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Lacerations & Avulsions

Friday, 22 February 2013 00:00 Written by  Dr. Estra

Skin injuries are frequent and commonly occurring injuries, particularly for those who spend a lot of time outdoors. There are different types of these injuries and varying degrees of severity, as well as treatment. Skin injuries can be minor and superficial, with a linear direction such as your paper cuts, or deeper and more prone to infection such as lacerations. Basically, your skin injuries can be classified into several categories, these would be lacerations, abrasions, puncture wounds, and avulsions.

Most minor skin injuries have common first aid management, such as compression with a clean and preferably sterile bandage to prevent bleeding, along with washing it with sterile solution or clean water to remove any foreign body. Let’s talk about this in more detail. Take note that if ever you need to administer first aid to an individual who is bleeding, always use gloves to protect both yourself and the patient. There are many blood borne infections that you can get and it would be prudent to take the necessary precautions. You should also put into consideration the patient’s tetanus vaccine history, particularly for deeper and dirtier wounds. If unsure, always bring the patient to a hospital to assess the need for a tetanus vaccine, as well as further management.

Lacerations

Lacerations are wounds that affect all layers of the skin. It can also involve deeper layers such as subcutaneous fat, nerves, and underlying blood vessels. Lacerations characteristically cause a gap in the skin that can be approximated when put together or even opened further. Here are some important first aid management tips that you can do if you or one of your team suffers a laceration.

  • Compression – Apply direct pressure on the area with a clean cloth or preferable sterile gauze for 1 to 3 minutes. If the blood continues to drip, apply continuous pressure until it stops. A good advice to follow is to avoid checking it or taking a peek frequently, as this may hinder the blood’s clotting mechanism. Take note that if the blood comes out in “spurts”, then this might indicate an injury to an artery, which may be potentially life threatening. In this situation, continue applying pressure. You may consider applying a tourniquet, however, be careful when applying tourniquets as this might totally cut off the blood supply to the entire injured limb. A good rule of thumb to follow if ever you have to apply a tourniquet is to apply it over a wide surface area to prevent extensive tissue damage, and to apply pressures enough to stop or minimize severe bleeding, without totally compromising blood flow. There are also available products that help in coagulating blood during an injury, and you might want to consult your healthcare provider about this.
  • Wash the affected area – Once the area has stopped or at least has minimal bleeding, you can proceed to wash it with sterile water, or sterile saline solution. Do not use peroxide or iodine to wash a wound directly as it will further injure the tissues, including the healthy tissues. Use iodine or peroxide to clean the healthy surrounding skin around the wound. When washing the affected area with sterile water, make sure to wash it vigorously to dislodge all debris and foreign material, which might make it prone to infection.
  • Dry and bandage the area – Pat dry the affected area immediately with a clean cloth or sterile bandage to hasten healing and prevent further infection. You can then apply a topical antibiotic cream and dress it with a sterile dressing.
  • Apply Steri-strips – You can apply Steri-strips, which are adhesive strips used to approximate minor and small cuts, without the need for suturing
  • Deeper and larger wounds may require suturing – This is reserved for year health care provider as suturing requires certain techniques and skills.
  • Avulsions - Skin avulsions are deep skin injury, which involves partial or total shearing of the skin. This is often a major skin injury, depending on the depth and amount of skin sheared off and highly prone to bleeding and infection. First aid management is the same as lacerations. All avulsions should always be bought as soon as possible to a qualified healthcare provider.

Abrasions

Abrasions are superficial wounds that remove the topmost layers of the skin, and are usually due to friction. They tend to be very painful and bleed less profusely than lacerations or avulsions. Here are some tips on how to apply first aid to skin abrasions.

  • Clean with water and soap – Clean the affected area immediately with clean water and soap to rinse of debris and foreign material, which may cause infection. If you cannot clean off all the debris, then bring it to a qualified healthcare provider.
  • Bandage – Once cleaned and dried, you can apply a topical antibiotic on the affected area, and cover it with a sterile gauze bandage. Change this bandage once or twice day, applying fresh antibacterial ointment on it before reapplying a new bandage.

Puncture wounds

Puncture wounds tend to be very deceiving injuries, since the extent of the injury is through deeper skin and tissues not visible to the eye. They tend to be highly prone to infection and require immediate medical attention, particularly an updated tetanus vaccine. First aid management of puncture wounds are given below.

  • Wash the area – Wash the area thoroughly with clean water.
  • Compression – Apply continuous pressure if there is bleeding
  • Bandage the affected area – Bandage the affected area with a sterile gauze or cloth,and immediately seek a qualified healthcare practitioner to further manage the area.

Take note that a deep puncture wound to the chest may cause a collapsed lung due to air or blood accumulating in the space inside and compressing the lungs. The major symptom of this is difficulty of breathing and can be potentially fatal if not addressed quickly. First aid for this condition would consist of sealing or packing the punctured area tightly with cloth or sterile gauze. If you have available duct tape at hand, then this a much better option as this is highly impermeable to air. Puncture wounds to the abdomen can also be potential serious injuries if it hits any internal organs. This might cause insidious internal bleeding, so watch out for symptoms of that.

Conclusion

Now, these are just but a few tips on first aid management for the above conditions. Remember, when both indoors or outdoors, always have a handy and complete first aid box with you at all times so you can quickly address these situations with a first aid solution if ever you encounter it. Most of all stay calm even during the most stressful of emergencies.

Dr. Estra is a contributing writer for www.dansdepot.com, a survivalist blog. He got his MD from  New York College of Podiatric Medicine.

Last modified on Friday, 22 February 2013 00:34
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1 comment

  • Comment Link anon Tuesday, 26 February 2013 16:24 posted by anon

    What are your thoughts on using a Cyanoacrylate adhesive like Krazy or Super glue to close a bleeding wound. I've personally used it many times with great results, the last being a severe kitchen accident that likely needed stitches, but slowing the blood with a rubber band and closing with Super glue fixed it. I had some QuikClot nearby as a backup, but was able to stop the bleeding. Healed just fine too, no scar. Thanks.

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