First aid for wounds

1. Shri Mahavir Medical College of
Naturopathy and Yogic Sciences, (C.G.)
WOUNDS
Presented by : MEGHA KOCHAR (BNYS final
year)

2. CONTENTS
Definition
Etiology
Risk Factors
Classification
Pathophysiology of a wound infection
General management for wounds
i. Wound with foreign body
ii. Special wounds {palm of hand, abdominal
wounds, penetrating chest and back wounds,
crush injuries}
 Influencing factors for wound healing
 Complications of wound

3. DEFINITION:
 A wound is an abnormal break in the
skin or other tissues which allows blood
to escape. External wounds are
complicated by the fact that germs can
enter the tissues and cause infection.

4. ETIOLOGY:
Surgical incisions
Trauma
Radiation
Infection
Shearing Force
Friction
Poor Circulation etc.

5. RISK FACTORS FOR WOUND:
Broken Skin
Nutritional Status
Age {old and young }
Stress
Hereditary
Disease process
Medical therapies – steroids, chemotherapy,
radiation, diuretics.

6. CLASSIFICATION OF WOUND:
According to status of skin integrity :
Open wound
Closed wound
According to the cause of wound :
Intentional or surgical wound
Unintentional wound

7. Continue…
According to severity of injury :
Superficial {abraded} wound
Penetrating wound
Perforated wound
Puncture or stab wound
According to cleanliness /contamination :
Clean wound
Contaminated wound
Infected or septic wound
Colonized wound

8. According to skin integrity :
WOUNDS
OPEN
WOUND
CLOSED
WOUND
Incised wound
Avulsions
Lacerated
wound
Contused
wound
Abrasions
Punctured
wound
• Penetrating
wound
Bruises
Internal
bleeding

9. OPEN WOUND : CLOSED
WOUND :
 Skin or mucous
membrane is broken
and blood is allowed
to escape from the
body.
 Tissues are injured
but skin is not broken
and blood is allowed
to escape from
circulatory system but
not from body.

10. CLOSED WOUND :
Internal bleeding :
 In this blood is lost
from circulatory
system and collects in
one of the body
cavities and remains
concealed. It may
reveal by flow of blood
from one or more of
the various openings
such as mouth , ear ,
nose or rectum.
Bruises :
• Condition in which
small blood vessels
under the skin rupture
causing blood to leak
into the underlying
skin tissue.

11. OPEN WOUNDS :
Incised wound : Avulsions :
 Sharp even cut that
bleeds freely. They
are caused by sharp
objects like knife,
razor, blade or broken
glass.
 An avulsions involves
the tearing loose of a
flap of skin, which may
either remain hanging
or be torn off altogether.

12. Lacerated wound : Contused wound :
 Open wound with torn
tissues and jagged
edges.
 Most common type of
bruises , typically
caused by blunt force
trauma.

13. Abrasions : Punctured wound :
 Superficial wound
caused by rubbing or
scrapping in which
part of skin surface
has been lost.
 Caused by a stab
from pointed object
such as nail, knife,
bullet, sword.
 Each object tear the
skin and proceed in a
straight line damaging
all tissues in its path.
 Opening in the skin
may appear small but
the wound can be
very deep.
 2 types i.e.
penetrating and

14. Penetrating Wound : Perforating Wound :
 Only wound of entry is
seen. It may be
shallow or deep.
 Penetrating objects :
nail, thorn, splinters.
 It has wound of
entrance and exit.
Generally, it is seen
with gunshot wounds.
 Entrance wound is
always smaller as
compared to exit
wound.

