Difference between revisions of "Clean a Wound"
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== Steps == | == Steps == | ||
===Cleaning the Wound=== | ===Cleaning the Wound=== | ||
| − | #Examine the wound. The first step in treating any injury is to examine it closely. You'll need to determine the nature and severity of the wound. Take a close look at the injury and pay attention to the following:<ref>Bret Nicks, Elizabeth Ayello, Kevin Woo, Acute Wound Management : Revisiting the approach to Assessment , Irrigation and Closure, Journal of International Emergency Medicine, 2010, Dec, 3 (4) 399-407)</ref> | + | #Examine the wound. The first step in treating any injury is to examine it closely. You'll need to determine the nature and severity of the wound. Take a close look at the injury and pay attention to the following:<ref name="rf1">Bret Nicks, Elizabeth Ayello, Kevin Woo, Acute Wound Management : Revisiting the approach to Assessment , Irrigation and Closure, Journal of International Emergency Medicine, 2010, Dec, 3 (4) 399-407)</ref> |
#*The amount of blood. How rapidly is the person bleeding? Does the blood come out in a steady flow, or is it pulsing? | #*The amount of blood. How rapidly is the person bleeding? Does the blood come out in a steady flow, or is it pulsing? | ||
#*Foreign objects in the wound. This might be the cause of the wound itself, like a fishhook, or a piece of glass. | #*Foreign objects in the wound. This might be the cause of the wound itself, like a fishhook, or a piece of glass. | ||
#*Dirt or debris in or around the wound. | #*Dirt or debris in or around the wound. | ||
| − | #*Evidence of a bone fracture, like a protruding bone, swelling over a bone, or inability to move a limb. Look for this especially if the person was injured in a fall.<ref>http://www.webmd.com/a-to-z-guides/understanding-fractures-symptoms</ref> | + | #*Evidence of a bone fracture, like a protruding bone, swelling over a bone, or inability to move a limb. Look for this especially if the person was injured in a fall.<ref name="rf2">http://www.webmd.com/a-to-z-guides/understanding-fractures-symptoms</ref> |
| − | #*Evidence of internal bleeding, like swelling, large purple areas on the skin, or abdominal pain.<ref>http://www.webmd.com/first-aid/internal-bleeding-causes-signs</ref> | + | #*Evidence of internal bleeding, like swelling, large purple areas on the skin, or abdominal pain.<ref name="rf3">http://www.webmd.com/first-aid/internal-bleeding-causes-signs</ref> |
#*In the case of animal attacks, look for signs of bites and multiple injuries. If you live in an area where there are venomous snakes or insects, it may be helpful to know what those injuries look like. | #*In the case of animal attacks, look for signs of bites and multiple injuries. If you live in an area where there are venomous snakes or insects, it may be helpful to know what those injuries look like. | ||
#Determine if medical attention is needed. You can often treat minor wounds at home. But, in the case of a serious wound, the injured person should see a doctor immediately. Seek medical attention if: | #Determine if medical attention is needed. You can often treat minor wounds at home. But, in the case of a serious wound, the injured person should see a doctor immediately. Seek medical attention if: | ||
#*The wound is bleeding a lot, the bleeding is pulsing, and/or it won't stop. | #*The wound is bleeding a lot, the bleeding is pulsing, and/or it won't stop. | ||
#*The wound is more than one centimeter deep. This may require stitches. | #*The wound is more than one centimeter deep. This may require stitches. | ||
| − | #*There is any significant head trauma.<ref>http://www.mayoclinic.org/first-aid/first-aid-head-trauma/basics/ART-20056626</ref> | + | #*There is any significant head trauma.<ref name="rf4">http://www.mayoclinic.org/first-aid/first-aid-head-trauma/basics/ART-20056626</ref> |
| − | #*There is evidence of a bone fracture or internal bleeding.<ref | + | #*There is evidence of a bone fracture or internal bleeding.<ref name="rf3" /> |
| − | #*The wound is dirty and the injured person has not had a recent tetanus vaccination.<ref>Center for Disease Control. Tetanus Vaccines for Wound Management.</ref> This is especially important if the wound came from a rusty metal object. | + | #*The wound is dirty and the injured person has not had a recent tetanus vaccination.<ref name="rf5">Center for Disease Control. Tetanus Vaccines for Wound Management.</ref> This is especially important if the wound came from a rusty metal object. |
#*The person is known to be taking blood thinners. This is especially important if the person has suffered head trauma. | #*The person is known to be taking blood thinners. This is especially important if the person has suffered head trauma. | ||
#Stop the bleeding. Apply gentle pressure to the wound using a wad of cloth or gauze, with excess fabric wrapped around the wounded area. Elevate the wounded area above the person's heart, if possible. | #Stop the bleeding. Apply gentle pressure to the wound using a wad of cloth or gauze, with excess fabric wrapped around the wounded area. Elevate the wounded area above the person's heart, if possible. | ||
