FIRST AID:

SPECIFIC
WOUNDS


SPECIFIC WOUNDS

I. PUNCTURED WOUNDS

Punctured wound is caused by an object piercing the skin and
creating a small hole. It can be in the surface and others can be
very deep, depending on the source and cause. A puncture
wound does not usually result in excessive bleeding.
It is not the same as cuts. It has small entry hole caused by a
pointed object. In contrast, a cut is an open wound that produces
a long tear in the skin. Puncture wounds require different treatment
from cuts because these small holes in the skin can disguise serious
injury.
Proper treatment within 24 hours is especially important with
puncture wounds because they carry the danger of embedding
the piercing object (foreign body) under the skin. Research shows
that complications can be prevented if the patient seeks
professional treatment right away.
A variety of foreign bodies can become embedded in a puncture
wound. Nails, glass, toothpicks, needles, and seashells are common
ones.
All puncture wounds are dirty wounds because they involve
penetration of an object that isnt sterile. Anything that remains in
the wounds increases your chance of developing other problems.

SEVERITY OF WOUNDS
There are ways of determining the severity of punctured wound.
First. Depth of the wound is one way to evaluate it. The deeper the
puncture, the more likely it is that complications such as infection will
develop.
Second. The type and the cleanliness. Larger or longer objects can
penetrate deeper into the tissues, possibly causing more damage. The
dirtier an object, the more dirt and debris are dragged into the wound,
increasing the chance of infection.
THINGS TO DO

Seek treatment right away.
Get a tetanus shot if needed (usually every ten years).
See the doctor within 24 hours.
Follow your doctors instructions:
Keep your dressing dry.
Keep weight off the injured foot.
Finish all your antibiotics (if prescribed).
Take your temperature regularly.
Watch for signs of infection (pain, redness, swelling, fever).
Call your doctor if these signs appear.

II. POWDER WOUND

CAUSE
Exploding firecrackers and blank pistols.

CHARACTERISTICS
Some are actual burning of the skin
Multiple tiny puncture wounds caused by small particles of burned
powdered which penetrates the skin.

DANGER
Unless proper treatment is given, tetanus often develops.

FIRST AID
Depends on whether there is actually a burn or merely small
wounds.
Take the injured person to the physician for further treatment of his
injury and administration of tetanus antitoxin.
Until the physician is available, the wounds make wash with
antiseptics, dressed and bandaged.

TREATING
Firecrackers occasionally cost people their fingers or toes. Prompt
medical treatment can reattach them.
Call emergency hotline.
Lay the victim down and elevate the injured body part.
Remove any visible foreign objects.
Apply direct pressure to the wound for 15 minutes to stop bleeding.
If possible, retrieve the amputated finger or toe and rinse (dont
scrub) it clean, the wrap it in a clean, damp cloth and make sure it
goes to the hospital with the victim. Dont place the digit on ice,
which damage the blood vessels and make reattachment difficult.


III. GUNSHOT WORD

Gunshot wounds are unpredictable puncture wounds that cause
major tissue damage. Three factors work together to determine the
severity of a gunshot wound.

SPECIAL CONSIDERATIONS (Treating a bullet wound)
To the head. Gunshot wounds to the head are frequently fatal.
Keep the head elevated and get the victim to a trauma center as
soon as possible.
To the face and neck. These wounds typically bleed severely. Use
direct and keep the victim upright. Be careful not to obstruct
breathing. Be careful that blood flow to the carotid arteries isnt
disrupted; as this can be reduce blood flow to the brain.
To the chest and back. Apply direct pressure to the control
bleeding; its difficult to control chest bleeding because the ribs
make it difficult to compress the structures that are bleeding. Treat
these as follows: Apply an airtight bandage on three sides of the
wound. Do not close the bandage on the fourth side. This will allow
the chesty to achieve its usual negative pressure state. Air will
escape through the valve during inhalation.
To the abdomen. Apply direct pressure to the injury site. As with the
chest, controlling bleeding in these cases can be quite difficult.
To the arm or leg. Use direct pressure to control bleeding. If you
have a length of fabric or string on hand make a tourniquet. Arm
and leg injuries from gunshots can be elevated above the heart.
Use pressure points in the arm, groin, or behind the knee if direct
pressure does not control bleeding.