17. PATHOPHYSIOLOGY OF WOUND
INFECTION :
 Most wounds are contaminated except for
surgical wounds made under aseptic conditions.
 Wound infection follows contamination by dirt,
damaged tissue and foreign bodies.
 The bacteria invade tissues and cause more
damage while tissues which have not been
damaged resist infection by a process called
inflammation.
 When a wound is inflammed , blood vessels
dilate to bring more blood to injured part.
 The capillary walls change so that antibodies and
white cells can pass through more easily.
 The result is the part becomes warmer and
redder because there is more blood in it , and
swollen because there are more white cells and

18.  Pain is partially due to increased swelling in the part,
and partially due to effects of inflammation process.

19. CARDINAL SIGNS OF
INFLAMMATION :
 Rubor {redness}
 Tumor {swelling}
 Dolor {pain}
 Calor {heat}
 Functio laesa {loss of function}

20. Types of wound drainage :
1. Serous drainage – clear, watery
fluid.
2. Purulent drainage – Thick
green , yellow or brown drainage.
3. Serosanguineous drainage –
Thin watery drainage that is blood
tinged.
4. Sanguineous drainage – bloody
drainage
large amount – suspect
hemorrhage
bright drainage – indicates fresh

21. MANAGEMENT OF WOUND
HEALING :
1. Control bleeding
 Lay the victim quiet
 Cover the wound with gauze and apply
pressure
 Elevate the limb
 If necessary apply torniquet.
2. Treat shock
3. Immobilize the part and keep the victim quiet
4. Prevent further contamination by applying
dressing and bandage.
5. Do not remove impacted objects. The object
should be stabilized with bulky dressings.

22. 6. Preserve avulsed parts : Torn off parts should be
saved and flaps of skin may be folded back to their
normal position before bandaging.
7. Do not try to replace protruding organs : Protruding
eyeballs or protruding intestines should be covered as
they are and no attempt should be made to replace
them in their normal position with in a body cavity. The
covering for intestines should be kept moist.
 Wound with foreign body :
Foreign bodies
• Carefully remove any small, foreign bodies from
the surface of a wound if they can be wiped off
easily with a swab or rinsed off with cold water.
• If the casuality has a large foreign body
embedded in the skin , never attempt to remove

23. TREATMENT :
• Apply direct pressure by
squeezing the edges of
the wound together
alongside the foreign
body.
• Gently place a piece of
gauze over and /or around
the foreign body.
• Place a ring pad or
crescent shaped pads of
cotton wool or similar
material around the
wound. If possible , build
up the padding until it is
high enough to prevent

24.  Secure with a diagonally applied bandage. Make sure
bandage is not over the foreign body.
 Elevate the injured part and immobilise as far as
possible.
 Remove to hospital immediately maintaining treatment
position.
 If severe bleeding persists use indirect pressure.
 Railings/spikes – do not attempt to lift off , but make
casuality comfortable by supporting weight of limbs and
trunk. Call an ambulance immediately asking control to
notify fire-brigade because cutting tools may be
required.

25. Infected Wound -
Open wounds get contaminated by germs which enter
either from air or from first aider’s breath or fingers.
Sign and symptoms :
• Erythema and
oedema
• Painful and tender
• Fever
• Fatigue
• Drainage and odor-
tan, cream ,green ,
yellow.

26. Management :
• Remove the soiled
dressing by picking it up
at the corners. Do not
touch the other portions.
• Wash your hands with
soap and water.
• Moisten the swab with
antiseptic solutions.
• Remove the dried blood
and foreign matter using
the swab.
• Apply bandage to keep
dressing in place.

27. SPECIAL WOUNDS :
1. Wounds to palm of
hand
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
• Profuse bleeding
• Loss of sensation and
movement in the fingers
and hand if underlying

28. Treatment
• Control bleeding. Place
sterile dressing or gauze
and pad of cotton wool
over the wound and
apply direct pressure.
You can use any clean
cloth or tissue.
• Ask casuality to maintain
pressure first by
clenching the fist over
the dressing . If this is
not possible the casuality
should grasp the fist of
injured hand with the

29.  Elevate the injured limb
 Bandage the fist firmly. Tie off tightly across the knuckles to
maintain the pressure.
 Support the arm on elevation sling.

