4-8 SPECIAL WOUNDS AND THEIR TREATMENT

LEARNING OBJECTIVE: Recall medical precautions and wound-treatment procedures for the following list of wounds: animal bites, eye wounds, head wounds, facial wounds, abdominal wounds, crushing injuries, and the removal of foreign objects.

The body’s physiologic response to the irritation is to dilate local blood vessels, which increases the blood supply to the area. The increased blood flow, in turn, causes the skin to appear red and warmer. As the blood vessels dilate, their injured walls leak blood serum into surrounding tissues, causing edema and pain from increased pressure on nerve endings. In addition, white blood cells increase in the area and act as scavengers (phagocytes) in destroying bacteria and ingesting small particles of dead tissue and foreign matter.

Inflammation may be caused by trauma or mechanical irritation; chemical reaction to venom, poison ivy, acids, or alkalies; heat or cold injuries; microorganism penetration; or other agents such as electricity or solar radiation.

Inflammation should be treated by the following methods:

  1. Remove the irritating cause.
  2. Keep the inflamed area at rest and elevated.
  3. Apply cold for 24 to 48 hours to reduce swelling. Once swelling is reduced, apply heat to soft tissues, which hastens the removal of products of inflammation.
  4. Apply wet dressings and ointments to soften tissues and to rid the area of the specific causal bacteria.

Abscesses

An abscess is a localized collection of pus that forms in cavities created by the disintegration oftissue. Abscesses may follow injury, illness, or irritation. Most abscesses are caused by staphylococcal infections and may occur in any area of the body, but they are usually on the skin surface.

A furuncle (boil) is an abscess in the true skin caused by the entry of microorganisms through a hair follicle or sweat gland. A carbuncle is a group of furuncular abscesses having multiple sloughs, often interconnected under the true skin. When localized, there are several “heads.” Symptoms begin with localized itching and inflammation, followed by swelling, fever, and pain. Redness and swelling localize, and the furuncle or carbuncle becomes hard and painful. Pus forms into a cavity, causing the skin to become taut and discolored.

As a medical technician, you should find most general wounds very easy to diagnose and treat. There are other wounds, however, that require special consideration and treatment. They are discussed below.

Eye Wounds

Many eye wounds contain foreign objects. Dirt, coal, cinders, eyelashes, bits of metal, and a variety of other objects may become lodged in the eye. Since even a small piece of dirt is intensely irritating to the eye, the removal of such objects is important. However, the eye is easily damaged. Impairment of vision (or even total loss of vision) can result from fumbling, inexpert attempts to remove foreign objects from the eye. The following precautions must be observed:

Small objects that are lodged on the surface of the eye or on the membrane lining the eyelids can usually be removed by the following procedures:

  1. Try to wash the eye gently with lukewarm, sterile water. A sterile medicine dropper or a sterile syringe can be used for this purpose. Have the victim lie down, with the head turned slightly to one side as shown in figure 4-29. Hold the eyelids apart. Direct the flow of water to the inside corner of the eye, and let it run down to the outside corner. Do not let the water fall directly onto the eyeball.

Figure 4-29.—Irrigating the eye.

  1. Gently pull the lower lid down, and instruct the victim to look up. If you can see the object, try to remove it with the corner of a clean handkerchief or with a small moist cotton swab. You can make the swab by twisting cotton around a wooden applicator, not too tightly, and moistening it with sterile water.

CAUTION

Never use dry cotton anywhere near the eye. It will stick to the eyeball or to the inside of the lids, and you will have the problem of removing it as well as the original object.

  1. If you cannot see the object when the lower lid is pulled down, turn the upper lid back over a smooth wooden applicator. Tell the victim to look down. Place the applicator lengthwise across the center of the upper lid. Grasp the lashes of the upper lid gently but firmly. Press gently with the applicator. Pull up on the eyelashes, turning the lid back over the applicator. If you can see the object, try to remove it with a moist cotton swab or with the corner of a clean handkerchief.
  2. If the foreign object cannot be removed by any of the above methods, DO NOT MAKE ANY FURTHER ATTEMPTS TO REMOVE IT. Instead, place a small, thick gauze dressing over both eyes and hold it in place with a loose bandage. This limits movement of the injured eye.
  3. Get medical help for the victim at the earliest opportunity.