IV. INFECTED WOUNDS
Infected wounds are wounds in which bacteria or other
microorganisms have colonized, causing either a delay in wound
healing or deterioration of the wound. Most wounds are typically
contaminated by bacteria.

SIGNS OF WOUND INFECTIONS
Redness, warmth, and tenderness in the area of the wound.
Pus- a foul-smelling, yellowish-white fluid coming from the wound.
Fever

WHAT INCREASES MY RISK FOR A WOUND INFECTION?
Diseases such as diabetes, cancer, or liver, kidney or lung
conditions slow healing.
Foreign objects such as glass or metal can get stuck in the wound
and delay healing.
Poor blood supply to the wound increases your risk for infection.
Blood flow may be decreased by high blood pressure, and blocked
or narrowed blood vessels.
Repeated trauma to a healing wound may increase your risk for an
infection, and delay healing.
A weak immune system caused by radiation, poor nutrition, or
certain medicines increases your risk for an infection.

HOW IS A WOUNMD INFECTION DIAGNOSED?
Blood tests may be done to check for infection.
X-rays may be done to look for broken bones, other injuries, or
objects stuck in the skin.
A CT or MRI scan may be used to take pictures of the bones and
tissues in your wound area.
A wound culture is a test of fluid or tissue used to find the cause of
your infection.

HOW IS A WOUND INFECTION TREATED?
Treatment will depend on how severe the wound is, its location, and
whether other areas are affected. It may also depend on your
health and the length of the time you have had the wound. Ask
your doctor about these and other treatments you may need:
Wound cleaning may be done with soap and water to wash away
germs and decrease the risk for the infection. Your doctor may cut
open a part of the affected area to clean it better. The wound may
be rinsed with sterile water. Germ-killing solutions may also be used.
Objects, dirt, or dead tissue from the wound will be removed with
debridement (surgical cleaning). Wet bandages may be placed
inside the wound and left to dry. Other wet or dry dressings may
also be used. Your caregiver may also drain the wound to clean out
pus.
Antibiotics help fight or prevent an infection caused by bacteria.
V. WOUND OF THE ABDOMEN

Shot or deep stab
1. Danger of the internal bleeding and injury of organs may be
present.

2. Operation is usually necessary.

3. First aid.
a) Keep the patient lying down flat on his back.
b) Apply dressing to the wound and binder.
c) Maintain warmth.
d) Give nothing by mouth, not even water.
e) Dont give any stimulants.
f) Provide careful immediate transportation to a hospital. Shock
is usually severe in these cases.

Cut with the intestines protruding
1. Keep the patient flat, knees flexed, if the wound is across the
abdomen; legs straight, if the wound is vertical.
2. Dont replace the intestine.
3. Cover the intestine with warm, moist cloth.
4. Keep the patient warm.
5. Apply binder if the victim is to be transported.
6. Transport carefully, or best, call a physician to the scene.
7. Support the wound if the victim vomits, or needs to be moved into
the recovery position. Press lightly on the bandage to prevent
intestines protruding; do not attempt to replace them. Cover with a
clean piece of plastic film.
MAJOR ORGANS
Damage to any of the bodys major organs can be life threatening
and prompt action must therefore taken to minimize the effects of
injuries to the chest or abdomen. Even when external bleeding is
slight the risk of internal bleeding cannot be discounted. Knowing
where in the body the organs are located will help first responder to
assess a situation and decide the most appropriate information
when the emergency services arrive.

VI. ANIMAL BITES

A. DANGERS

1. Severe infection, and possibly tetanus.
2. Special danger of rabies, or hydrophobia.

RABIES

Is an increasingly rare but potentially very serious, even fatal,
condition carried by animal bites. Rabies in the US is rare, but if the
bite is from an animal that may have come into the country without
going through normal checks, or if you are bitten overseas, then
seek immediate medical attention. There is no cure for rabies but
early vaccination following a bite can help develop immunity.

Deep bites can cause serious wounds, severe bleeding, and tissue
damage.

All animal bites can cause infection.

There is a risk of infection with any animal bite, no matter how small.
The bite should be assessed by a doctor as soon as possible to see if
tetanus or rabies injection, or a cause of antibiotics, is required. First
aid treatment for bites is to keep the wound clean and control any
bleeding.

