Wounds comprise injuries that break or remove the skin (such as cuts and abrasions). Most small wounds can be treated successfully at home. The aim of first aid is to promote healing and to minimise the risk of infection.
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Large wounds or severe bleeding need immediate medical attention as blood loss can lead to falling blood pressure and shock.
Get help immediately if:
The wound is large or deep and bleeding cannot be controlled after 10 minutes of applying pressure
The person has lost of lot blood, is drowsy or pale
There is numbness or weakness in the limb beyond the wound
There is something stuck in the wound
The person cannot move his fingers or toes
Stitches are required
The wound is on the face or neck
Home treatment
Minor wounds
Most minor wounds stop bleeding on their own. If bleeding continues, apply pressure to the wound with a clean bandage.
Wash the skin around the wound with soap and water. Hold the wound under running water to remove dirt. Pat the wound dry with sterile gauze and apply antiseptic ointment.
In the case of cuts, close the wound with sterile adhesive wound closure strips. If strips are not available, cover the wound with clean gauze and adhesive tape. Don’t use cotton wool. Adhesive non-adherent bandages can be used for abrasions that continue to ooze blood.
Change the dressings at least once a day and watch for infection – remember that an infection will only be obvious after a day or two.
Major wounds
For deeper cuts or severe bleeding, apply direct pressure onto the wound with a clean towel or gauze and follow first aid for severe bleeding.
If there is a foreign object in the wound, don’t attempt to remove it. Apply pressure around the wound. Build padding around the object to the same height as the object and secure it with a bandage.
See a doctor if:
There are signs of infection (such as extensive redness and swelling, a general sick feeling, pus from the wound or a temperature above 37.7°C).
The wound has been contaminated with dirt or gravel and the injured person hasn't had a tetanus injection in the past ten years.
The wound hasn't healed after two weeks. (Minor facial wounds usually take three to five days to heal, wounds on the chest and arms should take between five and nine days, and on the leg wounds, seven to twelve days)
When stitches are required
If a wound doesn't close easily, the wound is deep (more than 0.6cm), gaping or jagged-edged, you may need stitches to promote healing, prevent infection and minimise scarring. Stitches are often necessary in small children as they tend to remove dressings, or if the cut is on the face or hands or joints. Stitching should be done within eight hours.
Bruises
A bruise is dark discolouration of skin caused by blood seeping under the skin after small blood vessels near the surface of the skin have been broken. As the bruise heals, the body breaks this blood down and reabsorbs it, turning the area a typical greenish-blue. Bruises are more common in people who are on treatment to prevent blood clots (warfarin, coumarin, heparin or aspirin).
Signs
Pain
Tenderness
Change in colour of the skin (red, purple of black)
Swelling
Get help immediately if:
There is a bruise as a result of an injury to the loin or flank, and blood is present in the urine. This could indicate injury to the kidneys or other organs.
The bruise is the result of a serious fall from a tricycle, bicycle or any other traumatic accident (a jungle gym tumble, for example). Your doctor may want to check for less obvious injuries.
Head injury is followed by a bruise. You banged your head and have a bruise behind the ear; it may be a sign of a skull fracture.
Home treatment
Most bruises are relatively minor and will get better on their own over a period of about ten days.
If the bruise is quite large and swollen, then you can apply ice packs to reduce the swelling. This will also relieve the pain. Make an ice-pack by wrapping ice or frozen peas in a damp cloth. Don’t put it directly on the skin as this could cause damage. Put the ice-pack on for 10-20 minutes every two hours for the first 24 hours and every four hours for a further 24 hours.
Elevate the area if the bruise is on a leg or an arm to reduce swelling.
A pain killer such as paracetamol can be used if needed.
Call your doctor if:
A bruise that doesn't fade in 14 days.
The person is in pain for more than 24 hours or if pain on the site of the bruise gets worse; this may be caused by a broken bone.
Blisters
Blisters can develop from friction against the skin or as a result of burns or certain illnesses.
Blisters that are draining can become infected and should be covered until a scab forms.
Home treatment
Don't treat blisters that are small and closed.
f blisters are caused by friction, avoid the clothing or activity which caused it.
Protect blisters on the foot with a circular moleskin pad which covers the area around the blister but not the blister itself.
Drain large blisters (more than 2.5 cm across): hold a needle over an open flame to sterile it and use it to make a hole at the edge of the blister. Gently squeeze the blister to drain the fluid through the hole. Smooth the skin that covers the blister flat - don't remove it.
Wash the area with soap and water and apply an antibiotic ointment and sterile bandage.
Don't use a bandage at night.
Change the bandage at least once a day.
Call a doctor if:
There are signs of infection (fever, pus, red streaks extending from the blister, swelling and redness)
Crushed fingers
If the injury is limited to the fingertip and the finger is not deformed or severely swollen, there is seldom need to visit the doctor. Apply an ice pack to reduce the swelling.
If the injury involves more than the fingertip, the person should see a doctor.
Blood under the nail
The pressure created by blood under the nail can be very painful. Draining the blood through a hole will relieve the pain.
Straighten a steel paper clip. Hold it with a pair of pliers and heat the tip in a flame until it is red hot.
Place the hot tip of the paper clip on the nail and allow it to melt through – don't use any pressure. This is a painless procedure as the nail has no nerve endings. Reheat the paper clip if necessary. The blood will seep through the hole.
If the problem returns, repeat the procedure using the same hole.
Reviewed by Dr Elmin Steyn, trauma specialist, Cape Town.
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