CHAPTER 2 WOUNDS AND CONTUSIONS ‘A wound is said to oceur when the continuity of the skin ‘of mucous membrane is broken. ‘ TYPES OF WOUNRS Incised Wound, —This type of wound occurs when the skin is broken by a sharp instrument such as a knife or a piece of glass. The wound usually bleeds freely; ‘put heals quickly. Puncture Wound. —In this type “Of wowlid: the depth is greater than the length and there is danger of deep organ being damaged. This type of wound is caused by 2 pointed frattament such as a spike, 2 needle, a bayonet or by gunshot. ‘There is danger of internal organs being damaged. Lacerated Wound. —In this type of wound the skin and tisgues are torn rather than clean cut and the edges of the tissues ‘are irregular. There is commonly “rushing” of the weareind muscles. This type of-wound occurs when a,jimb is sieht up in machinery. or after a road accident, Scratching by mas or the claws of an animal can cause laverated wounds, 1) facerated wounds there is usually less bleeding than in an jneised wound but there is more skin and tissue damage- Contused Wound, —In this type of wound there may be relatively little damage to the skin but underlying tissues may be severely damaged with bleeding from ‘blood-vessels under the skin, This release of blood causes “bruising.” Contused wounds are caused by violence from a blunt instrument. For example, by hitting the finger with a hammer. A “black eye” fan example of a mild. contusion. In many instances there may be very little, if any, external. bleeding, but quite consider- able internal bleeding. COMPLICATIONS ASSOCIATED WITH WOUNDS ‘There are several complications which can occur when the skin or mucous membrane is damaged. Tutection. The skin acts as one of the main defences 34 FIRST AID against infection, When it is broken micro-organisms can easily enter and thus infection occurs. Hemorrhage. — When blood-vessels are severed loss of blood ‘occurs. The subsequent hemorrhage may be slight or severe and may be internal or external. Shock. ~ Depending upon the extent of the damage vary- ing degrees of shock may be present. In severely lacerated and contused wounds the shock may be quite considerable. Injury to Deeper Organs.—In punctured wounds it is quite possible for deep organs such as the liver, spleen or the lungs to be damaged. If deep organs are damaged there is a danger of internal hemorrhage. Fractures. —If limbs are injured, particularly in road accidents, or if they are caught up in machinery, a fracture ‘of one or more bones may occur. TREATMENT OF WOUNDS: 1. To prevent infection, the wound must be covered immediately with as clean a dressing as possible. The inside of a clean handkerchief is probably as close to a sterile dressing as can be obtained in an emergency, but if a sterile dressing can be obtained it should be used. The dressing should be applied and bandaged firmly in position. * 2. If hemorrhage is present this must be stopped as quickly as possible and all means described in the chapter ‘on hemorrhage used as they are required. 3. If the wound is at all severe shock is likely to be present and should be treated, 4. Each wound has to be judged on its own merit and the first-aid worker will have to use common sense in deciding how serious it is and if deeper organs haye been affected. If greater damage is suspected than merely the breaking of the skin then medical aid should be sought and arrangements made to transport the patient to hospital ‘as soon as possible. 5. If glass or foreign bodies are present in a wound the first-aid worker should not try to remove them but should apply a “ring pad.” For example, a handkerchief rolled up and applied round the wound rather than on it, and this should be bandaged lightly in position. 1f a fracture is suspectedWOUNDS AND CONTUSIONS =| 5 the wound should be dressed and the limb immobilised as for a fracture, See Chapter on Fractures, Cut Throat. — A cut throat may have occurred accidentally or it may be a suicidal attempt. It can be extremely serious if the jugular vein or the carotid artery has been severed. Treatment. 1, _ Make the patient sit down with the head bent for- wards. This helps to keep the edges of the wound together. 2. Apply a clean or if possible sterile dressing to the ‘wound and bandage it in position. 3. Send fot medical aid or arrange immediate transport to hospital. 4, If it is a suicide attempt the patient must be watched very carefully ashe may try to tear off the bandage and dressing. 5. Never leave the patient alone. Use helpers to get dressings and bandages, and to send for medical aid or arrange transport if the patient is to go to hospital.