Chapter 4

1. Chapter 4 Care of Bleeding, Wounds, and Burns

2. Lesson Objectives (1 of 2) • List the steps to control bleeding. • Identify the different types of open wounds. • Describe the procedure for cleaning a wound. • Explain the procedure for wound irrigation. • Evaluate movement and sensation beyond the wound. • Recognize the signs and symptoms for an infected wound. • Know how to close a wound.

3. Lesson Objectives (2 of 2) • Identify risks for infection and know how to recognize an infected wound. • Know how to care for special wounds, such as amputations, blisters, and bruises, and know when to consider evacuation because of a wound. • Recognize burns by classification and severity. • Know how to manage electrical burns. • Know how to manage sunburn.

4. Bleeding (1 of 2) • Controlling bleeding • First priority is to control bleeding • Major bleeding can lead to cardiovascular shock. • Shock occurs when tissues do not get enough oxygenated blood.

5. Bleeding (2 of 2) • Steps to control bleeding: • Use a barrier device. • Apply direct pressure. • Use elevation. • Use a pressure bandage. • Add more dressings.

6. Wounds (1 of 14) • Types of wounds • Abrasions • Lacerations • Incisions • Puncture wounds • Avulsions • Amputations © E. M. Singletary, M.D. Used with permission.

7. Wounds (2 of 14) • Cleaning a wound • Wash the wound. • Use soap and clean water for shallow wounds. • Cover with a sterile or clean dressing.

8. Wounds (3 of 14) • Wound irrigation • Clean with a large syringe, bulb syringe, or plastic bag with a small hole in the corner. • Remove remaining fragments. • Do not use disinfectant in the wound. • Clean only the surface of puncture wounds.

9. Wounds (4 of 14) • Evaluating function • Check movement and sensation beyond the wound. © Howard Backer, M.D.

10. Wounds (5 of 14) • Wound closure • Close small wounds with tape or “butterfly” strips. • Pack large wounds with sterile dressings. • Cover all wounds with sterile or clean dressings. • Change dressings every 24 to 48 hours.

11. Wounds (6 of 14) • Wound infection • Deep, dirty wounds, punctures, and bites are at high risk for infection. • Animal and human bites have high risk of infection.

12. Wounds (7 of 14) • Wound infection • What to look for • Redness • Warmth • Swelling • Pain • Tenderness • Pus © Shout/Alamy Images

13. Wounds (8 of 14) • Wound infection • What to do • Clean the area. • Allow pus to escape. • Soak in warm water. • Change dressings often.

14. Wounds (9 of 14) • Amputations • Attempt to preserve part. • Control breathing and treat victim for shock. • If amputated part is found: • Rinse with clean water. • Wrap part in sterile gauze. • Place in waterproof container. • Place on ice or in snow. • Take part to hospital with victim.

15. Wounds (10 of 14) • Blisters • A collection of fluid underneath the skin caused by friction. • Prevent by taping susceptible areas with duct tape or adhesive or cover with adhesive felt.

16. Wounds (11 of 14) • Blisters • What to do • Unbroken blisters: Clean with soap and water, puncture edges with sterile needle, cover with nonstick dressing. • Broken blisters: Wash; cover with tape or a nonstick pad; If infected, cut away skin and begin warm soaks.

17. Wounds (12 of 14) • Bruises • A collection of blood within or under the skin • What to look for • Pain and discoloration • Possible fraction

18. Wounds (13 of 14) • Bruises • What to do • Apply a cold pack for 20 minutes, four times a day. • If cold pack is not available, wrap firmly with an elastic bandage. • Do not cut off circulation.

19. Wounds (14 of 14) • Wounds requiring evacuation • Uncontrolled or severe bleeding • Deep wounds • Severe wounds of hands or feet • Large or deep puncture wounds or embedded objects • Human or animal bites • Serious eyelid injuries • Infected wounds • Amputations • Open fractures

20. Burns (1 of 9) • Caused by: • Thermal energy • Electrical energy • Radiant energy • Chemicals

21. Burns (2 of 9) • Burn classification • Depth • Extent • Location • Severity • Other considerations

22. Burns (3 of 9) • Immediate action • Stop the burning! • Remove victim from flame or smoke-filled area. • Cut off smoldering clothing or soak it with water.

23. Burns (4 of 9) • What to do at first • Check breathing. • Care for burns. • Check for additional injuries. • Remove jewelry and watches. • Remove belts and clothing from burned area. • Keep burn clean and prevent blisters from breaking. • Evacuate. • Give large amounts of fluids. • Relieve pain and inflammation.

24. Burns (5 of 9) • What to do later • First-degree burns: Apply ointment or cream to soothe. • Second- and third-degree burns: Wash gently, apply antibiotic ointments, cover with nonstick dressing and bandage.

25. Burns (6 of 9) • Electrical burns • Caused by lighting strikes, in remote households, or job sites. • Can produce entrance and exit wounds. • Can penetrate nerves and blood vessels, causing extensive damage.

26. Burns (7 of 9) • Electrical burns: What to do • Unplug or disconnect power. • Check breathing. • Check for fractures. • Monitor for shock. • Perform CPR if necessary. • Treat entrance and exit wounds. • Evacuate if necessary.

27. Burns (8 of 9) • Sunburn • Caused by ultraviolet rays from the sun. • Sun reflects strongly of water, sand, and snow. • Prevent by wearing sun-protective clothing and sunscreen.

28. Burns (9 of 9) • Sunburn • What to look for • Red skin • Blisters • What to do • Soothe burned skin with cool compresses, baking soda, or calamine lotion. • Give antihistamine pills for itching and ibuprofen for pain and inflammation.