a. Immediate Care.

Initially, control the bleeding from the wound.

Nature usually stops bleeding. For example, a person cuts his finger. Blood will gush from the lacerated blood vessels. These vessels constrict which tends to lessen the bleeding. The clotting process also stops bleeding. When blood escapes from an artery or vein, the blood undergoes changes which cause it to clot. The blood clot seals off the injured blood vessels, and bleeding stops.

If the wound is large or clotting does not occur, apply direct pressure over the wound to stop bleeding. Use sterile pads if possible, but if they are not available, use a handkerchief, clean cloth, or even a bare hand as a last resort. Then, check the entire body for injuries.

b. General Evaluation.

Make a general evaluation of the patient. Take care of him as a whole. Examine the patient from head to toe, checking for associated injuries.

Follow the guidelines given below.

(1) Check his entire body for injuries.

(2) Ensure the airway is secure, spinal injuries are immobilized, etc.

(3) If there is an injury in an extremity, check the distal pulse and sensation in that extremity.

(4) Obtain a history of how the wound occurred.

(5) Find out what medications the patient is taking: steroids,
chemotherapeutic agents, anticoagulants, anti-inflammatory, etc.

(6) Ask if the patient has any illness or chronic diseases such as diabetes, cancer, peripheral vascular disease (PVD), or anemia. (Wound healing may be difficultfor a patient with a chronic disease or illness.)

(7) Ask if he has a current tetanus immunization.

(8) Find out if the patient has any allergies.

c. General Wound Care (Not Life- or Limb-Threatening).

Follow this procedure to care for general wounds. Begin by removing foreign bodies, then cover the wound with a sterile dressing. This is enough if immediate evacuation is possible. If
evacuation is delayed, follow the procedure given below.

(1) Cover the wound and clean the surrounding area with povidone-iodine solution (dilute).

(2) Uncover the wound and irrigate it with water. Sterile water or normal saline is preferred if available, but using potable water is better than doing nothing.

(3) Irrigate repeatedly with water using a syringe and 18-gauge catheter. This will help obtain the optimal pressure required to clean the wound without using too much pressure that could cause debris to be forced deeper in the wound.

(4) Change gloves and blot the area dry with a sterile dressing.

(5) Cover the packing with a dry, sterile dressing.

(6) Clean and dress the wound every 24 hours.

d. Wound on Extremity.

If the wound is on an arm or leg, splint the wound and elevate the arm or leg. Elevating such an extremity increases blood circulation, thus aiding in the healing process.

e. Local Wound Procedures.

Do not suture the wound closed. Follow this procedure to care for a local wound.

(1) Cleanse the surrounding skin with surgical soap and water.

(2) Irrigate the wound profusely with sterile saline in a syringe.

(3) Apply antiseptic solution to the surrounding skin. These steps are taken in an effort to prevent infection. Skin and mucous membranes normally have microorganisms on them. To reduce the risk of transferring these microorganisms to the wound, antiseptic is used on and around the wound.

(4) Remove foreign matter and dead tissue as early as possible, preferably within the first eight hours after injury. Remove only enough skin tissue as necessary. Remove only the edges of fascia (connective tissue that covers the body under the skin). Any wound requiring more significant exploration should be evaluated by the
surgeon.