Chapter 16 Classification of Wounds

Wounds and Injuries of the Soft Tissues of the

 Contusion
Facial Area
 Abrasion
Objectives of this topic:  Laceration
 Penetrating wound
1. To know the definition of wounds.
2. To identify each classification of wounds.  Gunshot, Missile and War wounds
3. To gain knowledge on how to treat each  Burns
type of wound. The Four Major Phenomena may threathen life:
4. Discuss within small groups on how
intraoral wound of each type has been 1. Blood Loss
inflicted/ obtained and how are they being 2. Tissue Damage
treated. 3. Defense against bacteria is broken
4. Mechanical Defect may develop
Wound
Contusion
 an injury to living tissue caused by a cut, blow,
or other impact, typically one in which the skin Definition: It is a bruise, usually produced by an
is cut or broken. impact from a blunt object without breaking the
skin.
Regardless of the wound encountered, early care is
of the utmost importance to ensure restoration of It affects the skin and subcutaneous tissue and usually
normal function and prevent facial disfigurement. causes a self limiting subcutaneous hemorrhage.
Ecchymosis usually becomes evident in approximately
“It is better to have an assymetrical body than a 48hours.
symmetrical corpse. “
Treatment:
Life saving procedures:
 OBSERVATION
• Establishment and maintenance of a patent
airway. Abrasion
• Arrest of hemorrhage. Definition: It is a wound produced by the
• Recognition and Treatment of Shock. rubbing or scraping off of the covering surface.
• Recognition of associated head injuries.
• Treatment of intra-abdominal or thoracic It results from friction. Usually its superficial and
wounds. produces a raw bleeding surface.

General condition of the patient has stabilized and his Treatment:

life is no longer endangered, attention should be
directed to the soft tissues of the face.
Early closure seals off the pathways of infection and
promotes rapid healing which keeps scar tissue and
contracture at a minimum.
It also reduces the need for nursing care, improves
patient's morale, and permits an early return to a
satisfactory method of feeding.
 Mechanical scrubbing with surgical
detergent soap.
 Placement of antiseptic solution.
(Benzalkonium)
 Local application of antibiotic cream with
continued mechanically cleansing.
Laceration
Definition: It is a wound resulting into tear.

It is the most frequently soft tissue wound which is

caused by a sharp object.
 • May be shallow or deep. Perforating Wound: Missile produces a wound
• May nerves and and vessels. exit.

Treatment: Avulsive Wound: When large portions of the

soft tissue or osseous structures are carried
 Cleasing of the wound
away or destroyed.
 Adequate Debridement
 Complete Hemostasis Treatment
 Proper Closure of Wound
 Check on the general health of patient.
 Adequate Supportive Therapy
 Ensure adequate airway.
Adequate Supportive Therapy  Arrest hemorrhage.
 Control of Shock.
• Drains -Penrose or rubber dam drain (removed
 Treat the area of concern.
after 2-4 days).
Burns
• Dressing- Fine mesh gauze, pressure pack.
Definition: An injury caused by exposure to heat
• Prevention from infection- utilization of
or flame.
antibiotics.
3 Classifications
• Prophylaxis against tetanus- *CLOSTRIDIUM
TETANI* 1. First Degree Burn
2. Second Degree Burn
 First Dose:
3. Third Degree Burn
 Second Dose: 6 weeks after first dose.
 Third Dose: 6-12 months after second First Degree Burn
dose.
• The outer layer (epidermis)of the skin is
 Active Immunization is effective for
burned.
min. of 1 year.
• Least serious burn.
 Booster: Anytime within next 10 years.
Symptom: Erythema of the skin, skin is dry, swelling.
Penetrating wound

Definition: A puncture type of wound caused by

a sharp object. Second Degree Burn
Deep wounds: • A second degree, or partial thickness, burn
affects both the upper layer of the skin and
Ex. Knife, Ice pick, Nail
the skin underneath it.
Treatment:
Symptoms: Redness, Swelling, Pain and Blistering.
 Conservative treatment and directed
primarily to control of infection.
 Clean and irrigate wound. Third Degree Burn
 Tetanus Immunization
 Let the wound heal. • A third degree, or full thickness.
 Sometimes may need a secondary • Burn extends through every level of skin
procedure. • One of the most severe burns

Gunshot, Missile and War Wounds Symptoms: Bleeding, Appearing a bit black,Skin
appearing dry or leathery,
Penetrating Wound: Missile is retained in the
wound.
 Treatment: Burn

 Major Systemic complication: Hypovolemic

Shock
 Prevention: Restoration of normal blood
volume. (With colloids and electrolytes)
 Hematocrit, Hemoglobin determination
 Weight of patient, Extent of burn surface.

First 24hours

 Colloid

=Percentage of body burned X body weight X 0.25

 Electrolyte

=Percentage of body burned X Body weight X 0.50

 Glucose in Water =2,000ml

Second 24 hours

 Half amount of Colloids and Electrolyte.

 2,000ml of Glucose in water.

3rd Day

 Moderate burned patient- oral intake of fluids.

 Severe burned patient- continue IV therapy.

Therapy

• Supportive Care

 prevention/treatment of shock.
 Prophylactic Antibiotics for control of
infection.
 Tetanus vaccinations

• Local Care

 Cleansing, Debridement of burned area,

dressing of the area, antiobiotic
treatment.
 For 3rd Degree Burn: Skin grafting