Open Trauma Wounds

Open trauma wounds include abrasions, lacerations, avulsions, crush wounds, puncture wounds, and missile injuries resulting from accidental injury or acts of violence.

Causes

Most commonly, open wounds result from an accidental injury at home or work or from a motor vehicle crash. Other open wounds, such as stab and gunshot wounds, may be intentionally inflicted by the victim or by someone else. Open wounds occasionally are self-inflicted by patients with psychiatric disorders or suicidal ideations.

Treatment

For all types of traumatic wounds, treatment includes stabilizing the airway and immobilizing the victim if you suspect spinal injuries. I.V. lines are established and the patient should be treated for hypovolemic shock if present. When airway, breathing, and circulation are stable, apply direct pressure to obvious bleeding (especially arterial bleeding).

The patient should be evaluated neurologically and other major trauma evaluated. When the patient is stable, the wounds are evaluated and treated according to type. Thorough cleaning and irrigation of the affected area and administration of tetanus prophylaxis may be indicated.

Small avulsions require a nonadhesive pressure dressing. Larger avulsed areas may be repaired by reattaching the avulsed tissue or by split-thickness grafting.

Grossly contaminated lacerations require treatment with a broad-spectrum antibiotic. Lacerations are closed by suture or Steri-Strips. Crush and puncture wounds may require surgery, debridement, and repair.

Missile injuries and some puncture wounds require stabilization of life-threatening insults. Endotracheal intubation, volume replacement (with lactated Ringer's solution), and surgery may be necessary.

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