Management of Wounds,

Question 1

What is a wound

Answer 1

An injury to the skin or underlying tissues or organs by a blow, cut, missile or stab. Also including injuries caused by chemicals, cold, friction, heat, pressure and rays; and manifestation in the skin of internal conditions such as pressure sores or ulcers
- Churchill Livingstone Medical Dictionary

Question 2

Types of Wound?

Answer 2

Contusion (bruising)
Abrasion (grazes)
Puncture (stab)
Laceration (tear)
Incision (cut)
Burn
Gunshot

Question 3

Wound Complications?

Answer 3

Infection
Underlying injuries 
Diabetes
Chronic Illness
Patients age

Question 4

Foreign Objects

Answer 4

Small objects, such as grit, may be removed by irrigation or use of tweezers.

Large objects or apparently embedded objects should not be removed pre hospital, dressings placed over and/or around the object and wound.

Question 5

What is bleeding?

Answer 5

Bleeding is the loss of blood from a damaged blood vessel
Can be classified by the type of vessel involved (i.e. artery, vein or capillary)
Internal or external
Also known as haemorrhage
What would be the differences between arterial, venous and capillary blood lose?

Question 6

Managing Wounds

Detecting concealed bleeding?

Answer 6

Pulse rate
Blood pressure
Pulse pressure
Respiratory rate
Capillary refill time (CRT)
Mental status

Question 7

Manage Bleeding

The haemostasis escalator

Answer 7

Direct pressure and/or elevation of limb

Wound packing and/or haemostatic agents

Limb positioning, traction and splints

Tourniquet

Question 8

What is a Thermal Injury?

Answer 8

Heat Injury
Flame: common in adults, often associated with smoke inhalation

Scalds: common in children, usually due to spillages of hot drinks or immersion in hot water

Contact: caused by a brief contact with a very hot object, or more commonly prolonged contact with a cooler object

Question 9

Chemical Burns

Answer 9

Generally result from exposure to acids, alkalis and other corrosive materials

Alkali burns are generally more serious as they penetrate further than other chemicals

Severity depends on concentration of the chemical, the duration of exposure and the speed of applying first-aid measures

Question 10

Common Chemicals

Acids

Answer 10

Acids

Sulphuric acid
Lead-acid batteries

Nitric acid
Used in fertilisers
explosives

Hydrochoric acid
Found in gastric acid
Used in descaling products

Question 11

Common Chemicals

Alkalis

Answer 11

Alkalis

Sodium Hydroxide
AKA Lye and caustic soda
Used in soaps and detergents

Cement

Question 12

Radiation Burns

Answer 12

Commonly caused by ultraviolet radiation from the sun or sunlamps

Can be caused by radioactive materials

80% of skin cancer is preventable and avoiding sunburn is key

Question 13

Electrical Injuries

Answer 13

Rare occurrence
Can cause significant damage and death
Majorly occur in the work place and involve high voltages
Electrocution from lightening strikes are rare
External injuries do not indicate the severity of the injury

Question 14

Estimating a thermal injury size

Answer 14

Rule of nines does not work for children under 14 as body proportion is different: use charts such as Lund and Bowder for this. JRCalc states that child’s hand including digits equates to 1%; ACP states 0.77%

Question 15

Burn severity

Answer 15

For burns <15% or >85% it is acceptable to use the patients hand inc. fingers as a size estimate.

This equates to approx. 1% (JRCALC) for both adults and children or 0.82% for adults and 0.77% for children (ACP)
(palm only equates to 0.5%)

Don’t consider areas of erythema in calculation

Question 16

Thermal Injury Complications?

Answer 16

Thermal Injury Complications
First 24 Hours
Burn shock due to excessive fluid loss

After 3 – 5 days
Respiratory failure

Following few weeks
Burn wound sepsis

Question 17

Time-critical features?

Answer 17

Time-critical features?
Any major ABCD problems
Airway burns
History of hot air or hot gas inhalation
Respiratory distress
Evidence of circumferential (completely encircling the neck, torso or limb) burns

Question 18

Time Critical Features

Answer 18

Significant facial burns
Burns covering more than:
	15% TBSA in adults
	10% TBSA in children
Presence of other major injuries

Question 19

Time-critical management

Answer 19

Time-critical management
Start correcting A and B and undertake a time-critical transfer to the nearest appropriate hospital according to local arrangements

Consider Non-accidental injury (NAI) and safeguarding