Wound Care

A Wound:• Is any break in the soft tissues of the body.• A wound can either be open or closed.• Open – break in the outer layer of the skin. -results in bleeding therefore permitting the entrance of germs that cause infection.• Closed- no break of the skin or external

bleeding and therefore little risk of infection.• - the soft tissue damage however,

occurs under the skin ex) bruise.

Aim of Wound Care:*Stop the bleeding* Prevent further contamination and infection.

Contusion : a bruise, an injury to the deeper tissues through the skin. Damage to blood vessels results in the classic bluish-purple skin discoloration. The red pigment hemoglobin turns blue as it loses its oxygen and is later broken down into green and yellow bile pigments. Stagnant blood is an ideal environment for bacteria to multiply in. Any slight breach in the surface of the skin can result in infection. Contusions, while classically not breaching the skin's integrity are generally accompanied by other injuries which do.

Abrasions A graze - a superficial injury caused by rubbing or scrapping. Despite this it is a very painful injury that may bleed or ooze serous fluid. If someone has been dragged along a dirty pavement or road surface, the wound can be contaminated by ingrained dirt which if not cleaned adequately results in a 'tattooing' effect. Soil, that may have become ingrained in the wound, also has a severely damaging effect on tissues. It provides the necessary conditions for the growth of micro-organisms.

Fungating WoundsThe term 'fungating' referring to a malignant process of both ulcerating and proliferative growth. Lesions that have a predominantly proliferative growth pattern may develop into a nodular 'fungus' or 'cauliflower' shaped lesion. A lesion that is ulcerating will produce a wound with a crater-like appearance. Sometimes a lesion presents with a mixed appearance of both proliferating and ulcerating areas.

Fungating wound on the breast, chest wall and upper arm arising from recurrent breast cancer

Ulcerating- crater -like

Cuts and Puncture WoundsA cut, also called a laceration, is a break or opening in the skin. The cut may be deep, smooth, or jagged. It may be near the surface of the skin, or affect deep tissues, such as tendons, muscles, ligaments, nerves, blood vessels, or bone.

A puncture is a wound made by a pointed object (such as a nail, knife, or sharp tooth).

First AidIf the wound is bleeding severely, call 911.Do NotDo NOT assume that a minor wound is clean because you can't see dirt or debris inside. Wash it. Do NOT breathe on an open wound. Do NOT try to clean a major wound, especially after the bleeding is under control. Do NOT remove a long or deeply embedded object. Seek medical attention. Do NOT probe or pick debris from a wound. Seek medical attention. Do NOT push exposed body parts back in. Cover them with clean material until medical help arrives.

If you receive a serious wound, your doctor may order blood tests to check for bacteria.

Call 911 if:• The bleeding is severe, spurting, or cannot be

stopped (for example, after 10 minutes of pressure).

• There is impaired function or feeling from the cut. • The person is seriously injured. • The wound is large or deep, even if the bleeding

is not severe. • You think the wound might benefit from stitches

(the cut is more than a quarter inch deep, on the face, or reaches bone).

*The person has been bitten by a human or animal. *A cut or puncture is caused by a fishhook or rusty object. *You step on a nail or other similar object. *An object or debris is embedded -- DO NOT remove it yourself. *The wound shows signs of infection (warmth and redness in the area, a painful or throbbing sensation, fever, swelling, or pus-like drainage). *You have not had a tetanus shot within the last 10 years.

Contamination!When there are germs, dirt or foreign material in an open wound.This may lead to an infection.

Inability to deliver adequate oxygen and circulation to injured tissue

Tetanus*Known as Lockjaw prior to the 1920's, was described as early as Biblical times. *The C. tetani bacteria can live for years in soil, dust or animal feces and is widespread. It can live just about anywhere and in the inactive spore form can survive most chemical antiseptics as well as autoclaving (heating to sterilize). *The real danger of C. tetani is in the toxin it produces - an exotoxin which is one of the most powerful neurotoxins known to man. Less than 200 nanograms of C. tetani's deadly neurotoxin is enough to kill most humans.

The toxin produces progressive spasming of the muscles, starting with the jaw, which locks tight and prevents opening the mouth or swallowing. Sometimes the illness ends here, with the person having difficulty breathing and a quick death, but most often, the stiffening, uncontrollable muscle spasms progress down the body - the neck stiffens and hyperextends over the back, the arms and shoulders begin to posture and so forth. The spasms themselves can be so powerful as to snap bones, and for those who survive, paralysis from broken spinal cords may be a reality.

30% of cases will not survive, however, and many will end up looking like this poor soldier who died shortly after this posture was seen.

*Once symptoms start, the anti-toxin is of limited use, but is often still given to keep symptoms from worsening. *Supportive therapy for airway, draining the bladder, providing nutrition, etc. are the mainstays of treatment. *Each year in the present-day US, approximately 20-100 people still develop tetanus infections, with about 10% dying, most often related to not updating boosters every 10 years or IV drug use (particularly heroin, which is sometimes contaminated with C. tetani).