Wound

A wound is type of a physical trauma wherein the skin is torn, cut or punctured. Not only do severe wounds pose a significant chance of death due to loss of blood, there is increased chance of infection due to bacteria entering a wound that is exposed to air.
A person suffering from a significant wound may lose too much blood and go into shock, which requires serious medical attention. Due to the risk of infection, wounds should be kept clean, and closed if possible until professional help is available.
Before any medical or paramedical evaluation, a wound is considered as minor when:

• it is superficial;
• it is away from natural orifices;
• there is only a minor bleeding;
• it was not caused by a tool or an animal.

Any other wound should be considered as severe. If there is any doubt, a wound should be considered as severe. "Severe" does not necessarily means that it endangers life, but it must at least be seen by a physician.

Table of contents [hide]

1 Types of Wound 2 First aid 2.1 Minor wound (small cuts and grazes) 2.2 Severe/Major wound 2.3 If an object is embedded in a wound 3 Wound healing

Types of Wound

Wounds can be classified into a number of different types, according to the object that caused the wound. The types of wound are:

• Incisions - caused by a clean, sharp-edged object such as a knife or a razor.
• Lacerations - rough, irregular wounds caused by crushing or ripping forces.
• Abrasions (grazes) - a superficial wound in which the topmost layers of the skin are scraped off, often caused by a sliding fall onto a rough surface.
• Puncture wounds - caused by an object puncturing the skin, such as a nail or needle.
• Stab wounds - caused by an object such as a knife entering the body.
• 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 at the site of exit.

All stab wounds and gunshot wounds should be considered major wounds.

First aid

Minor wound (small cuts and grazes)

1. Remove the cause of wound so nobody else gets hurt, or at least to lead the casualty away and mark out the dangerous area.
2. Wash your hands thoroughly with soap and water, dry them, and put on disposable gloves if available.
3. Wash the wound gently with clean, potable water (alternatively a sterile saline solution may be used), and clean the surrounding area with mild soap and water.
4. Pat the wound dry with a clean gauze swab or similar clean, non-fluffy material.
5. Cover the wound with a dressing (for small cuts a sticking plaster) is ideal.
6. If the bleeding does not stop, if there is a special risk of infection, or if the wound does not begin to heal within 48 hours, advise the injured person to seek medical attention.
7. Ask whether the casualty has been vaccinated against tetanus. If the injured person has never been immunised, or if he or she is unsure if the the course of vaccinations was completed, or if the last injection was more than ten years ago, advise the casualty to seek medical advice.

Severe/Major wound

The priority with major wounds is to prevent further blood loss. Treat the casualty to control the bleeding, prevent shock, and call for help as soon as possible.

1. Put on disposable gloves, if available, to protect yourself from infection. Remove or cut the casualty's clothing to expose the wound.
2. Get the casualty to raise the wound above the level of the heart (if the wound is in a limb) and, if there is no object embedded in the wound, apply direct pressure to the area with their own hand.
3. Help the casualty to lie down (on a blanket or carpet to protect them from the cold). If you suspect that shock may develop, raise the casualty's legs and support them on a chair or similar.
4. Apply a sterile dressing (or if none is available, an improvised dressing made from a clean towel or cloth). Secure the dressing with a bandage that is tight enough to maintain pressure on the wound (but not so tight as to impair circulation beyond the wound).
5. If blood seeps through the first dressing, apply a second dressing on top of the first. If blood seeps through the second dressing, remove both dressings and apply a fresh one, ensuring that sufficient pressure is applied.
6. Support the injured part in a raised position - a leg supported on a chair, or an arm rested across the chest (so that it is above the level of the heart).
7. Summon an ambulance, if you have not sent someone to do so already, and monitor the casualty's condition until help arrives.

If an object is embedded in a wound

If there is an object (for example, broken glass) embedded in the wound, or an open fracture where a broken bone sticks through the skin, do not apply pressure over the object or attempt to remove the object yourself. Treat as follows:

1. Put on disposable gloves, if available, to protect yourself from infection.
2. Press firmly on either side of the embedded object to push the edges of the wound together.
3. If the wound is in a limb, raise and support the limb above the level of the heart.
4. Help the casualty to lie down (on a blanket or carpet to protect them from the cold). If you suspect that shock may develop, raise the casualty's legs and support them on a chair or similar.
5. Build up padding on either side of the object (using dressing pads, rolled-up bandages, or similar), so that you are able to bandage over the object without pressing on it.
6. Summon an ambulance, if you have not sent someone to do so already (alternatively if the wound is minor, the wound is not bleeding heavily, and the casualty is comfortable, arrange to transport the casualty to hospital by another means). Monitor the casualty's condition until help arrives.

Wound healing

When a wound first occurs, a wound healing cascade is immediately unleashed. The events in this cascade overlap in time but are usually separated into three phases: the inflammatory, proliferative, and maturation phases. In the inflammatory phase, damaged tissue is debrided, bacteria and debris are engulfed by phagocytes, and chemical factors like growth factors are released to attract cells involved in the proliferative phase. In the proliferative phase, granulation tissue is formed, fibroblasts secrete collagen and other components of the extracellular matrix, new blood vessels are formed, the wound contracts, and the area is reepithelialized as epithelial cells migrate across the wound bed to cover it. In the maturation phase, collagen is cross-linked and realigned along lines of tension.