Wounds
Cuts or tears in tissue (lacerations), scrapes (abrasions), and puncture wounds can be caused by bites (see Section 24, Chapter 298) or other injuries. Wounds that are not caused by bites usually heal rapidly without any problems. However, some wounds can cause extensive blood loss. Others can become complicated by infection or injury to deeper structures, such as nerves, tendons, or blood vessels. A piece of foreign material can also remain hidden inside a puncture wound.
Shallow cuts to most areas of the skin rarely bleed much and often stop bleeding on their own. Cuts to the hand and scalp as well as cuts to arteries and larger veins often bleed vigorously.
Infection can develop when a wound is contaminated with dirt and bacteria. Although any wound can become infected, infection is particularly likely in deep scrapes, which grind dirt into the skin, and in puncture wounds, which introduce contamination deep under the skin. Also, wounds that contain foreign material (such as splinters, glass, or clothing fragments) almost always become infected. The longer a wound remains contaminated, the more likely it is that infection will develop.
Wounds can be painful at first, but usually the pain lessens after the first day. If a cut affects a nerve or tendon, the person may be unable to move the body part fully. Some nerve injuries cause numbness. If a foreign object remains inside a puncture wound, usually the part of the wound near the object is painful when touched.
Pain that worsens a day or more after the injury is often the first sign of infection. Later, an infected wound becomes red and swollen and may ooze pus. A fever may develop.
First-Aid Treatment
The first step in treating a cut is to stop the bleeding. Visible bleeding can almost always be stopped by firmly compressing the bleeding area with a finger or hand for at least 5 minutes. Whenever possible, the bleeding part is elevated above the level of the heart--for example, by raising a limb. Because tourniquets shut off all blood flow to a body part and deprive it of oxygen, they are rarely used.
To prevent infection, dirt and particles are removed and the wound is washed. Large, visible particles are picked off. Smaller dirt and particles that cannot be seen are removed by washing with mild soap and tap water. Dirt and particles that remain after washing often can be removed with a more highly pressured stream of warm tap water. Harsher agents, such as alcohol, iodine, and peroxide, are not recommended. These solutions can damage tissue, impairing the capacity to heal. Scrubbing is required to clean deep scrapes. After cleaning, antibiotic ointment and a bandage are applied. If a wound is very small, it can be kept closed with certain commercially available tapes. Stitches may be needed for deep or large cuts.
Professional medical assistance is needed under the following circumstances:
- If a cut is longer than about 1/3 inch, is on the face, appears deep, or has edges that separate
- If bleeding does not stop within several minutes or after pressure is applied
- If there are symptoms of a nerve or tendon injury
- If a scrape is deep or has dirt and particles that are difficult to remove
- If there is a puncture wound, particularly if a foreign object in the wound is likely
- If the person has not had a tetanus vaccination within the past 5 years.
All wounds, whether treated at home or by medical professionals, should be observed for symptoms of infection during the first several days after treatment. If any symptoms of infection develop, professional medical assistance should be sought within several hours. Most small wounds heal within a few days.
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