▷ FIRST AID: for WOUNDS. What IS? HOW can TREAT?

Wounds in first aid are classified as:

• Simple wound: this is caused by a sharp instrument (knife, razor, etc.) and does not injure the organs located under the skin.

• Compound wound: this is a wound that often has irregular edges and injures not only the skin, but also muscles or tendons, nerves, arteries, etc.

• Complicated wound: this is complicated by a local or sometimes general infection (tetanus, gas gangrene, etc.).

• Penetrating wound: this is a wound that penetrates a cavity of the body: peritoneum, pleura, pericardium, joint cavity. These are more serious wounds.

• Non-penetrating wound: this is a wound that injures the skin and other superficial planes, without penetrating the cavities of the body.

• Erosion: this is caused by violent friction of a rough surface against the skin, which causes the superficial layers of the skin to peel off. They are frequent in places of the skin that are usually uncovered: knees, hands, elbows, face, etc.

• Puncture wound: is caused by a sharp instrument, such as a needle, awl, nail, wire, thorn, farmer's pitchfork, sword, etc. If the instrument is thin and well-sharpened, when it penetrates it will separate the various elements it finds in its path, without cutting them. The hole left by this type of wound at the level of the skin is small and a few drops of blood come out of it.

• Cutting wound: is produced by a sharp instrument: knife, scalpel, razor, glass, etc. In these, the length predominates over the width. Their edges are clean and neat. The cutting wound generally produces bleeding, the degree of which depends on the quantity and caliber of the sectioned vessels.

• Contused wound: also known as a lacerated wound, the contused wound is produced by an instrument such as a stick, hammer, or by falls on the ground. The edges of the wound are irregular, often torn. The amount of blood coming out of the wound and the pain are less than in a cutting wound of the same area, due to the crushing of blood vessels and nerves. There is a tendency for the wound to cool due to lack of vitality of the tissues.

The following what is the steps first aid measures for wounds and how to properly assist an injured person.

• Stop the bleeding if it is abundant. If the blood is light red and comes out in intermittent streams, an artery or arteriole has been severed. Apply pressure above the wound, between the heart and the edge of the wound.

• If the stream stops, it is probably because you are applying pressure at the right point. Pressure can be applied with the tips of your fingers, or better yet, with the backs of your fingers. Sometimes it helps to apply pressure on the wound at the same time with a sterile gauze.

• If you are unable to stop the bleeding, apply a tourniquet, remembering that this is only a temporary treatment (it should never be left on for more than 20 minutes at a time) and that, if precautions are not taken, it can cause serious damage.

• If the blood is dark red and comes out continuously, a vein has been severed. Pressure should be applied under the wound, between the wound and the extremity of the limb, or between the wound and the upper part of the neck or face when the wound is on the neck or head.

• If the bleeding is of moderate intensity and the blood is not very dark in color, it is likely that the bleeding vessels are small. If you have sterile gauze on hand, stop this type of bleeding by compressing the wound with a good amount of gauze. Sometimes the same procedure can be used to stop arterial or venous bleeding that is not very intense. If there is nothing sterile that can be used to press on the wound, apply pressure above and below it.

• Avoid traumatic shock or try to prevent its progress. Lay down the seriously injured person; if possible, with the head lower than the feet. Keep him covered to prevent cooling. If there is already traumatic shock (paleness, sometimes with a bluish tint to the nails and lips, a weak and rapid pulse, rapid and irregular breathing, skin covered in cold sweat) avoid moving the patient and do not worry about treating the wound, except to stop the bleeding and put a sterile dressing on it. Treat the traumatic shock first.

• Avoid bringing more germs into the wound than the traumatic agent has already introduced. Do not put your hands, or any substance or cloth that has not been sterilized, in direct contact with the wound.

• Sometimes, naturally, when faced with a serious neck wound with a section of a large vessel, it may be necessary to put your hand in the wound to stop the bleeding. It is better for the injured person to remain alive with a contaminated wound than to die with an uncontaminated wound.

