An introduction to wound care

Question 1

Wound-

Answer 1

break in the continuity of the skin

Question 2

3 layers of the skin

Answer 2

Outer to inner
-epidermis- hairs on surface
-dermis- lots blood vessels
-subcutaneous tissue- contains fatty/ adipose tissue

Question 3

8 types of wound

Answer 3

-incision- linear wound, clean line, caused by sharp cutting implement
-laceration- tear or split of skin, ragged edges, caused by blunt force
-gunshot- entrance and exit wound, small entry point, larger exit point
-puncture- penetrating wound, caused by object penetrating skin and underlying structures eg. nail/ knife
-haematoma- localised collection of blood outside vessels eg. egg on your head
-contusion (bruise)- type haematoma, blood soaks into nearby tissues
-abrasion- only affects superficial layers, caused by friction shearing skin away
-burns- injury caused by energy transfer to the body tissues eg. heat, friction, electrical

Question 4

Types of burn

Answer 4

-epidermal burn- skin intact eg. sun burn
-superficial partial thickness burn- involves epidermis and part of the dermis
-deep partial thickness burn- involve epidermis, papillary dermis down to reticular dermis
-full thickness burn- involve whole of skin and possibly subcutaneous tissue
-full thickness burn + - involves entire skin and sub lying structures eg. muscle and bone

Question 4

Wound management
3 main aspects

Answer 4

-control of bleeding
-prevent infection
-prevent further complications

Question 5

Sources of blood loss

Answer 5

-arteries- high pressure, bright red spurting (oxygenated), lots of blood loss
-venous- darker (deoxygenated blood), lower pressure, flows freely, severe if from jugular or femoral vein (except varicose veins as under similar pressure to arteries)
-capillaries- presents as oozing

Question 6

4 sources of internal bleeding

Answer 6

Blood on the floor plus 4 more
-thoracic cavity
-abdominal cavity
-pelvic cavity
-long bones

Question 7

Factors affecting blood loss

Answer 7

-depth of wound
-type of wound
-size of wound
-type damaged blood vessel
-medication eg. warfarin
-duration of bleeding
-position of injury
-age and size of patient

Question 8

2 other types of injuries

Answer 8

-amputation
-degloving- loss of skin around a bone eg. removing skin from finger

Question 9

Managing skin flap

Answer 9

-caused by blunt injury eg. hitting shin on step
-consider blood supply and aim to preserve this
-use wet dressing to cover
-carefully encourage skin flap back into place (but don’t stretch the skin)

Question 10

Management of external bleeding

Answer 10

-Position- lie down
-Elevate- lift wounded limb above the heart
-Expose and Examine the wound
-Pressure- apply direct and firm pressure

Question 11

What to do if direct pressure doesn’t work

Answer 11

-pack the wound- gauze, haemostatic agent (helps blood clot)
-limb position- box or traction splints
-pressure points- brachial artery, femoral artery (crease groin), popliteal artery (behind knee)
-tourniquets