UNIVERSIDAD DE ORIENTE

NÚCLEO DE BOLIVAR
DEPARTAMENTO SOCIO-HUMANISTICO
ASIGNATURA: INGLES INSTRUMENTAL
DR. PEDRO A. RASSE M.

First Aids - Some Common Injuries and Accidents

Wounds

Wounds are injuries resulting from many types of accidents.

We would like to discuss wounds that occur as a result of an accident and how to prevent and manage
them.

A wound is a breakage through the skin surface or mucous membranes. Causes of wounds include: falls,
cuts, RTA. There are different types of wounds.

The different types of wounds which occur in accidents such as:

 Bruises: Wounds where there is bleeding under the skin following trauma.
 Incised wounds: Wounds with clean-cut edges caused by a sharp knife or glass.
 Lacerated wounds: These are wounds with ragged edges and are commonly seen in road traffic
accidents. They are frequently dirty and contaminated with organic matter. There is an increased risk
of infection.
 Crushed wounds: These wounds are often seen in industrial accidents, severe road accidents and war
injuries.

First Aid Treatment

For cuts and wounds, it’s important to always make sure you clean the wound thoroughly to prevent
infection. Here’s the first aid treatment for cuts and wounds.

 Wash hands – Before treating or applying any first aid treatments to an open wound, it’s important
to wash your hands first. This helps keep the wound clean and prevent infection.
 Stop the bleeding – The next important step in wound care is to stop the bleeding. For deep
wounds like lacerations and avulsions, it’s the utmost priority to stop the hemorrhage to prevent
hypovolemic shock, which is potentially fatal. Apply gentle pressure with a clean cloth or bandage.
Elevate the wound until the bleeding stops.

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  Clean the cut or wound – After making sure the wound has stopped bleeding, rinse the wound
with clean water for about five minutes. Make sure dirt and debris are removed. You can clean the
wound with soap and water.
 Disinfect – To prevent infection, apply a topical antiseptic.
 Dress the wound – Cover the wound with a sterile gauze pad with dressing and secure with
adhesive tapes. However, for minor scrapes or abrasions, you can leave the wound uncovered.
 Refer to a physician or hospital – If the wound is deep and there’s heavy bleeding, refer the
patient to a physician or bring them to hospital. Deep wounds that bleed heavily may require more
intensive treatment such as suturing or other surgical procedures.
 Watch out for signs of hypovolemic shock – For patients with heavy bleeding, always look for
the signs of hypovolemic shock, including palor, cyanosis or clammy skin, weak and rapid pulse,
irregular breathing, and weakness.

Assessment of the wound

Wounds associated with accidents in children are common and should be assessed.
First take history from mother. This should include:

 How did the child get the wound?

 How long ago did the child get the wound?
 Has the child had active immunization against tetanus?

Secondly examine the wound.

 Look for active bleeding and grade it as slight, moderate or severe bleeding.
 See the general condition of the patient. Is the patient anaemic, in shock, restless, unconscious,
gasping, etc?
At this stage you shall be able to make your diagnosis and be able to treat the patient.

Treatment of wounds
1. Safe guard the life of patient by removing from the site of accident. For example, if it is a road traffic
accident, remove the patient from the road to the side of the road.
2. Take care of the airway especially for wounds involving head, neck and chest.

 Remove any secretions, blood clots, or soil in the airway.

 Put the patient in a left lateral position.
 See if the patient is able to breathe well with the measures above.

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3. If the wound is bleeding, stop the bleeding at once by applying a dressing on the wound and then hold it
firmly. The best dressing is a pad several layers thick of surgical gauze, sterile if possible. However, when
at the site of accident, such pads are usually not available. Under these circumstances, use the patient’s
clothing or dress.

4. Any wound that is severely bleeding so be treated in a hospital because it may involve large blood vessels
and these may need careful repair by surgeons.