30. 2. Abdominal Wounds
• Underlying organs may have been punctured or
lacerated.
• Part of intestine may be protruding from the wound.
Symptoms and Signs
• Abdominal pain
• Bleeding and associated wound
• Protrusion may occur
• Vomiting
• Symptoms and signs of shock.

31. Treatment :
A. General management :
1. Control any bleeding by carefully squeezing the edges of
wound together.
2. Place the casuality in half sitting position with the knees
bent up to prevent the wound gaping and reduce strain
on the injured area. Support the shoulders and knees.
3. Apply a dressing to the wound and secure with a
bandage or adhesive strapping .
4. If the casuality becomes unconscious but is breathing
normally , support the abdomen and place the Casuality
in recovery position.
5. If breathing and heart rate stop , begin resuscitation
immediately.
6. Treat shock.
7. Look for evidence of internal bleeding .
8. If vomiting occurs support the abdomen by pressing
gently on the cloth or dressing to prevent protrusion of
intestines.
9. Shift to hospital.

32. B. If part of intestine protrudes from the wound
1. Control bleeding but avoid heavy direct pressure.
2. Cover with a damp sterile dressing or clean cloth
secured with a loose bandage .
3. If the casuality coughs or vomit support the wound.
NOTE : Do not give the casuality anything by mouth.

33. 3. Penetrating chest and backwounds :Chest
and back injuries are caused by sharp knife or
gunshot which penetrate the body or ribs and force
outwards through the skin . This allows entry of air
into chest cavity.
MECHANISM
• In such injuries the lung
on affected side deflates,
even if it is not punctured
and is unable to take in
air.

34. • During inhalation , air
gets filled in chest cavity
and impairs the normal
lung function.
• The amount of oxygen
reaching the blood
stream may be
insufficient and asphyxia
may result.

35. Sign and Symptoms :
• Pain in chest
• Difficulty in breathing.
• Blueness of mouth , nail beds and skin indicating
onset of significant asphyxia.
• If the lung is injured casuality will cough up bright red,
frothy blood.
• The sound of air being sucked into the chest may be
heard during breathing.
• Blood stained liquid bubbling from the chest wound
during breathing out.
• Symptoms and sign of shock.

36. Treatment :
1. Immediately seal open wound with palm.
2. Place the casuality in half sitting posture with head and
shoulder supported .Incline body towards injured side .

37. 3. Gently cover the wound with a sterile unmedicated
dressing as soon as possible.
4. If possible, form an airtight seal by covering the
dressing with a plastic bag,sheet or metal foil. Secure
and seal the dressing with layers of adhesive tape ,
strapping and / or a bandage

38. 5. If the casuality becomes unconscious but is breathing normally ,place in
recovery position with the sound lung uppermost.
6. Treat shock.
7. Check breathing rate , pulse and levels of responsiveness at 10 mins.
Intervals. Check for signs of internal bleeding .Shift the case to hospital
immediately.

39. 4. Crush Injuries :
• Sometimes casuality may
show little sign of injury when
released like redness and
swelling .
• If the part remain crushed for
more than an hour, serum will
pour into the injured tissues
causing them to swallow and
become hard . Blood
pressure will fall and shock
will develop.
• There will be accumulation of
toxic chemicals within the
body because of substances
released by damaged
muscles. On release from
crushing these substances
can flow back to the rest of

40. Symptoms and Signs :
• Tingling and numbness in the crushed limb.
• Injured part becomes swollen and hard.
• Bruising and formation of blisters at site of injury.
• Fractures may develop.
• Limb may become pale and pulseless.
• Symptoms and signs of shock.
Treatment :

42. Wound Healing influencing factors:
Age
Nutrition
Obesity
Extent of wound
Smoking ,drugs
Wound stress
Circulating oxygen
Chronic diseases
Infections

43. COMPLICATIONS :
 Hemorrhage
 Infections
 Wound dehiscence
 Wound evisceration
 Fistula
 Abscess formation
 Cellulitis
 Necrosis or gangrene
 Keloids
 Pain
 Fluid collection
 Interference with organ function.