First aid for minor wounds is:

• Carefully wash the skin around the wound with gauze or cotton soaked in an antiseptic solution, then thoroughly clean the wound surface with boiled water and cotton balls.

• If the wound is very dirty and has foreign bodies that are deeply embedded, it may also be necessary to use soap and a small pair of tweezers to remove them.

• In some cases, a brush is necessary, but since this is painful, it will be essential to first touch the wound surface with a pantocaine or xylocaine solution to anesthetize it.

• Once the surface of the wounded skin has been cleaned, it can be sprayed with an antibiotic solution, such as injectable gentamicin.

• DO NOT PLACE ANTISEPTIC POWDERS OR SOLUTIONS ON THE WOUND.

• Once a wound has been disinfected with mercurial (merthiolate, metaphen, etc.), iodine should not be used, nor vice versa, as they form an irritating compound.

• The best dressing is what is known as fatty tulle, or alternatively, Vaseline gauze, to prevent the wound from adhering. Put dry gauze on top and then cotton.

• The patient should be careful to avoid movement of the affected area, especially if the injury is on the knee, elbow or knuckles. On the face and even on other parts of the body, it may be useful to leave the minor wound uncovered, protecting it with tulle or gauze until a protective scab has formed.

First aid for contused wounds is:

• Stop the bleeding. If the bleeding is not caused by injury to a major blood vessel, it can be stopped by simply compressing the wound with sterile gauze. In general, within half an hour or less, the wound will not bleed again and treatment can be continued.

• The person providing first aid should wash their hands thoroughly. Do not place any material that has not been disinfected or sterilized in contact with the wound.

• Protect the wound with gauze while, with boiled water, soap and cotton balls, the skin around the wound is cleaned. If the skin is dirty with greasy substances, clean it with ether, benzine, naphtha or acetone. Once the skin around the wound is clean, clean the edges of the wound. If the inside of the wound contains foreign bodies, it should be cleaned with a stream of physiological saline solution (water containing 2 teaspoons of kitchen salt per litre and boiled), or hypochlorite solution, or simply boiled water.

• Sometimes it is necessary to remove foreign bodies with tweezers or another instrument that has been boiled beforehand. If the wound is in an area covered with hair, shave the surrounding area.

• Disinfection should be done on the skin surrounding the wound, and it is not necessary, except in special cases, to disinfect the inside of the wound. This disinfection can be done with 2% iodine tincture or with merthiolate tincture or some other disinfectant (hexachlorophen, metaphen, etc.). If the skin is disinfected with iodine tincture, it is advisable to rub alcohol afterwards until the skin is clear, to avoid staining.

• Finish first aid by placing a sterile gauze on the wound, which will be covered with cotton, preferably also sterile, material that will be held in place with a bandage or by means of adhesive tape.

First aid for puncture wounds is:

• Try to make the wound bleed by applying gentle pressure, thereby drawing out any substances that may contaminate it.

• If the foreign body is still lodged (thorn, splinter, etc.), remove it with sterile tweezers or water.

• Clean the skin around the wound with boiled water and soap, or with naphtha, ether or benzine if it is dirty with grease or lubricants.

• Disinfect the skin with 2% iodine tincture, then rub it with alcohol until the skin is clear, and apply a sterile dressing.

First aid for gunshot wounds is:

• If bleeding is intense (which is rare), stop it by applying pressure to the wound with sterile gauze or a clean cloth. If this is not enough, a tourniquet can be applied temporarily.

• Clean the skin with boiled water, taking care that the water does not penetrate the wound, which would drag germs into it.

• Disinfect the surrounding skin with 2% tincture of everything.

• Place sterile gauze on the wound, without trying to extract the bullet or explore its path.

• Keep the injured person well covered, preventing him from cooling down, in order to prevent or attenuate the traumatic shock.

• The same general principles of wound treatment studied above must be applied to these cases, that is, careful hand washing, not putting items that have not been sterilized or disinfected into contact with the wound, etc.