5. During the transfer/referral process, raise the bleeding part above the chest level. This also reduces the
bleeding.

6. If your health facility has all that is needed, then do the following:-

 For severe injuries, give first aid as above and then inform senior most person in the unit so that he/she
can manage patient appropriately. If you are most senior person and all equipment is there and you
have the qualifications and experience to handle such injuries, then:
 All clean cut/incised wounds should be sutured if they were sustained less than six hours before.
 If a wound was sustained over six hours before, or a dirty, contaminated wound then, first do
surgical toilet which involves:
 Painting the whole area with a mild antiseptic live savlon, hibitane in water or a thorough wash with
soap and plenty of water.
 Wipe (clean) the wound with sterile towels.
 Clean the wound with a knife, cut away a thin strip of the skin edges all around the wound. Cut
away any damaged, dirty subcutaneous fat and any dead muscle.
7. You can then decide the method of suturing, either immediately primary suturing or delayed primary
suture.

8. Give tetanus toxoid immunization to prevent tetanus infection.

9. Give antibiotics, PPF, once a day for 5 days to treat infections.
10. Give pain killers such as Paracetamol or brufen.

Prevention of wounds

 Prevent road traffic accidents as we saw under that section.

 Do not allow children to play with sharp objects such as blades, knives, etc.
 Use personal protective equipment such as gloves, shoes, and head gear.
 Create adequate awareness among patients, children and the whole country about wounds.

We cannot conclude the topic of child injuries by describing accidental injuries alone. There is a rising
problem of child injuries which are caused willfully or intentionally by their own parents or guardians which
are referred to as non-accidental injuries and popularly known as child abuse. They are described below to
enable you recognize them and manage them effectively a required.

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Types of injuries

These are similar in kind to the accidental injuries. They include; cuts, wounds, burns, scalds, bruises,
contusions, fractures, lacerations and scars. They, however, differ from accidental injuries in that they are
multiple, occur in unusual parts of the body where accidental injuries are unlikely to occur, such as: in
perineum, soft palate, tongue or at the back. They are also in different stages some fresh, others healing or
healed with scar formation. The injuries may have appearance and shape indicating the object used to
cause them. They may be linear scratches or cuts, circular, teeth bite, shape of buckles or belts.

Characteristics of the injured children:

Children who are difficult to satisfy, crying children, frequently sick children, crippled children, step children
are at greater risk of non-accidental injuries. The following are alerting signs of non-accidental injuries.

 The parent delayed to seek medical care for the injuries.

 The parents give history of the cause of injuries which are hard to believe.
 The child is frightened or quite subdued in the presence of the offender.
 The child may be brought by concerned neighbors or relatives.

Objects used for Non-Accidental Injuries

These include a wide variety of objects, such as fingers nails, teeth, sticks, knives, buckles of belts, hot flat
iron, hot liquids; porridge, tea or fire.

Fractures, sprains and dislocations:

A fracture is a break in the continuity of bone. It may be complete or incomplete.

The causes of fractures are:

1. Direct force: This is when the bone breaks when direct force is applied, for example from a kick or
blow.
2. Indirect force: This is when the bone breaks some distance from the spot where the force is
applied.

There are two main classifications of fractures:

1. Closed fractures: This is where the over lying skin is not broken.
2. Open fractures: This is when the over lying skin is broken. The broken bones can easily be seen
through the broken skin.

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Signs and Symptoms:
These may include:

 Pain, which may be severe.

 Tenderness on touch.
 Failure to use the affected part of the body.
 Swelling of the affected part.
 Bleeding in an open fracture.
 Deformity, such as irregularity of the bone, shortening of the limb, depression of flat bone.
 Angulation or rotation of the bone.

Management:
It is important to take a proper history because this will influence your treatment of the fracture. For example,
if you learned that the fracture happened several weeks ago, you will realize that the reduction will be
difficult. It is also important to carry out thorough examination. There are three steps in examining a fracture:

1) LOOK: Observe the injured part carefully. Bear in mind the normal appearance of the affected part so
that you recognize any abnormalities. For example, look for flexion, rotation, adduction and shortening.

2) FEEL: Always be gentle, especially with children. If you hurt your patient at the beginning of the
examination, the child will not readily co-operate.

If there are areas of tenderness, note exactly where they lie. If they are over a bone, then a fracture is likely.

Another sign to look for is crepitus. This is a grinding sensation as the splintered ends of the bone rub
together. This test is unnecessary and cruel.