| − | #*Elevating the wounded area will decrease blood flow to the wound and decrease bleeding.<ref>http://www.dhhs.nh.gov/dcbcs/bds/nurses/documents/firstaid.pdf</ref> | + | #*Elevating the wounded area will decrease blood flow to the wound and decrease bleeding.<ref name="rf6">http://www.dhhs.nh.gov/dcbcs/bds/nurses/documents/firstaid.pdf</ref> |
| − | #*If bleeding doesn't stop within 10 to 15 minutes, seek immediate medical help.<ref>Hoffman, R. Benz E.J. Jr., and L.E. Heslop. Hematology: Basic Principles and Practice. Laboratory Evaluation of Hemostatic and Thrombotic Disorders</ref> | + | #*If bleeding doesn't stop within 10 to 15 minutes, seek immediate medical help.<ref name="rf7">Hoffman, R. Benz E.J. Jr., and L.E. Heslop. Hematology: Basic Principles and Practice. Laboratory Evaluation of Hemostatic and Thrombotic Disorders</ref> |
#Remove small foreign objects. If there are any objects in the wound that you can remove (such as a a small rock, splinter, or fishhook), carefully take them out. | #Remove small foreign objects. If there are any objects in the wound that you can remove (such as a a small rock, splinter, or fishhook), carefully take them out. | ||
#*Use sanitized tweezers for small objects, if you have them available. | #*Use sanitized tweezers for small objects, if you have them available. | ||
| − | #*Do not remove large objects from a wound. You can further open the wound and increase bleeding.<ref | + | #*Do not remove large objects from a wound. You can further open the wound and increase bleeding.<ref name="rf6" /> |
#*If there is a large amount of debris in the wound, especially if the wound is large (e.g. a "road rash" injury), seek medical attention. Removing the debris can require painful scrubbing, and a local anesthetic may be a good idea. | #*If there is a large amount of debris in the wound, especially if the wound is large (e.g. a "road rash" injury), seek medical attention. Removing the debris can require painful scrubbing, and a local anesthetic may be a good idea. | ||
| − | #Irrigate the wound. Once the bleeding has stopped, the next step is thoroughly cleanse the area with warm, flowing water. This is arguably the most important step for promoting speedy recovery.<ref> Bret Nicks, Elizabeth Ayello, Kevin Woo, Acute Wound Management : Revisiting the approach to Assessment , Irrigation and Closure, Journal of International Emergency Medicine, 2010, Dec, 3 (4) 399-407.</ref> There are several good ways to do this: | + | #Irrigate the wound. Once the bleeding has stopped, the next step is thoroughly cleanse the area with warm, flowing water. This is arguably the most important step for promoting speedy recovery.<ref name="rf8"> Bret Nicks, Elizabeth Ayello, Kevin Woo, Acute Wound Management : Revisiting the approach to Assessment , Irrigation and Closure, Journal of International Emergency Medicine, 2010, Dec, 3 (4) 399-407.</ref> There are several good ways to do this: |
#*Use a bulb syringe (available in most drug stores) filled with warm tap water or normal saline (you can use a large bottle of saline solution for contact lenses if you're in a pinch). Squeeze the liquid out onto the wound. Repeat for a volume of approximately two liters. You won't need to irrigate as much on the face or scalp. These areas have many blood vessels and will clean the wound naturally through bleeding. | #*Use a bulb syringe (available in most drug stores) filled with warm tap water or normal saline (you can use a large bottle of saline solution for contact lenses if you're in a pinch). Squeeze the liquid out onto the wound. Repeat for a volume of approximately two liters. You won't need to irrigate as much on the face or scalp. These areas have many blood vessels and will clean the wound naturally through bleeding. | ||
#*A 60cc syringe with IV catheter tip provides the best volume and pressure of irrigation. It also provides directed irrigation to get behind skin flaps and other difficult areas. If you go to a doctor for care, this is most likely what he or she will use. | #*A 60cc syringe with IV catheter tip provides the best volume and pressure of irrigation. It also provides directed irrigation to get behind skin flaps and other difficult areas. If you go to a doctor for care, this is most likely what he or she will use. | ||
#*You can also use running warm tap water. Run at least two liters, the size of a large plastic soda bottle, over the wound. Continue until all wound areas are free of debris and all flaps cleaned under. | #*You can also use running warm tap water. Run at least two liters, the size of a large plastic soda bottle, over the wound. Continue until all wound areas are free of debris and all flaps cleaned under. | ||
| − | #*Wounds from burns should be generously irrigated with cool water to bring down temperature.<ref | + | #*Wounds from burns should be generously irrigated with cool water to bring down temperature.<ref name="rf6" /> In the case of chemical burns irrigation dilutes the chemical and reduces tissue damage. |
#Bandage the wound. After cleaning the wound, wrap it in a clean bandage. Bandaging restricts mobility so that wound edges can come together and heal. It also protects from further injury and infection. | #Bandage the wound. After cleaning the wound, wrap it in a clean bandage. Bandaging restricts mobility so that wound edges can come together and heal. It also protects from further injury and infection. | ||
| − | #*Use a bandage that is slightly larger than the wound itself.<ref | + | #*Use a bandage that is slightly larger than the wound itself.<ref name="rf6" /> |