The human bite is among the most infectious.


TETANUS

Tetanus bacteria carry a particular risk when carried deep into a
wound with jagged edges or a puncture wound. Animal bites carry
a potential risk of tetanus. Tetanus affects the CNS and can cause
muscle spasms breathing problems, and sometimes death. There is
a vaccination for tetanus but immunity is not lifelong and anybody
suffering a potentially hazardous injury should seek medical advice
on having a booster injection.

CHECKING FOR INFECTION
Increased pain
Swelling
Redness around the site of the wound
Discharged from the site
Unpleasant smell from the site of the wound
Red tracks from the site to the wound to the heart
Swollen glands

B. BITTEN WITH DANGER RABIES
1. CAUSE

a. The disease is caused by a virus present in the saliva of the rabid or
mad animal.
b. A rapid dog is not always excited or vicious. In one form known as
dumb rabies, the disease begins the paralysis of the lower jaw, or
of the upper extremities. The factious as in the furious type.
c. Warm-blood animals and those that nurse their young are
susceptible.



2. MANNER OF SPEED
a. The disease is spread to man most often by sick dogs and occasionally by
cats. The virus usually enters the body through a bite, or more rarely when
a fresh wound is licked, or when the saliva of a rabid animal comes in
contact with the thin mucous membrane of the lips or nose, it cannot
penetrate a normal, unbroken skin.

b. Rabies virus travels to the brain along the nerves, not in the blood, which
accounts for the slowness in developing symptoms.

3. DANGER OF RABIES
a. The bite of rabies is greater when the wounds involve the head or neck,
and are especially dangerous.

4. PREVENTION
a. Rabies is always fatal when symptoms develop, but it can usually be
prevented by the prompt immunizing method known as the Pasteur
treatment.

b. It is vitally important that anyone bitten by an animal receive prompt
medical advice.

5. FIRST AID
a. Wash the wound thoroughly with soap and water, to remove the saliva.

b. Dress the wound with bandage.

c. Send the patient to a physician at once, the first aid cleansing does not
insure against the development of rabies or tetanus, but it is of some help.
The physician will then decide whether it is safe to postpone immunization
of the victim while the dog is under study and whether preventive
measures against tetanus are necessary. He will also treat the wounds
more effectively.
C. CARE OF THE ANIMAL
1. Dont kill the animal unless absolutely necessary.

2. Confine the dog and observe it for ten days. If the animal shows no
changed disposition in ten days, its saliva could have not been infectious
at the time of the bite. If it develops definite symptoms of dies within that
period, the Pasteur treatment should be given without delay.

VII. SNAKE BITES

Snakes can strike across a distance equal to about half their body
length. If you see a snake, head back the way you came.

Familiarize yourself with snakes that are common in your area. In the
event of a bite, identifying the type of snake may help with your
pets treatment.

A. NON-VENOMOUS

1. Common species
a. Pythons
b. Worm snakes
c. River snakes (Calabucab)
d. Frog snakes (Mamalaka, Palakang-ahas, Manoca, etc.)

2. Characteristics
a. Constrictors (hold on)
b. Bite marks- horseshoe shape

B. VENOMOUS
o Snakebite first aid recommendations vary in part because
different snakes have different typrs of venom.

1. Slightly venomous
a. Green snakes (Dahung palay)

2. Deadly species:
a. Sea snakes (Malabasahan)
b. Cobra (Alupong, Atay-bia, Bibiyain, Camamalu, Juguason,
Ulupong)
c. Vipers (Rimuranon in Albay; Alimuranin in Tagalog; Mandadalag
Anamon, Dupong, Philippine Pit Viper, etc.)

3. Characteristics:
a. Strikes, recoils, and is ready to strike again or runs off.
b. Fang marks. Two punctures on top, and a half horseshoe teeth
marks under.

C. PREVENTION
Keep your yard tidy by clearing away undergrowth, toys and tools that
make great hiding places for snakes.

Keep walkways clear of brush, flowers and shrubs.

Clean up any spilled food, fruit, or bird seed, which can attract rodents
and therefore snakes to your yard.

When walking your pet, keep him on a leash.

Steer your pet clear of long grasses, bushes and rocks.


