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. 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. [4] X Trustworthy Source Cleveland Clinic Educational website from one of the world’s leading hospitals Go to source Evidence of internal bleeding, like swelling, large purple areas on the skin, or abdominal pain. [5] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source 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. If you suspect the animal has rabies, seek medical attention immediately to prevent infection or complications.
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. There is any significant head trauma. [6] X Research source There is evidence of a bone fracture or internal bleeding. [7] X Research source The wound is dirty and the injured person has not had a recent tetanus vaccination. [8] X Research source Center for Disease Control. Tetanus Vaccines for Wound Management. 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.
Elevating the wounded area will decrease blood flow to the wound and decrease bleeding. If bleeding doesn’t stop within 10 to 15 minutes, seek immediate medical help. [9] X Research source Hoffman, R. Benz E. J. Jr. , and L. E. Heslop. Hematology: Basic Principles and Practice. Laboratory Evaluation of Hemostatic and Thrombotic Disorders
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. 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.
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. 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. In the case of chemical burns, irrigation dilutes the chemical and reduces tissue damage.
Use a bandage that is slightly larger than the wound itself. 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. Iodine impregnated gauze is best for wounds that need to stay open, such as abscesses or puncture wounds. [11] X Research source 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)
If the bandage is crusted on to wound and won’t come off easily, soak it in warm water. [12] X Research source While the wound is exposed, assess for signs of infection. These include redness of the skin around the wound edges or progressing up the injured limb, warmth around the wound, and swelling. Look for drainage of pus or that is greenish-yellow in color. [13] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source 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. If an infection becomes trapped inside the skin, the wound may need to be reopened by a doctor. Some infected wounds require antibiotics or even an operation under general anesthesia. This is especially common in cases where the wound was not irrigated properly. If you have a chronic skin wound or ulceration, go to a wound care clinic to get treatment or topical antimicrobials. Those with diabetes mellitus and peripheral vascular disease are at risk of worsening complications with non-healing wounds.
Use soap and water to clean the surrounding skin and parts of the wound that are not wide open. Sing the birthday song twice while washing the area and you will have done a thorough job!
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.
Repeat the inspection process daily until the wound is healed. Continue to elevate wound as much as possible, for at least the first few days. This will minimize the pain and swelling.