#*Any commercially available bandage material will work for most wounds. Gauze is the mainstay, either rolled or in 2x2 or 4x4 options depending on wound size. | #*Any commercially available bandage material will work for most wounds. Gauze is the mainstay, either rolled or in 2x2 or 4x4 options depending on wound size. | ||
#*Burns, abrasions, or wounds with irregular edges should be covered with a non-stick or Telfa pad, as dried blood and healing skin can stick to gauze. | #*Burns, abrasions, or wounds with irregular edges should be covered with a non-stick or Telfa pad, as dried blood and healing skin can stick to gauze. | ||
| − | #*Iodine impregnated gauze is best for wounds need to stay open, such as abscesses or puncture wounds.<ref> Bret Nicks, Elizabeth Ayello, Kevin Woo, Acute Wound Management : Revisiting the approach to Assessment , Irrigation and Closure, Journal of International Emergency Medicine, 2010, Dec, 3 (4) 399-407)</ref> | + | #*Iodine impregnated gauze is best for wounds need to stay open, such as abscesses or puncture wounds.<ref name="rf9"> Bret Nicks, Elizabeth Ayello, Kevin Woo, Acute Wound Management : Revisiting the approach to Assessment , Irrigation and Closure, Journal of International Emergency Medicine, 2010, Dec, 3 (4) 399-407)</ref> |
===Managing the Wound=== | ===Managing the Wound=== | ||
#Reexamine the wound daily. After 48 hours, recheck the wound daily.Carefully remove the bandage and look for signs of infection or other complications. Contact a doctor if you see signs of infection. | #Reexamine the wound daily. After 48 hours, recheck the wound daily.Carefully remove the bandage and look for signs of infection or other complications. Contact a doctor if you see signs of infection. | ||
| − | #*If the bandage is crusted on to wound and won't come off easily, soak it in warm water.<ref>http://www.webmd.com/first-aid/tc/cleaning-and-bandaging-a-wound-topic-overview?page=2</ref> | + | #*If the bandage is crusted on to wound and won't come off easily, soak it in warm water.<ref name="rf10">http://www.webmd.com/first-aid/tc/cleaning-and-bandaging-a-wound-topic-overview?page=2</ref> |
| − | #*While the wound is exposed, assess for signs of infection. These include redness of the skin around the wound edges or redness progressing up the injured limb. Look for drainage of pus or that is greenish-yellow in color.<ref>http://www.webmd.com/skin-problems-and-treatments/symptoms-of-infection-after-a-skin-injury</ref> | + | #*While the wound is exposed, assess for signs of infection. These include redness of the skin around the wound edges or redness progressing up the injured limb. Look for drainage of pus or that is greenish-yellow in color.<ref name="rf11">http://www.webmd.com/skin-problems-and-treatments/symptoms-of-infection-after-a-skin-injury</ref> |
#*Feel gently with your fingers for warmth in the area, and increased swelling. These can be warning signs, especially in the presence of redness. | #*Feel gently with your fingers for warmth in the area, and increased swelling. These can be warning signs, especially in the presence of redness. | ||
#*Check the injured person's temperature for fever. Anything of 100.4 or above is cause for alarm, and you must seek immediate medical attention. | #*Check the injured person's temperature for fever. Anything of 100.4 or above is cause for alarm, and you must seek immediate medical attention. | ||
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#Irrigate the wound. If the wound is clean, irrigate again to maintain cleanliness. Just run water over the wound for one minute. Wash any clotted blood off with soap and water. | #Irrigate the wound. If the wound is clean, irrigate again to maintain cleanliness. Just run water over the wound for one minute. Wash any clotted blood off with soap and water. | ||
#*Use soap and water to clean the surrounding skin and parts of wound that are not wide open. Sing the birthday song twice while sudsing and you will have done a thorough job! | #*Use soap and water to clean the surrounding skin and parts of wound that are not wide open. Sing the birthday song twice while sudsing and you will have done a thorough job! | ||
| − | #Apply an antibiotic. Once is it cleansed, apply a small coating of neosporin or other topical antibiotic ointment to the wound with a Q-tip. This reduces the chances of infection.<ref>http://www.webmd.com/drugs/2/drug-3744-7125/neosporin-top/combinationantibiotic-topical/details</ref> | + | #Apply an antibiotic. Once is it cleansed, apply a small coating of neosporin or other topical antibiotic ointment to the wound with a Q-tip. This reduces the chances of infection.<ref name="rf12">http://www.webmd.com/drugs/2/drug-3744-7125/neosporin-top/combinationantibiotic-topical/details</ref> |
#*This is ''not'' a substitute for thorough cleaning and irrigation. Apply sparingly, and if the wound is macerated, let it dry before applying any ointment. | #*This is ''not'' a substitute for thorough cleaning and irrigation. Apply sparingly, and if the wound is macerated, let it dry before applying any ointment. | ||
#Bandage the wound. Place a clean bandage over the wound. Between inspections, keep the bandage clean and dry. | #Bandage the wound. Place a clean bandage over the wound. Between inspections, keep the bandage clean and dry. | ||
