2OBJECTIVES Trainees should be able to: Describe the different types of soft tissue injuriesDescribe the principles of sterile dressingExplain field care for various types of injuriesApply proper First Aid for soft tissue injuries
3SCOPE INTRODUCTION TO WOUNDS TYPES OF SOFT TISSUE INJURIES CLOSED WOUNDSOPEN WOUNDSPRINCIPLES OF STERILE DRESSINGFIELD CARE MANAGEMENT (PRACTICAL)CONCLUSION
4A break in the continuity of soft tissue (flesh) WHAT IS A WOUND?A break in the continuity of soft tissue (flesh)Types of wounds :Open WoundClosed Wound
5CLOSED WOUNDS INTRODUCTION Damage to tissue beneath the skin No break in the skinSIGNSSwelling and painBlack & blue markTYPESContusionHematomaecchymosis- a discoloration of the skin resulting from bleeding underneath, typically caused by bruising5
6WARNING!The following slides contain (OR may contain) pictures of shocking nature
7CONTUSION Commonly described as a ‘bruise’ Capillaries beneath skin ruptured by a blunt blow e.g. punchBleeding under skinBlood leaking into tissues causes bruisingSkin occasionally splitsecchymosis- a discoloration of the skin resulting from bleeding underneath, typically caused by bruising7
9HEMATOMA Force impacts on arteries and veins close to skin Bleeding (internal) & swellingBlood collects under the skin
10OPEN WOUNDS Break in the skin Risk of infection Open wounds can be classified according to the object that caused the wound, and the severity of the wound. Some examples of open wounds are:Small cuts / GrazesIncisions / Incised WoundLacerationsAbrasionsPenetration Wounds (Impaled Objects)
12Procedure for Treatment of Small Cuts and Grazes Wash your hands thoroughly, and put on disposable gloves if available.Apply pressure with a clean piece of cloth to stop the bleedingIf the wound is dirty, clean the wound by rinsing lightly under running tap waterThe best way to remove superficial pieces of glass or grit is with tweezers if you have them.Wipe away the water with a piece of clean cloth/ tissue paper.Do not cough or sneeze over the wound and avoid touching the wound directly.If there is a special risk of infection, advise the casualty to see a doctor.
131) Peel open the finger-sized plaster as shown: Peel open here (top & bottom)Or tear from the side
142) Peel open the plaster from the top and remove it from its packaging : Peel open here (top & bottom)Or tear from the side (might be easier
153) Remove adhesive strip from package Sterile Pad.Shield Protectors3) Remove adhesive strip from package4) Remove the two shield protectorsfrom the center of the plaster.Do not touch the sterile pad.
165) Place the sterile pad on the wound and fix the adhesive plaster firmly on both sides of the wound.Secure adhesive bandage firmly
18Pointers to take note of Use each plaster only once.Store the plaster in a cool dry place.Do not use if package is damaged.Do not use after expiry date.
19Pointers to take note of A cut might become infected if it is not washed and cleaned.If the bleeding is severe and cannot be stopped, send the victim to a doctor immediately.
20ABRASION Also described as a ‘graze’ Superficial wound Top layers of skin scraped offRaw, tender area left behindEmbedded foreign particles may result in infectionMinor capillary bleeding
21LACERATION Rough tears to the skin caused by crushing/ripping forces May bleed less profusely than clean-cut woundsHowever, more tissue damage and bruising is likelyHigh risk of infection as they are often contaminated by germs
22INCISION Results from a clean cut from a sharp edge (E.g. Broken glass)Profuse bleeding may result as blood vessels at wound edges are cut straight across
23AVULSION Forceful tearing of full thickness of the skin Wound margins jaggedRemaining tissue may appear shredded
25PARTS of FADLonger EndSTERILE PADDINGShorter End
26PRINCIPLES OF STERILE DRESSING Wear glovesHygiene purposePrevent infection to the woundFace and give assurance to casualtyCalm him down as he’s in panicExpose woundSupport injured limbSo as not to aggravate the injuryOpen FAD as close to wound as possibleTo minimize infection
27PRINCIPLES OF STERILE DRESSING Do not touch sterile padHygiene purposePrevent infectionDo not drop long end of FADCover wound completelyTie knot onto padAdd pressure to the wound Prevent further blood lossImmobilize the injured limbSo as not to aggravate the injury
28FIELD CARE MANAGEMENT HEAD PRIMARY DRESSING 126.96.36.199.188.8.131.52.Use FAD 14/15. Place sterile pad on wound, apply firm & direct pressure on it throughout procedure.The other side before the ear.Follow through (slightly below chin), covering the rest of the sterile pad. (Do not choke victim by tying too tight)Criss-cross the bandages when pad is fully covered.Wrap the remaining bandage round his head (above eyebrow).Tie a reef knot.Twirl the ends together and tuck it underneath the wrap.Tidy up the dressing.Tuck shorter side of the bandage behind ear.
