a bony prominence against a table. He sustains a linear laceration as in a shear injury. The wound edges, however, are crushed as in a compression injury. The combination is shear laceration and compression laceration.
(3) Treatment. Be sure you have good lighting and that you use aseptic technique. Irrigate and mechanically debride the wound. Then, use one of these three types of closure: primary closure, secondary closure, or tertiary intent closure.
(a) Primary closure is the term for a wound that is repaired immediately after the injury. Use sutures, skin tapes, staples, or tissue adhesives such as steri-strips and butterflies to cover the wound. For example, a child falls down and skins his knee. The wound is cleansed and a bandage applied over it. This is primary closure. Wounds treated in this manner heal fastest and with the best cosmetic results; that is, with little or no scarring. Primary closure is the treatment of choice for any wound that is not infected or grossly contaminated. Most lacerations closed in this manner must be done within eight hours from the time of the injury.
(b) Secondary closure is the term for wounds which are allowed to granulate on their own without surgical closure. Clean and prep the wound in the usual manner, then cover the wound with a sterile dressing. Secondary closure is used for certain kinds of wounds such as fingertip amputations or partial thickness tissue loss.
(c) Tertiary intent closure is the process of cleaning and dressing a wound initially, but not closing the wound. The patient returns for definite closure in three to four days. Tertiary intent closure is also called delayed primary closure. This is the method of choice for repairing contaminated lacerations that would leave unacceptable scars if not closed. This method can also be used for patients who did not seek immediate care for their lacerations.
NOTE: The body’s skin tension lines are important in wound closure. Pinch your skin together and you can see lines or creases that naturally occur in the skin. The configuration of creases is different in various parts of the body. A laceration that follows the lines will heal with less scarring than a laceration that runs across the lines. Other names for these lines are cleavage lines and Lines of Langer.
Impaled Foreign Object
An impaled object in a puncture wound requires careful treatment. A knife, a steel rod, a glass shard, or any number of other objects can be impaled. General treatment rules are given below.
(1) DO NOT remove the impaled object. Removing it may cause severe bleeding if the object was exerting pressure on severed blood vessels. Removing the object could also cause additional injury to muscles, nerves, and other soft tissues.
(2) Carefully expose the wound area; that is, cut clothing away so that you can see the wound site. Be very careful not to disturb the impaled object as you do this. DO NOT lift clothing over the impaled object. If the impaled object is long, stabilize it by hand while you are trying to expose the wound, control bleeding, and dress the wound.
(3) Control profuse bleeding. Place your hand so that your fingers are on either side of the impaled object and use your hand to exert pressure down. If the impaled object has a sharp edge (a glass shard or a knife, for example), be careful in exerting pressure. You do not want to injure the patient further or cut your hands.
(4) Stabilize the impaled object. As another person stabilizes the impaled object, put several layers of bulky dressing around the injury site. Make sure the impaled object is surrounded by dressings on all sides.
(5) Secure the dressings. Use adhesive stripsto hold the dressings if the area around the wound site is free enough from blood and sweat so that adhesive sticks to the skin. Use cravats if adhesive will not stick to the skin. Tie one cravat above the impaled object and one below the impaled object.
(6) Treat for shock, if necessary.
(7) Keep the patient quiet and give emotional support.
(8) Evacuate the patient to a medical treatment facility.
NOTE: Impaled objects in the eye or cheek require special procedures.
An animal’s mouth is heavily contaminated with bacteria. Serious infection may result if the bite occurs on the hand or face. Treat an animal bite in the following manner.
(1) Wash the bite vigorously with soap and water for at least 10 minutes. This is done to remove the animal’s saliva.
(2) Flush the wound with water.
(3) Apply a sterile dressing (if the wound is in a location that you can do so).
(4) DO NOT suture the wound unless you must do so to stop profuse bleeding.
(5) DO NOT stop bleeding right away unless it is profuse. The flow of blood helps to cleanse the wound.
(6) Evacuate the patient to a medical treatment facility for tetanus toxoid and rabies precautions, as necessary.