D. SYMPTOMS
1. Pain is immediate.
2. Severe swelling occurs rapidly.
3. Dark purple discoloration of the skin.
4. As venom absorbs, more general effect begin to appear.
5. Rapid weak pulse.
6. Great weakness.
7. Nausea and vomiting.
8. Frequently unconscious and dim vision.
E. FIRST AID
1) FOR NON-VENOMOUS BITES:
a. Only the first aid recommended for minor scratches.
b. The victim should not be subjected to the more serious
measures necessary for the bites of venomous snakes.
c. The experience, the snake constricting on the limb, may
give the patient minor shocks, like faintness, weakness,
and clammy skin.
d. Treat for shock.

2) FOR VENOMOUS BITES
Prompt action is imperative because removal of the
venom is more difficult, or even impossible, after it is
absorbed.

a. Make the victim lie down and keep quiet. Muscular efforts
only spread the venom.
b. Tie a constricting band firmly around the limb just above the
bit, to restrict the spread of the venom and make the veins
stand out on the surface. It should be tight enough to
prevent the return flow of blood and lymph in the surface
vessels, but not tight enough to affect the deeper arteries
and veins. Too much deeper pressure is dangerous.
c. Make a cross-cut incision through each fang mark. If the
venom spread out, make additional cuts around the bite.
Cuts should be long and or more deep to get into the
soft tissues beneath the surface where the venom has been
injected. Cut through the skin to avoid cutting tendons and
blood vessels.
d. Apply suction immediately and keep it up until the doctor
arrives. Suction by mouth may have to be applied first before
suction cups are available if and when there are no teeth or
gum injury. Rinse mouth with water from time to time.
e. Send to the physician for antivenin and other care.
f. Further care if physician is not immediately available for a
long period of time.
g. If the venom spreads the first constricting band, another
should be tied up the limb to keep ahead of swelling.
h. Other successive cuts should be made as swelling progresses
and wherever it is pronounced and especially toward the
body. As many as 30 or 40 cuts may be necessary in a severe
case. Keep the limb slightly lower than the level of the body.
i. Apply suction to each of these cuts for 15 minutes in every
hour.
j. Keep the cuts covered with wet, hot, compresses of strong
Epsom salts solution or table salt solution between the periods
of suction.
k. Give a dose of Epsom salts internally to act as purgative.
l. Give plenty of water to drink. Alcoholic drinks are not
recommended.
m. Continue the regular first aid for shock. Keep the victim warm
and lower his head.
n. Sent the patient to a physician.

In summary, the key facts in giving first aid for venomous snake bites are:
Construction
Incision
Suction

VIII. WOUNDS IN WHICH FOREIGN BODIES REMAIN

A. FREQUENT CAUSES:

1. Splinters of wood
2. Small pieces of glass and metal shaving

B. FIRST AID

1. Small foreign bodies near the surface.
a. Sterilize surface with antiseptic.
b. Sterilize instrument such as needle, knife, point or tweezers over a
flame.
c. Remove the foreign body.
d. Encourage the bleeding by gentle pressure.
e. Apply sterile compress and bandage.
f. Need for physicians care.

2. Large or deeper foreign body
a. Do not attempt to remove.
b. Apply a proper dressing and bandage
c. Take the patient to a physician.

I. Foreign Bodies in the Ear

a. TREATMENT
- Do not attempt to remove an object from the ear you are
likely to push it in further, causing more damage particularly
in the eardrum.
- Reassure the child and take her to hospital.

b. SIGNS AND SYMPTOMS OF A FOREIGN BODY IN THE EAR
Pain
Temporary deafness
Discharge


II. Foreign Bodies in the Nose

a. TREATMENT
- Sit the person down, and reassure him.
- Encourage the child to breathe through his mouth rather
than his nose.

b. SIGNS AND SYMPTOMS OF A FOREIGN BODY IN THE EAR
Pain
Swelling
Discharge (if the object has been there for some time)
Breathing difficulties
A snoring sound on breathing

III. Foreign Bodies in the Eye

a. TREATMENT
- Sit the person down facing the light.
- Examine the eye by gently separating the eyelids with your
finger and thumb. Ask the person to move the eye up and
down and from left to right. Allow the person to blink.
- If you can see the foreign body and it is not embedded or
touching the colored part of the eye, gently wash it out. Tilt
the head to one side and run water through the eye,
holding the eyelid open.
- Try to remove the object with a moist piece of clean cloth (if
washing does not work).
- Take the person to the hospital (if object remained unable
to be removed).

