(INJ) Open and Closed Wounds Lesson One

Open and Closed Wounds

To be sure, bleeding is one of the most common injuries that you will care for using first aid. While we discussed severe bleeding in the previous module, in this lesson we will focus on injuries that are characterized by minor to moderate bleeding. This generally involves wounds that affect the soft tissues, such as skin, fat, and muscles. These wounds can be classified as open and closed, much the same as external and internal bleeding.

Closed Wounds

Closed wounds are injuries that do not break the skin and damage occurs beneath the skin. The most common and simplest of these is a contusion, also known as a bruise. They are a result of a blunt trauma damaging tissue and vessels under the surface of the skin. Blood leaks into the surrounding tissues causing discoloration of the skin and possibly swelling around the bruise site. The more significant the force of the trauma is, the more profuse the internal bleeding.

Luckily, most closed wounds require only minimal medical care. Applying an ice pack to the area will help decrease the amount of internal bleeding, as well as, helping to manage the pain and swelling. This can be a commercial ice pack or an improvised ice pack made by filling a plastic bag with ice and water. Apply it to the injured area for about 20 mins., using a thin barrier such as a cloth or paper towel, between the ice pack and skin. Help the victim to rest comfortably in a position that does not cause more pain or injury.

Remember, closed wounds can also become life threatening. To review the signs and symptoms, refer to the previous module.

Open Wounds

Open wounds are characterized by a break in the skin. These can range from very minor scrapes to deep, penetrating wounds. Again, reviewing the image below depicting the types of bleeding, as well as the previous module content will help your understanding and treatment for these injuries.

ARTERIES
VEINS
CAPILLARIES
• Spurting blood
• Pulsating flow
Bright red color
• Steady Flow
• Dark red color
• Slow even flow
Oozing blood

Let's look at the 4 main types of Open Wounds

Care and Treatment for Open Wounds

As with all first aid situations, the priority is to protect yourself, so put on protective gloves before approaching the victim.

Most open wounds can be treated by helping to prevent infection and controlling external bleeding with direct pressure, dressings and bandages.

In general, follow these steps:

Special Cases

Nosebleeds	Embedded Objects	Stab, puncture or gunshot wounds to the body	Severed Body Part
If a person has a nosebleed, have them pinch the soft part of the nose firmly between thumb and forefinger, just below the end of the bone. It is preferable to have them do it themselves if they are able to do it effectively. The victim should lean their head slightly forward and breathe through their mouth. You can also leave the head in a neutral position, but never tilt the head back. Tilting the head forward ensures that blood isn't ingested (as it can cause vomiting) or inhaled (choking hazard). If you are unsuccessful at stopping the bleeding after 10 minutes of direct pressure, you should assess the blood flow. If the blood flow is minor, you could consider using an ice pack on the bridge of the nose to help stem the flow. If the nose continues to bleed with a fast flow, you should seek medical assistance.	If there is something embedded in the wound, do not remove it. Instead, apply pressure around the object using a sterile dressing, such as gauze, as described above. Rolled bandages are perfect for this. Be careful not to disturb the object, as moving it may exacerbate the bleeding. This doesn't apply to superficial splinters and such. A useful rule of thumb: if it's causing bleeding, don't remove it. If it isn't, feel free. Apply pressure and secure with bandages then seek medical aid.	These wounds are life threatening, and after assessing the ABCs of the victim, you should immediately call 9-1-1. As always, you should check that you are not in danger when approaching these victims (from someone with a knife or gun, for instance). As with all embedded objects, ensure you do not remove the item from the body. If possible, you should sit the victim up (as blood in the body will go to the lowest point, allowing the heart and lungs to work as efficiently as possible). You should also lean them to the injured side, keeping the healthy side free from incursion by blood. Assess the victim for open chest wounds or abdominal injuries, and treat accordingly.	If a body part has been amputated, immediately seek assistance, and treat the wound for bleeding first as above. Cover the amputated part with a moist dressing and place it in a clean plastic bag, and place this bag into a bag of ice and water, sending it with the victim to the hospital (it should be labeled with their name and where it belongs). You should avoid putting the part in direct contact with ice, as this can cause irreparable damage, meaning that surgeons are unable to reattach it. If the body part is partially amputated, do not detach, but treat as a wound.

Nosebleeds

Embedded Objects

Stab, puncture or gunshot wounds to the body

Severed Body Part

If a person has a nosebleed, have them pinch the soft part of the nose firmly between thumb and forefinger, just below the end of the bone. It is preferable to have them do it themselves if they are able to do it effectively.

The victim should lean their head slightly forward and breathe through their mouth. You can also leave the head in a neutral position, but never tilt

the head back. Tilting the head forward ensures that blood isn't ingested (as it can cause vomiting) or inhaled (choking hazard).

If you are unsuccessful at

stopping the bleeding after 10 minutes of direct pressure, you should assess the blood flow. If the blood flow is minor, you could consider using an ice pack on the bridge of the nose to help stem the flow.

If the nose continues to bleed with a fast flow, you should seek medical assistance.

If there is something embedded in the wound, do not remove it.

Instead, apply pressure around the object using a sterile dressing, such as gauze, as described above. Rolled bandages are perfect for this. Be careful not to disturb the object, as moving it may exacerbate the bleeding. This doesn't apply to superficial splinters and such. A useful rule of thumb: if it's causing bleeding,

don't remove it.

If it isn't, feel free. Apply pressure and secure with bandages then seek medical aid.

These wounds are life threatening, and after assessing the ABCs of the victim, you should immediately call 9-1-1. As always, you should check that you are not in danger when approaching these victims (from someone with a knife or gun, for instance). As with all embedded objects, ensure you do not remove the item from the body.

If possible, you should sit the victim up (as blood in the body will go to the lowest point, allowing the heart and lungs to work as efficiently as possible). You should also lean them to the injured side, keeping the healthy side free from incursion by blood. Assess the victim for

open chest wounds or abdominal injuries, and treat accordingly.

If a body part has been amputated, immediately seek assistance, and treat

the wound for bleeding first as above. Cover the amputated part with a moist dressing and place it in a clean plastic bag, and place this bag into a bag of ice and water, sending it with the victim to the hospital (it should be labeled with their name and where it belongs). You should avoid putting the part in direct contact with ice, as this can cause irreparable damage, meaning that surgeons are unable to reattach it. If the body part is partially amputated, do not detach, but treat as a wound.

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