Wounds' management and cleaning
Management
CLOSED WOUNDS
• Assess the patient’s airway, breathing and circulation. Sit them down and reassure them. Watch for and treat signs and symptoms of shock.
• Cool the affected area for 20 minutes. Pads soaked in cold water work well but warm up quickly, so keep changing them or adding more cold water. If the wound is on a limb, elevate the limb above the heart and support it to reduce bleeding and swelling.
OPEN WOUNDS
• Assess the patient’s airway, breathing and circulation.
• Stop severe bleeding immediately, by asking the patient to apply direct pressure. Sit them down and reassure them. Watch for and treat signs and symptoms of shock
• Stop bleeding by applying direct pressure or, if there is an embedded object, by applying pressure around it.
• Bandage the wound with a clean dressing or pad, pulling the edges of the wound together. If bandages are not easily accessible, use what you can – a clean handkerchief, clean clothes or the patient’s hands. Clean toilet paper, tissues or sanitary pads will also do. Due to possible infection, use your own hands as a last resort and only if wearing gloves.
• The bleeding will stop when a clot has formed. This can take 5–15 minutes. Damaged blood vessels automatically constrict, slowing down the blood flow to help the clot form. So be careful not to disturb this process by moving the injured part.
• Tape the dressing firmly in place when the bleeding has stopped.
If the wound is on a limb:
• Elevate and support the bleeding limb to help reduce bleeding and swelling.
• Apply a compression bandage – a bandage wrapped firmly around the wound, extending above and below the wound.
• Swelling may occur, making a firm bandage tight, so check the circulation below the wound every 10 minutes. Remove any jewellery or watches from the affected limb immediately after applying pressure.
• Prevent the patient moving the limb by splinting it. This will help to prevent the clots breaking up.
Cleaning the wound:
Most superficial cuts and grazes need only to be kept clean, dry and covered. Once you have dressed the wound, check it regularly for signs of infection, changing the dressing daily or when it becomes wet or dirty. You need to clean the wound, and keep it clean, to prevent infection. An infection that starts in a wound may spread to the skin (cellulitis), under the skin (fasciitis) or into the blood stream (septicaemia). Blood flowing from the wound starts the cleaning process by removing some dirt and bacteria. It is not generally necessary for you to clean the wound if the patient will be receiving medical attention within 2 hours.
Note: Do not attempt to clean the wound if it is life-threatening, or if there is severe arterial bleeding that is hard to control, as the bleeding may start again.
To clean a wound:
1. Thoroughly wash and dry your hands.
2. Make sure the bleeding has completely stopped.
3. Wash around the wound site with soap and water.
4. Wash the wound by gently pouring body temperature water over it. This should flush out any bacteria and dirt.
5. Brush out any leftover dirt and particles with gauze or another material that will not leave fibres behind.
6. Rinse the wound again with saline. If you are carrying salt, make a saline solution by adding 1/3tsp of salt to 1 cup of water, or 1tsp of salt to 1L of water. If saline is not available, use clean, fresh water. The most effective way to clean a deeper wound is to irrigate it with a syringe.
7. Dry around the wound, and cover it with a sterile dressing held in place by a bandage or tape.
Infected wound:
Infected wounds can be recognised by:
• Increased tenderness around the wounded area
• Redness and heat spreading around the wound
• Pus and an unpleasant smell
• Red lines tracking away from the wound
• Swollen lymph nodes in the armpit or groin
• A high temperature, with the patient sweating and shivering
If a wound becomes infected:
• Soak the infected area in warm water (40– 45°C) three or four times a day to encourage blood to flow to the area.
• Change the dressings every time you soak the area.
• Give the patient paracetamol to reduce a high temperature.
• Use a pen to mark where the red tracking or red area extends to and record the time. Note if the red area is increasing and how fast.
• Seek medical attention and antibiotics if the infection does not decrease.