Contenido:

WOUNDS

A wound is any lesion that causes damage to the skin, creating an access route for germs and facilitating the risk of infection.

As a Anterior and essential step in the treatment of any wound, whichever its kind, the following rules must be followed:

1. Prepare an area , as clean as possible, to place all material and sit or lay the patient down. Treat the pain, and if necessary (see Chapter 8.11, HEADACHE), give tetanus gammaglobulin (DRAWER 8, first aid kits A and B), unless the patient is correctly vaccinated against tetanus.
   
   
   
   Picture 7-1: Material for wound treatment.



2. Prepare the material which will be required (DRAWERS 9, 12, 14, first aid kits A and B) and disinfect the instruments (scissors, tweezers…) using any of the following methods:
   
   
   
   • Immersion in disinfectant solution, which may be prepared with 10 mlof chlorhexidine (DRAWER 14, first aid kits A and B) with 15 ml of water and 75 ml of alcohol 96º (DRAWER 14, first aid kits A and B) leaving it for two minutes.
   • Boiling for 20 minutes.
   • Flame (mover over a flame) and cool in alcohol.
     
     
     
     Picture 7-2: Three kinds of instrument disinfection
   
   
3. Wash hands with plenty of water and soap, brushing the nails, and disinfect with an antiseptic (alcohol) (DRAWER 14, first aid kits A, B and C).
   
   
   
   Picture 7-3: Washing hands.
   
   
   
   
   Picture 7-4: Brushing nails.

   
   Picture 7-5: Hand
   disinfection with alcohol.



4. Wear sterile latex gloves (DRAWER 14, first aid kits A, B and C) (see pictures 7-6, 7-7, 7-8, 7-9 , 7-10, and 7-11).
   
   
   
   
   Picture 7-6
   

   
   Picture 7-7
   
   
   Picture 7-8

   
   Picture 7-9
   
   Picture 7-10

   
   Picture 7-11
   Pictures 7-6 to 7-11: How to put sterile gloves on.
   
   
   Even though wounds may be classified in many different ways, from a practical point of view they should be divided into minor and major, as this will determine the treatment later on.

MINOR WOUNDS

These are small cuts or superficial erosions, which are not contaminated or infected.

Treatment

If the wound is long and deep, after these first steps the edges should be brought near to help in the healing process, using different methods :

1. Adhesive sutures (DRAWER 12, first aid kits A and B ). Stick one end to one side of the wound, making sure the area is dry; pull it to bring the edges closer, without excessive pressure, and attach the other end. It is convenient to start in the middle and finish at the ends of the lesion, with a distance of one centimetre approximately between sutures, until the whole wound has been closed.
   
   
   
   Picture 7-13: Adhesive suture.



2. Staples . With tweezers or by hand the edges of the wound are brought closer together, holding the stapler firmly (DRAWER 12, first aid kits A and B ). Pressing on it, the edges are held together by the staple. The distance between two staples should be no less than 0,5 centimetres or more than 1 centimetre.
   
   
   
   Picture 7-14: Staple stitching technique.
   
   



3. Thread sutures (in DRAWER 12, first aid kit A there are suture threads with
   set up needles). It is the safest way to close a wound.
   
   Suture technique To handle curved needles we must use the needle carrier tweezers (DRAWER 12, first aid kit A) (see picture 7-15); the straight ones may be used by hand and are simple to use.
   
   As with the adhesive sutures, we should always start stitching in the middle of the wound. Push the needle in perpendicularly to the skin on one of the edges and after that on the other one (see picture 7-16), pulling the thread
   
   
   
   
   Picture 7-15: How to place the needle in the needle carrier.
   
   
   
   
   
   Picture 7-16: How to give a stitch.
   
   
   to bring both sides closer together. It is convenient to tie three knots on the thread to avoid it coming out (see picture 7-17). The ends have to be cut one centimetre away from the knot. Once the suture is finished rub with iodine solution (DRAWER 14, first aid kits A, B,C and RAFTS), cover the wound with a sterile gauze or fat (DRAWER 14, first aid kits A, B and C) and bandage (refer to IMMOBILISATION Y BANDAGES).
   
   
   
   
   
   
   

   
   
   
   
   
   Picture 7-17: How to tie the suture thread.
   

   To stitch a lip, refer to picture 7-18.

   
   If there are no complications, the stitches or staples may be removed in seven days (in the face, 4-5 days; in places such as palms, close to joints or back, ask a doctor).
   
   
   
   Picture 7-18: Where to start stitching a lip.
   
   
   Use the scissors to cut one of the ends close to the skin and pull from the other to completely remove the thread (see picture 7-19).
   
   
   
   
   Picture 7-19: How to remove a stitch.
   
