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October 2012

Wound-wise, An Emergency

Dr Kalpesh Khatter & Dr Aeraj Mohammed 
There cannot be a person who has not sustained injuries like simple cuts and wounds. A wound is an injury caused by a cut or blow or any impact that results in the skin surface getting cut or broken. It commonly occurs in children during play, sports and other physical activities. It can also happen at home, while working, in the kitchen, gardening, doing paper work, carpentry and so on.

Types Of Wounds

  • Abrasions: Scraping of upper layers of skin without complete break in skin.
  • Incised/cut wounds: Break in continuity of skin by sharp instrument.
  • Puncture wounds: Wounds caused by sharp instrument penetrating into the skin
Cuts and wounds lead to a lot of pain and distress. When untreated, they lead to infection and further complications.

A wound must be normally checked by a doctor to decide whether it needs to be closed, and if so, how it should be closed. Treatment in terms of cleansing with saline solution and antiseptic, dressing, and a tetanus shot would suffice for majority of wounds. A wound can be closed by suturing, stapling or with surgical glues (quick fix). Cases where a wound is big and infected, and the wounds suffered on the face and hands may call for a surgical procedure or time in the operation theatre.

Home Care
At home it is helpful to have a first aid kit containing Dettol/liquid antiseptic, sterile gauze pieces, plaster, bandage cloth, and antibiotic ointment.

Seek Special Care
  • Dirty wounds: Take a TT (Tetanus Toxoid) injection, if not taken in the last 5 years.
  • Active bleeding: If bleeding doesn’t stop, apply pressure on wound and seek immediate help.
  • Deep wounds: Seek immediate medical attention for suturing/ stitching.
  • Puncture wounds: Always seek medical attention, as chances of infection to underlying organs (or viscera) are very high.

The most serious result of an untreated wound is sepsis, where the infection spreads through the body, causing fever and low blood pressure, and requires hospitalization. Wounds can also lead to the lifethreatening infection called tetanus, in unvaccinated persons.

Injury From Sharp Objects
Cuts from sharp objects like glass, blades and knives tend to be more serious due to their depth of penetration. Deep cuts can injure underlying organs, blood vessels and nerves. Broken glass can also get embedded in the skin and muscle, which can lead to further injury whenever movement occurs. Since dirt can get embedded deeply, such wounds have a higher chance of infection and sepsis. First aid in such wounds involves covering the wound with clean cloth and taking the injured to the nearest hospital. Any embedded object must not be pulled out. It is best for a doctor or a surgeon to deal with such injuries.

The Do’s
  • Clean the wound under running tap water, to remove debris and dirt.
  • Use Dettol or other liquid antiseptic if available. Dilute it - 1 capful in 1 mug of water to wash the wound.
  • Apply direct pressure with a clean cloth so that the bleeding stops (in about 15-20 minutes).
  • Apply antibiotic ointment or powder and cover the wound with a sterile gauze piece.
The Don’ts
  • Don’t keep the wound open.
  • Don’t try to pull out the deeply embedded foreign body or debris from the wound. (When you do so, you risk injuring the blood vessels and nerves.).
  • Don’t touch the wound with bare and dirty hands.
  • Do not apply any cosmetic talc, toothpaste or powder.

Dr Kalpesh Khatter is Emergency Physician, Apollo Health City, Hyderabad.
Dr Aeraj Mohammed is Emergency Physician, Apollo Health City, Hyderabad.