Head Wounds

Head wounds must be treated with particular care, since there is always the possibility of brain damage. The general treatment for head wounds is the same as that for other fresh wounds. However, certain special precautions must be observed if you are giving first aid to a person who has suffered a head wound.

Facial Wounds

Wounds of the face are treated, in general, like other fresh wounds. However, in all facial injuries make sure neither the tongue nor injured soft tissue blocks the airway, causing breathing obstruction. Keep the nose and throat clear of any obstructing materials, and position the victim so that blood will drain out of the mouth and nose.

Facial wounds that involve the eyelids or the soft tissue around the eye must be handled carefully to avoid further damage. If the injury does not involve the eyeball, apply a sterile compress and hold it in place with a firm bandage. If the eyeball appears to be injured, use a loose bandage. (Remember that you must NEVER attempt to remove any object that is embedded in the eyeball or that has penetrated it; just apply a dry, sterile compress to cover both eyes, and hold the compress in place with a loose bandage).

Any person who has suffered a facial wound that involves the eye, the eyelids, or the tissues around the eye must receive medical attention as soon as possible. Be sure to keep the victim lying down. Use a stretcher for transport.

Chest Wounds

Since chest injuries may cause severe breathing and bleeding problems, all chest injuries must be considered as serious conditions. Any victim showing signs of difficulty in breathing without signs of airway obstruction must be inspected for chest injuries. The most serious chest injury that requires immediate first aid treatment is the sucking chest wound. This is a penetrating injury to the chest that produces a hole in the chest cavity. The chest hole causes the lung to collapse, preventing normal breathing functions. This is an extremely serious condition that will result in death if not treated quickly.

Victims with open chest wounds gasp for breath, have difficulty breathing out, and may have a bluish skin color to their face. Frothy-looking blood may bubble from the wound during breathing.

The proper treatment for a sucking chest wound is as follows:

  1. Immediately seal the wound with a hand or any airtight material available (e.g., ID card). The material must be large enough so that it cannot be sucked into the wound when the victim breathes in.
  2. Firmly tape the material in place with strips of adhesive tape and secure it with a pressure dressing. It is important that the dressing is airtight. If it is not, it will not relieve the victim’s breathing problems. The object of the dressing is to keep air from going in through the wound.

NOTE

If the victim’s condition suddenly deteriorates when you apply the seal, remove it immediately.

  1. Give the victim oxygen if it is available and you know how to use it.
  2. Place the victim in a Fowler’s or semi-Fowler’s position. This makes breathing a little easier. During combat, lay the victim on a stretcher on the affected side.
  3. Watch the victim closely for signs of shock, and treat accordingly.
  4. Do not give victims with chest injuries anything to drink.
  5. Transport the victim to a medical treatment facility immediately.

Abdominal Wounds

A deep wound in the abdomen is likely to constitute a major emergency since there are many vital organs in this area. Abdominal wounds usually cause intense pain, nausea and vomiting, spasm of the abdominal muscles, and severe shock. Immediate surgical treatment is almost always required; therefore, the victim must receive medical attention at once, or the chances of survival will be poor. Give only the most essential first aid treatment, and concentrate your efforts on getting the victim to a medical treatment facility. The following first aid procedures may be of help to a person suffering from an abdominal wound:

 

Figure 4-30.—Protruding abdominal wounds.

Figure 4-31.—Applying compresses to a protruding abdominal wound.

Crush Injuries

Force can be transmitted from the body's exterior to its interior structure, leaving the skin intact, with a simple bruise as the only external evidence of trauma. This force can cause internal organs to be crushed or to rupture and bleed. When this happens, it is called a crush injury. Organs such as the liver and spleen contain a lot of blood. When crushed, these organs bleed severely, and this severe internal bleeding can cause shock. Contents of hollow organs (e.g., urine or digested food) can leak into the body cavities, causing severe inflammation and tissue damage. Bones can also be broken along with muscles, and nerves damaged. Assessment and treatment for the Hospital medical technician can be difficult when a crush injury is involved. Treat symptomatically and evacuate to the nearest medical treatment facility as soon as possible.

