WOUNDS
A Wounds is a type
of injury with happens relatively quickly in which skin is form, cut ,
or puncture (on open wounds) or where blunt force trauma cases a contusion ( a
close wound ) In pathology it
specifically refers to a sharp injury which damages the dermis of the
skin .
Classification
:-
According to the level of contamination a wound can be classified as :-
1.
Clean
wound :- A wound
made under sterile conditions where there are no organisms present in the wound
and the wound is likely to heal complication.
2.
Contaminated wounds:-Where the wound is as a result of accidental injury where there are pathogenic organisms
and foreign bodies in the wound.
3. Infected wound:-Where the wound has pathogenic organisms present and multiplying showing clinical signs of infection, where it looks yellow.
4.
Colonized
wound:-Where the wounds is a chronic one and there are a no of organisms present
and very difficult to heal as in a
bedsore .
(i)
Open :-
open wounds can be classified according to
the object that caused the wound . The types of Open wounds are:-
A . Incisions
or incised wounds:-
caused by a clean , sharp – edged
object such as a knife razor or glass
splinter .
B.
Lacerations :-
irregular tear –like wounds caused by
some blunt trauma laceration
and incision many appear (regular ) or
stellate (irregular ) The team laceration
is commonly misused in reference to incisions .
c.
Abrasions (grazes) :- superficial
wounds in which the topmost layer of
the skin ( The epidermis) is scraped off
. Abrasions are often caused by a sliding fall on to a rough
surface .
d.
Avulsions :- Injuries
in which a body structure is forcibly detached from its normal point of
insertion .
A type
of amputation where the extremity is pulled off rather than cut off.
e.
puncture wounds:-
caused by an object puncturing the skin
,such as a splinter, nail or needle.
f.
penetration wounds :- caused by an object such as a
knife entering and coming out
from the skin .
g.
Gunshot wounds :- caused by a bullet
or similar projectile driving into or
through the body . there may be two wounds , one at the site of entry and one
of the site of exit generally referred to as a through and through .
(II)
closed :- closed wounds have fewer categories , but are just as dangerous as open wounds . The type of close wounds
are:-
1
. Hematomas :- Also called
a blood tumor , caused by damage
to a blood vessels that in turn causes blood to collect under the skin .
2. Hematomas
that originate from internal blood vessel
pathology are petechiae .purpura and ecchymosis . The different classification are based on size .
3 . Hematomas that originate from an external
source of trauma are contusions, also commonly called bruises .
4 Crush
injury caused by a
great or extreme amount of force
applied over a long period of time .
Types of open
wound
An open wound (an avulsion ) A laceration to the leg .
An infected
puncture wound to the bottom of
the fore foot
A
puncture wound from playing darts . An incision a small cut in a finger .
Wound cause and types :-
Wound occur when the skin is broken or damaged because of injury . causes of injury be the
result of mechanical , chemical , electrical thermal or nuclear sources . The
skin can be damaged in a variety of ways depending upon the mechanism of injury .
Inflammation
:- Is the skin
initial response to injury
Superficial
:- (on the
surface ) wounds and abrasions leave the
deeper skin layers in tract . These type of wounds are usually caused by friction
rubbing against an abrasive surface .
Deep
abrasions cuts or lacerations :- Go through all the layers of the
skin and into under laying tissue like muscle or bone .
Puncture wounds :- Are usually caused
by a sharp pointed object entering the skin .Example of puncture wounds
include a needle stick , stepping on
a nail , or a stab wound with a knife .
Human
and Animal bites :- can be classified as puncture
wounds , abrasions ,or a combination of both.
Pressure
sources:-- ( bed sores)can
develop due to lack of blood supply to
the skin caused by chronic pressure on an area
of the skin ( for example , a
person who is bedridden ,sits for long
hours in a wheelchair , or a cast pressing
on the skin ) .Individuals with diabetes circulation peripheral vascular disease or malnutrition are at an increased risk of pressure
sores.
Wounds
signs and symptoms :- * The most common symptoms of wound are pain , swelling and bleeding .
The amount of pain , swelling and bleeding of a wound depends upon the location of the injury and
the mechanism of injury .
*Some large lacerations may not hurt very much if they are located in an area that has few nerve endings,
while abrasions (Which has a greater number of nerves ) can be very painful ,
for example a paper cut .
* Some
lacerations may bleed more if the area involved has a greater no of blood vessels , for example the scalp and face.
Wounds
Treatment :- patient
the health care practitioner will make certain that there is no associated injury with the wound (for ex: if a person
falls on their chin , they may be at risk for a jaw fracture ) and that the
risk of infections is minimized.
Good
cosmetic appearance with a thin scar is also goal , but it is not necessarily
the most important goal.
* History
is important to understand the circumstances of the injury , because mechanism
of injury will significantly affect the
care provide . An animal bite with require more medical care than one cause by
a fall on the playground .
* It is
important to know the circumstances of the injury to decide how dirty the wound might be, and whether there are any
potential underplaying injuries .
* Individual with diabetes , poor circulation
,on dialysis or taking medication that can compromise the
immune system are at higher risk
of infection : and the decision
to repair a wound may be affected by the
patients medical history .
*
Tetanus immunization status will be
required to determine it immunization is
required .
* The
time frame from when the initial injury occurred and when medical care is rough
is also a consideration . The longer a wound is left open . the higher the risk
of infection if it sutured .The guide
for many health care practitioners is between 6 &12 hours. If the wound is
older the 6 to 12 hours , it may not be sutured.
*
Lacerations of the extremities including
legs , arms ,feet and hands may involve
tendons , nerves and arteries .
Assessing their function is an important
part of the physical Ex amination
Sutures for
wounds (stitches):-
1.primary
closure :- The
health care practitioner will clean the
wound and then explore the area for
foreign bodies or underplaying
structures that may have been damaged prior to closing the wound with
sutures , staples or surgical glue .
It the
wound is too old ,too dirty or it there are any other reasons to believe
that closing the wound is appropriate ,
healing may occur by secondary intention
.
* The wound will be cleaned , dressed and
allowed to heal gradually over time
without sutures.
* In
otherwise healthy people with potentially dirty wounds , a combination of two
techniques may be considered (secondary intention and then primary closure ) In
this scenario , the health care practitioner will clean and dress the wound .
The patient will be asked to return within 3-5 days and it the wound shows no
evidence of infection , it may be closed with sutures, staples or surgical
glue.
2.
other wound dressing :-
Physiologic dressing
such as tegaderm or hydrogel may be
used to promote healing instead
of suturing in the elderly due to their very fragile skin , which makes it difficult to repair lacerations and tears
in the skin.
3
Antibiotic wounds :-
It a
wound is cleaned and cared for properly, there is often little
need to prescribe antibiotics . However animal bites human bites , wound
exposed to river od take .Water contamination or other significantly dirty wounds ,poor
circulations may be prescribed to prevent infection .Antibiotic may also be
prescribed if underlying structures like tendons bones are involved .
Management
:-* The overall treatment depends on the type cause , and depth of the wound as well
as whether or not other structures beyond the
skin (dermis) are involved .
*Treatment of recent
lacerations involves examining , cleaning and closing the wound . minor
wound like bruises, with heal on their own , with skin discoloration usually
disappearing in 1-2 weeks .
* Abrasions which are wounds with intact skin
(non – penetration through dermis to
subcutaneous fat ) , usually require no active treatment except keeping the area treatment except
keeping the area clean ,initially
with soap and water.
*
puncture wounds may be prone to infection
depending on the depth of penetration .
*
The entry of puncture wound is left open
to allow for bacteria or debris to be removed from inside .
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