   
   In case of staples, use staple remover scissors (DRAWER 12, first aid kits A and B) (see picture 7-20).
   
   
   
   Picture 7-20: How to remove a staple.
   
   
   Further treatments should be made every two days, cleaning the wound with water and soap, and antiseptic afterwards, leaving it in the open air. Ask for MEDICAL ADVICE VIA RADIO , especially if there is pain, pus or fever, or the wound is swollen, reddened and warm.
   
   Do not stitch if:
   
   
   1. More than six hours have elapsed since the wound occurred.
   2. Wounds are very dirty and with tissue loss.
   3. It is a deep wound with risk of tendon, nerve or vessel damage, and penetrating in thorax or abdomen.
   4. It is a wound with an open fracture (see FRACTURES).

SEVERE WOUNDS

The severity of the wound is determined by one or more of the following characteristics:

• Is large.
• Is deep.
• Foreign bodies are present.
• Is infected.
• Is caused by contusion or traction (large damaged areas and irregularly edged wound).
• If it is by stabbing or penetrating.
• If it perforates and internal organ.
• If there is a severe haemorrhage due to direct damage to blood vessels.
• If it is in regions such as face, natural orifices, hands, abdomen, thorax or skull.

Management of a severe wound:

1. Assess the general state of the patient (refer to Chapter 1, EMERGENCIES).
2. Prevent shock by placing the subject in the anti shock position and keep him warm (refer to Chapter 2, URGENCIES).
3. Control the haemorrhage, see HAEMORRHAGE.
4. Do not touch the wound with fingers.
5. Do not remove foreign bodies, including the object responsible (knife, wood, metallic splinter, abbr title="etcetera" lang="en">etc.), if they are very embedded.
6. Do not use antiseptics or ointments.
7. Cover the wound with a sterile bandage without pressing.
8. Ask for MEDICAL ADVICE VIA RADIO .

If the wound is in the thorax : After the initial treatment the patient should be placed in a semi-sitting position or leaning on the affected site with head and shoulders lifted to the position that provides him with more relief.

If the wound "breathes" (blows) or if blood with bubbles comes out, cover it first with the hand and then place a bandage made up of several fatty gauze layers (DRAWER 14, first aid kits A and B) to fully cover the wound, and occlude with plastic or tin foil, holding on three of its sides (see picture 7-25).

WOUNDS BY COMPRESSION OR CRUSHING

The skin is cold and the limb is usually swollen and hard, since the crushing causes capillary breakage.

If the accident has happened less than an hour before, release the affected limb and ask for MEDICAL ADVICE VIA RADIO . If more time has elapsed, do not do anything until medical help is provided.

WOUNDS BY EXPLOSION

Wounds are produced by a shock wave, with sudden pressure changes. Very severe internal wounds may appear (lung lesions, spleen rupture, tympanic membrane burst, etc.)

Complete rest is mandatory, do not give anything by mouth and ask for MEDICAL ADVICE VIA RADIO .

FISHHOOK WOUNDS

In the treatment of this kind of wounds, caused by the piercing of a hook in any part of the body, the general rules to prepare the material must be followed, instrument disinfection and hand washing of the person who is going to remove it (see HAND WASHING).

Before removing the hook, assess the possible damage of deep and delicate structures,
checking movement and sensibility of the area. If there is any impairment, immobilise the affected area and evacuate the accident victim.

In superficial wounds the procedure should be as follows:

• Disinfect the affected area and the tip of the hook coming out of the skin.
• Anaesthetise the area with a local anaesthetic by means of a cold spray (ethylene chloride, DRAWER 9, first aid kit A).
• Push the hook until the tip is felt under the skin.
• Make a small cut with a disposable scalpel (DRAWER 12, first aid kit A).
• Push the tip outwards. If resistance to the hook movement is noticed when doing this, stop and make a bandage as in the case of deep piercing, and evacuate the accident victim.
• Cut the tip and tongue with adequate metal shears.
• Undo the hook's trajectory backwards, trying not to cause any more tearing.
• Disinfect the wound as you would any other and bandage it without stitching.
  
  
  
  Picture 7-28: How to remove a hook.

Due to the frequency of this kind of wounds, it is convenient that all workers be vaccinated against tetanus. If this is not the case and there has been an accident, give protection against tetanus, as shown in the section WOUNDS.

Special situations:

• If the hook is double headed, it is recommended to split them with the metal shears and proceed as if they were two individual hooks.
• When the piercing is in the eyelid or eye, do not touch the hook at all, protect the area with a glass or cup without pressing, give an analgesic and ask for MEDICAL ADVICE VIA RADIO considering evacuation. The patient should remain with the eyes closed to avoid blinking.