29FIELD CARE MANAGEMENT HEAD SECONDARY DRESSING 184.108.40.206.5.6.Wrap round head, cross ends of bandage (at the back) and tie a reef knot once they’re brought to the front.Tuck the excess sheet beneath the wrap.Tuck the dressing in neatly.
30FIELD CARE MANAGEMENT EYE PRIMARY DRESSINGSECONDARY DRESSINGUse FAD 13. Place sterile pad on wound, apply firm & direct pressure on it throughout procedure.1.2.Cross method.220.127.116.11.Cover both eyes to ‘blind’ both sides so as not to aggravate the pain in the injured eyeShorter side goes above ear.Do not cover the other eye.Longer side below.
31FIELD CARE MANAGEMENT SHOULDER PRIMARY DRESSING Use FAD 15. Place sterile pad on wound, apply firm & direct pressure on it throughout procedure.PRIMARY DRESSING18.104.22.168.Avoid wrapping the shorter end of the dressing.Shorter end of bandage remains behind. Longer end will be doing the wrapping.Wrap around sterile pad (front to back, under the armpit)When sterile pad is firmly in place, wrap the bandage across chest.22.214.171.124.And round to the back.Tie a reef knot directly onto the wounded area.Tuck ends of remaining bandage in neatly.
32FIELD CARE MANAGEMENT SHOULDER SECONDARY DRESSING 1.2.3.Apex of triangular bandage facing casualty’s neck.Wrap bandage round upper arm. Secure bandage in place with tying a reef knot.Tuck apex underneath tee shirt (below the primary dressing).Immobilize injured limb to prevent aggravation.1.2.
33FIELD CARE MANAGEMENT LEG PRIMARY DRESSING 126.96.36.199.Place FAD 15 on the wound. Wrap round the sterile padding with the longer end of the bandage.Once sterile padding is covered, tie a reef directly over the wounded area.
34FIELD CARE MANAGEMENT LEG SECONDARY DRESSING 1.2.3.Using a broad bandage, wrap it over the FAD and tie a reef knot on the wounded area (similar to FAD shown earlier)
35AMPUTATIONForceful tearing of a limb from the body
38AMPUTATION VICTIM Put on disposable gloves if possible. As with other open wounds, the first aider should attempt haemorrhage control for amputation with direct pressure and elevation.You should avoid use of tourniquet if possible because the resultant damage can interfere with the reimplantation attempts.Reassure the victim.Raise the severed limp up.Apply sterile dressing ,or an non-fluffy clean pad
39AMPUTATIONAmputated part:Put on glove and wrap the severed part with plastic bagWrap the package in gauze or soft fabric and place in a container full of crushed iceMark the container with time of injury and casualty name . Pass the container to the emergency personnel yourself.DO NOT allow the amputated part to come into contact with moisture.
40FIELD CARE MANAGEMENT AMPUTATION PRIMARY DRESSING 188.8.131.52.Raise amputated limb to reduce blood loss.Place FAD 14 or 15 directly on the amputated limb.Wrap around the limb as shown in the diagrams with the longer end of the bandage.Tie both the shorter and the longer ends of the bandage.5.
41FIELD CARE MANAGEMENT AMPUTATION SECONDARY DRESSING 1.2.3.Using a broad triangular bandage wrap amputated limb.Twirl excess bandage and tuck it into the wrap.If the bleeding cannot be stopped by the first layer of FAD, add another layer of FAD on top of the first layer.
42IMPALED OBJECT Punctured wound Small entry site Deep track of internal damageHigh risk of infection as germs and dirt are carried far into body
44FIELD CARE MANAGEMENT IMPALED OBJECTS Control Bleeding Stabilize objectPad around objectImmobilize injured limbDO NOT REMOVE OBJECT THAT IS EMBEDDED IN THE WOUND
452 narrow-fold bandages to be looped in opposite directions. IMPALED OBJECTFIELD CARE MANAGEMENT184.108.40.206.Unwrap 2 FAD 13 and place them upright- locking the impaled object in position.2 narrow-fold bandages to be looped in opposite directions.Tie the ends of one bandage together with the ends of the other bandage.Be wary of the impaled object- make sure it is not being shifted when you’re attending to it.5.6.
46EVISCERATIONAbdominal organs protrude through wound
48FIELD CARE MANAGEMENT EVISCERATION Cover protruding organ with moist gauzeUse occlusive dressing to cover wound completelyIf possible, place casualty supine with knees bentDO NOT PUSH ORGANS BACK INTO PLACE
49Protruding Intestines (Evisceration) FIELD CARE MANAGEMENTPRIMARY DRESSING220.127.116.11.Place FAD 15 on the wound. Wrap round the moistened sterile padding with the longer end of the bandage.Using a triangular (narrow) bandage make a ring pad (donut shape) and place it round the protruding intestines.In supine position, knees have to be bent to prevent the stretching/tensing of the intestines.5.6.
50FIELD CARE MANAGEMENT Protruding Intestines (Evisceration) SECONDARY DRESSING3.1.2.Fold the triangular bandage into half, and wrap it round the FAD.4.5.