Incisions, Lacerations, Puncture Emergencies

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I received a call for assistance at a local deli. When I got there, the manager of the store told me that one of her workers cut a finger on a meat slicing machine. We rushed toward the back of the store, passing behind the counter where I saw the meat slicer. I noticed the blood on the blade, but I didn’t see excessive blood on the counter or the floor.

When we entered a small office in the back of the deli, I saw an adult female in her twenties sitting in a chair holding a bloody towel to her hand. She was wincing and pale.

I approached her and asked what happened. She told me she had been cutting meat when she suddenly felt a sharp pain and saw blood. “I must have accidently let my finger hit the slicing blade,” she whispered.

I asked her if she fell or passed out. She replied that she had not.

She said she had the bleeding under control with the towel she was holding on the wound. That seamed to be the case. But I noticed that she was still pale and apprehensive. Her vital signs were normal, but since she looked a little shocky, I had her rest on the cot they had back there. The manager covered her with a light blanket, while I gave the patient oxygen.

I asked the manager if she had looked for the avulsed part. She said no. I explained very briefly how to handle it if it was found, and she went out to the front of the store to find it.

When I unwrapped the towel to check the patient’s wound, I saw that she had cut off about a quarter of an inch from the tip of the middle finger. I cleaned it gently applied a sterile dressing and bandage. The patient seemed to feel comfortable holding it, so I had her hold some pressure to the bandaged wound to make sure the bleeding stayed in control. Since she was still nervous, I tried to reassure her and keep her calm. After a while, her color returned, and she said she felt better.

When the ambulance arrived, I filled them in with a brief history and gave them a copy of my report with vital signs. The manager had looked for the avulsed part around the slicing machine but couldn’t find it. Had it been found, or had it been larger, we would have preserved it and sent it to the hospital with the patient for possible reattachment.

INTRODUCTION

A soft-tissue injury is an injury to the layers of skin, fat, and muscle that protect underlying structure and organs. Such an injury is commonly referred to as a wound. Wounds may be classified as closed or open, single or multiple. They are also classified according to location (head wounds or chest wounds, for example). Although this type of injury may be the most obvious and dramatic, it is seldom the most serious-unless it compromises the airway or is associated with massive hemorrhage. Thus, the Health Guardian must search for life-threatening conditions before treating the soft-tissue trauma.

INCISIONS

Incisions are sharp cuts with smooth edges. They tend to bleed freely because blood vessels and tissue have been cut. Incisions are caused by any sharp object, such as a knife, razor blade, or broken glass. The greatest dangers with incisions are sever (often profuse) bleeding and damage to tendons and nerves. Incisions usually heal better than lacerations because the edges of the wound are smooth and straight.

Emergency Care

Provide the following care for incisions:

  1. Control bleeding by applying direct pressure.
  2. Draw the wound edges together. Apply a sterile dressing and pressure bandage.
  3. If the bleeding is severe, give emergency care for shock. Administer oxygen, if you are properly trained and allowed to do so by local protocol.
  4. Transport the patient to a physician or activate the EMS system. Follow local protocol.

LACERATIONS

A laceration is a tear that produces a ragged incision through the skin surface and underlying tissues. A laceration can also result from blunt trauma to tissue overlying a bone. Lacerations can cause significant bleeding if a blood vessel, especially an artery is cut. This is particularly true in areas where major arteries lie close to the skin surface, such as in the wrist. Because the edges of a laceration are jagged, healing is not as good as in an incision. Skin and tissue may be torn away partly or completely, and the laceration may contain foreign matter that can lead to infection.

Emergency Care

Provide the following care for lacerations:

  1. Control bleeding with direct pressure and elevation. If possible, use sterile dressing over the wound.
  2. Once bleeding is controlled, remove surface dirt and loose debris. Wound cleaning should be left to medical personnel. Follow local protocol.
  3. Cover with a sterile dressing, and bandage in place.
  4. Elevate the affected part to help control pain and bleeding. Splinting and immobilizing the injured part may also help control bleeding. Follow local protocol.
  5. Give emergency care for shock if bleeding is severe. Administer oxygen if you are properly trained and allowed to do so by local protocol.
  6. Transport the patient to a physician or activate the EMS system. Follow local protocol.

PUNCTURES

A puncture wound is caused by the penetration of a sharp object through the skin and underlying structures. Even though the opening in the skin may appear to be very small, the puncture wound may be deep, posing a serious threat of infection. Internal organs may also be damaged. In some cases, the object that causes the injury remains embedded in the wound. A puncture usually does not cause a bleeding problem unless it is located in the chest or abdomen, where bleeding can be rapidly fatal. In a puncture wound, always assess for an exit wound as well.

Emergency Care

Provide the following care for a puncture wound.

  1. Control bleeding with direct pressure. If an object is impaled in the wound, spread your fingers around the object. Avoid putting pressure on the object or tissue around its edges.
  2. Clean around wound with a light, sterile dressing, and bandage in place.
  3. Give the patient emergency care for shock if bleeding is severe or if the wound is to the chest or abdominal cavity. Administer oxygen if you are properly trained and allowed to do so by local protocol.
  4. Transport the patient to a physician or activate the EMS system. Immobilize the injured part in a comfortable position. Follow local protocol. If there is an impaled object in the wound, do not remove it. Efforts to do so can cause underlying tissue damage and severe hemorrhage.

 RELEVANT INFUSIONS

 Whole Body Protection

 The Epidermal System Protector®

 The Cardiovascular System Revitalizer®

 The Vascular Strengthener®

The Musculoskeletal System Gladiator®

 

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