Palpation is also useful in telling whether bones have been displaced.

3) MOVE: Get your patient to try to move the affected part. If he/she can do this normally get him/her to use
it. Often this is the point when it becomes obvious that something is wrong.

4) XRAY: In theory, every fracture should be X-rayed. However, this is not always possible. Certain fractures
can always be managed satisfactorily without x-ray.

Treatment:
In treating a fracture you should do the following: Immobilize the affected part with a splint. An emergency
splint is important to prevent pain and shock, especially if your patient has to be transferred a long way to
hospital. In splinting a leg you can:
 Tie it to the other leg
 Use sticks
 Use pillows

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Splintage until union:
In general, it is necessary to have splintage until union, or until bones have healed.

 For displaced fractures, reduction is required and then splintage.

 For non-displaced fractures that are stable, no splintage is required. Prescribe rest and protection.
 For non-displaced fractures that are unstable, splintage is required until union.
 For all fractures you must encourage muscle activity whether they are splinted or not.

Protection until splintage:

Protection is still necessary when the bone is united but not fully consolated. A fracture should still be
protected, for example by use of crutches or by not bearing weigh on it or, in case of broken ulna and radius
they should be kept in a cast.

Burns and scalds:

Burns are injuries on the body caused by dry heat, while scalds are injuries on the body caused by moist
heat. Small children are often burned or scaled since they often play close to fires and cooking pots and
have not yet learned wisdom through experience. Remember the saying that once bitten twice shy.

Dry heat can be caused by any of the following:

 Burning house.
 Fire or hot objects or exposure to sun.
 Contact with an electric current or by lighting.
 Friction from a revolving wheel or fast moving rope.
 Strong acids and alkalis such as sulphuric acid or caustic soda.

Moist heat can come from boiling hot water, such as tea, porridge or steam. If the burn is wide spread it can
cause systemic complications. For example:

 Large amounts of fluid are lost from the burned surface causing shock.
 Pain can also contribute to state of shock.
 Anaemia is caused by blood loss and other causes.
 Secondary infection can also occur.
 Later on unsightly scars on the face or contractures of limbs may occur during healing.

Types of Burns:
There are two main types of burns:
 Superficial burns: Here there is only partial skin loss. This usually heals by the epidermis growing from
the burnt edges.
 Deep burns: When the whole skin and deep structures have been burned. Deep burns are serious.
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Signs and Symptoms:
 Pain. This is the main symptom of burns.
 Redding of the skin in brown skinned persons or darkening of the skin in dark skinned persons.
 Blisters: This is when the burned areas forms small bubbles, like raised skin filled with fluid.
 Exposure of raw or charred flesh: This is when the deeper tissues of the body, like muscles, blood
vessels or even bones, get burned.

The severity of burns depends upon the extent of body surface area burnt and also how deep the resulting
injuries are.

Management:
 Examine the patient for shock. A patient in shock has cold nose and fingers. Feel for a thready pulse
and find out if the blood pressure is low. If the patient is in shock, refer him/her to hospital for IV fluids.
If he/she can still take fluids orally, encourage him/her to take plenty of oral rehydration solution.
 Assess the extent of the burn. Find out how much of the body surface has been burned. Use the rule
of 7 for children. Treat for shock including giving intravenous fluids and pain relief. Given a pain killer
such as paracetamol, asprin or ibuprofen.
 Stop bleeding if there is a bleeding site, by applying a firm dressing at the point of bleeding. Bleeding
may need a transfusion of blood or saline to prevent shock. Bleeding from an open wound needs a
pressure bandage or a firm dressing at the point of bleeding.
 Put up an intravenous drip on any patient who has lost blood before you send him/her to hospital. It
may make the difference between life and death. Encourage the patient to take fluids if he/she is
conscious.
 The patient will require blood transfusion at the hospital
 Give tetanus toxoid to prevent tetanus.

Damage to nerves and major blood vessels need urgent transfer to hospital.

Prevention:
Prevention of burns in children focuses on child supervision and protection of the cooking place. Caretakers
should be particularly careful when there are hot liquids, tea, porridge or soup in the environment of the
child. Children should not play with fire or box of matches.