b. SIGNS AND SYMPTOMS OF A FOREIGN BODY IN THE EAR
Irritation or pain
Watering or red eye
Blurred vision














FIRST AID:
EYE













THE EYE
The eye is one of the most complex parts of the body. The different parts
of the eye allow the body to take in light and perceive objects around
us in the proper color, detail and depth. This allows people to make
more informed decisions about their environment. If a portion of the eye
becomes damaged, you may not be able to see effectively, or lose
your vision together.

ANATOMY AND PHYSIOLOGY OF THE EYE
Globe shape 1diameter, located in the bony socket of the skull (orbit)

TWO FLUID CHAMBERS THAT MAINTAINS THE EYEBALLS (Globe) SHAPE:
Back chamber- contains vitreous hum or a clear fluid that cant be
replaced if lost.
Front chamber- in front of the lens. Contains aqueous hum or a clear fluid
that the body can replace with time.


Conjuctiva- a delicate membrane covering the inner surface of the
eyelids and surface of the eye.
Lacrimal Glands (Tear Glands)- produces fluid to keep the conjunctiva
moist.
Sclera- white of the eye. A tough fibrous tissue that helps maintain globes
shape.
Cornea- clear transparent membrane that allows light to enter.
Iris- the coloured portion of the eye. Circular muscle with an opening in
the middle that changes size, allowing light to enter.
Pupil- opening in the center of iris, normally black, which allows light to
enter the black of the eye.
Lens- lies behind the iris and focuses images.
Retina- light sensitive area at the back of the globe with numerous nerve
endings.
Optic nerve- transmits signals form nerve endings in the retina to the brain.

COMMON EYE INJURIES

1. BURN OF THE EYE

A. Chemical Burn

Emergency Cares
Flush the affected eye with water or sterile saline irrigation
solution.
Direct the greatest amount of solution or water as into the
eyes as gently as possible.
Irrigate the eye for at least 5 minutes.
If an alkali or a strong acid caused the burn, irrigate the eye
for at least 30 minutes.
Apply dry dressing
Transport

B. Thermal Burn

Emergency Cares
Cover both eyes with a sterile dressing, moisten with sterile
saline solution.
Transport

C. Light Burn

Emergency Cares
This kind of burn often is not painful at first, but may become so
in 3 to 5 hours later.
Patient usually develops severe conjunctivitis.
Ease pain from these corneal burns by covering each eye with
a sterile moist pad and an eye shield.

D. Laceration

Emergency Cares
Never exert pressure on the injured eye.
Gently apply moist sterile dressing.
Cover the injured eye with a protective eye shield.
Transport to the nearest hospital.
E. Contact lenses

Emergency Cases
Dont attempt to remove either kind of lens.
Never attempt to remove a lens from an eye that has been or
may have been injured.
Remove contact lenses in the field immediately in case of
chemical burn of the eye.
If it is necessary to remove a hard objects lens use a small
suction cup moistened with a saline.
To remove soft lenses, place 1 to 2 drops of saline onto the
lens, gently pinch it between your thumb and index finger and
lift it off the surface of the eye.

F. Nose bleeding

Emergency cases
Position the patient
Lean forward, ask the patient to open mouth.
Pinch the nose and apply cold compress at the bridge of the
nose.
If bleeding continue, apply sterile rolled dressing inside the
nostril and apply firm pressure.
Transport and refer to physician.


EYE WOUNDS

1. Scratched Eye (Corneal Abrasion)
Common causes of abrasions to the eyes surface (corneal
abrasions) are getting poked in the eye or rubbing the eye
when a foreign body is present, such as dust or sand. Corneal
abrasions are very uncomfortable and cause eye redness and
severe sensitivity to light.
Eye lacerations usually require emergency care. Dont hesitate
to visit an eye doctor immediately.
If you know something has scratched your eye, its very
important to see your eye doctor or an emergency
room/urgent care center to seek treatment for your eye injury.
Scratches also can make your eye susceptible to infection from
bacteria or a fungus. Certain types of bacteria and fungi can
enter the eye through a scratch and cause serious harm in as
little as 24 hours. Even blindness can result. This is especially true
if whatever scratched your eye is dirty or contaminated.
Remember also that infections from the eye injuries such as
scratches can originate from unexpected sources such as a
babys fingernails or tree branches.
If you have scratched eye, dont rub it. And dont patch your
eye, either. Bacteria like dark, warm places to grow, and a
patch might provide the ideal environment. Simple keep the
eye shield over it. See your doctor as soon as possible to check
out this type of eye injury.