Removing Foreign Objects

Many wounds contain foreign objects. Wood or glass splinters, bullets, metal fragments, bits of wire, fishhooks, nails, tacks, cinders, and small particles from grinding wheels are examples of the variety of objects or materials that are sometimes found in wounds. When such objects are near the surface and exposed, first aid treatment includes their removal. However, first aid treatment does not include the removal of deeply embedded objects, powdered glass, or any widely scattered material of this nature. You should never attempt to remove bullets, but you should try to find out whether the bullet remains in the victim. Look for both entrance and exit wounds. The general rule to remember is this: Remove foreign objects from a wound when you can do so easily and without causing further damage; but NEVER HUNT FOR OR ATTEMPT TO REMOVE DEEPLY BURIED OR WIDELY SCATTERED OBJECTS OR MATERIALS, except in a definitive care environ­ment.

The following procedure may be used to remove a small object from the skin or tissues if the object is near the surface and clearly visible:

  1. Cleanse the skin around the object with soap and water and paint with any available skin antiseptic solution.
  2. If necessary, pierce the skin with a sharp instrument (a needle, razor, or sharp knife that has been sterilized by passing it through a flame several times).
  3. Grasping the object at the end, remove it. Tweezers, small pincers, or forceps may be used for this purpose. (Whatever instrument you use should first be sterilized by boiling if at all possible.)
  4. If the wound is superficial, apply gentle pressure to encourage bleeding.
  5. Cover the wound with a dry, sterile dressing.

If the foreign object is under a fingernail or toenail, you may have to cut a V-shaped notch in the nail so that the object can be grasped by the forceps. Do not try to dig the object out from under the nail with a knife or similar instrument.

A curved or barbed object (such as a fishhook) may present special problems. Figure 4-32 shows one method of removing a fishhook that has become embedded in the flesh. As you can see from figure 4-32A, the barb on the hook prevents its direct removal. However, if you push the hook forward through the skin, as shown in figure 4-32B, you can clip off the barb with a wire cutter or similar tool, as shown in figure 4-32. The remainder of the fishhook can then be withdrawn in the manner indicated in figure 4-32D.

Figure 4-32.—Removing a fishhook.

Animal Bites

A special kind of infection that must be guarded against in case of animal bites is rabies (sometimes called “hydrophobia”). This disease is caused by a virus that is present in the saliva of infected animals. The disease occurs most commonly in wild animals, but it has been found in domestic animals and household pets. In fact, it is probable that all mammals are susceptible to it. The virus that causes rabies is ordinarily transmitted by a bite, but it can be transmitted by the saliva of an infected animal coming in contact with a fresh wound or with the thin mucous membrane of the lips or nose. The virus does not penetrate normal unbroken skin. If the skin is broken, DO NOT attempt wound closure.

If rabies develops in man, it is usually fatal. A preventive treatment is available and it is very effective, but only if it is started shortly after the bite. Since the vaccine can be obtained only at a medical treatment facility or a major ship, any person bitten by an animal must be transferred quickly to the nearest medical facility for evaluation, along with a complete report of the circumstances surrounding the incident. Remember, prevention is of utmost importance.

Immediate local treatment of the wound should be given. Wash the wound and the surrounding area carefully, using sterile gauze, soap, and sterile water. Use sterile gauze to dry the wound, and then cover the wound with a sterile dressing. DO NOT use any chemical disinfectant. Do not attempt to cauterize the wound in any way.

All of the animal’s saliva must be removed from the victim’s skin to prevent further contamination of the wound.

CAUTION

DO NOT allow the animal’s saliva to come in contact with open sores or cuts on your hands.

When a person has been bitten by an animal, every effort must be made to catch the animal and to keep it confined for a minimum of 8 to 10 days. DO NOT kill it if there is any possible chance of catching it alive. The symptoms of rabies are not always present in the animal at the time the bite occurs, but the saliva may nevertheless contain the rabies virus. It is essential, therefore, that the animal is kept under observation until a diagnosis can be made. The rabies treatment is given if the animal develops any definite symptoms, if it dies during the observation period, or if for any reason the animal cannot be kept under observation.

Remember that any animal bite is dangerous and MUST be evaluated at a treatment facility.