2. Foreign Bodies in the Eye

A. Dangers
a. Visions sometimes are seriously affected.
b. Foreign body may become embedded and infection and
vision damage occur.

B. Steps to prevent serious trouble:
a. Never rub the eye.
b. Never examine an eye until you have washed your hands
thoroughly.
c. Never be rough in handling.
d. Never attempt to remove a foreign body with a toothpick,
match, knife blade, or any instruments.
e. Never fail to send the patient to a physician if the foreign body
is embedded in the eye ball.

C. First Aid
a. Removal may be attempted if the foreign body is not
embedded.
b. Irrigation with boric acid solution (a half teaspoonful to a glass
of boiled water)
c. If removal is unsuccessful:
1. Put several of any heavy oil in the eye (olive oil, castor oil,
or mineral oil)
2. Send the patient promptly to a physician.

3. Wounds of Tissues about the Eye
a. Apply a pad of clean cloth or gauze and firm bandage.
b. Send the patient promptly to a physician.

4. Wounds of the Eyeball, serious, even if very tiny.
a. Dont remove any splinter which penetrates part way into the
eyeball.
b. Keep the victim flat on his back.
c. Apply pad and loose bandage.
d. Take to a physician immediately.

5. Red Eyes
a. Red eyes indicate an inflammation of the eyelids or the
eyeball. If a physician is not available immediately, cleans the
eye wit boric acid solution. Then apply hot compress from 5 to
10 minutes.


Boric acid has mild antibiotic properties against fungal or bacterial
infection.
Boric acid ophthalmic (for eyes) is used as an eye wash to cleanse or
irrigate the eyes. Boric acid provides soothing relief from eye irritation,
and helps remove pollutants from the eye such as smog, chlorine, or
other chemicals.


INTERNAL BLEEDING
COMMON SOURCES OF INTERNAL BLEEDING:

A. LUNGS. Tuberculosis is the most common spontaneous bleeding.
Puncture wounds, particularly when rib is broken and driven into a
lung, will also cause bleeding. Blood is coughed up and is bring red
and frothy in appearance.
B. STOMACH. The most common cause are wounds of the stomach
and stomach ulcers. Blood from the stomach is usually vomited up
and has the appearance of coffee grounds; the digestive juice
begin to act on the blood, causing it to turn brown and break up
into small clots about size of large coffee grounds.
C. BOWELS. Diarrhea and Dysentery are the common causes of
bleeding from the bowels. If the bleeding is from any point fairly
high up, the blood is partly digested and changed into a dark, tarry
mass most commonly described as tarry tools. If the blood is bright
red in the stools, the bleeding is from some point low down in the
bowel.

SYMPTOMS:
1. In any of these three conditions, the three chief symptoms of
early hemorrhage are restlessness, anxiety, and thirst.
2. Particularly accompanied by pallor, weak rapid pulse and
weakness-evidence shock.

FIRST AID (The same in all cases)
1. Keep the patient lying on his back as flat as possible, of with feet
elevated. Turn his head to one side for vomiting or coughing.
2. Keep the patient absolutely quiet.
3. Keep the patient warm.
4. Reassure the patient. Badly scared, increase circulation.
5. Call a physician immediately.
6. In chest injuries lung has been punctured prop up the patient
high enough to let him breathe.



INTERNAL INJURIES
CAUSES OF INTERNAL INJURIES:
1. Impacts, such as blows on the abdomen.

SYMPTOMS:
1. Nature and extent of the injury are not clear.
2. Severe shock is often present.

FIRST AID: Follow the general directions for giving first aid.
1. Keep the victim lying down.
2. Treat for a shock.
3. Call for physician.
4. If it is necessary to move the patient, transport him carefully in a
lying position.