Traumatic Wound Management
Traumatic wounds include abrasions, lacerations, puncture wounds, and amputations. A puncture wound occurs when a pointed object, such as a knife or glass fragment, penetrates the skin.
When caring for a patient with a traumatic wound, your first priority is to assess his circulation, airway, and breathing.1 Once these are stabilized, you can turn your attention to the traumatic wound. Initial management concentrates on controlling bleeding, usually by applying firm, direct pressure and elevating any affected extremity. If bleeding continues, you may need to compress a pressure point. You’ll next need to assess the condition of the wound; management and cleaning technique typically depend on the specific type of wound and degree of contamination.
Equipment
Sterile basin ▪ normal saline solution ▪ sterile 4″ × 4″ gauze pads ▪ sterile gloves ▪ clean gloves ▪ dry, sterile dressing, nonadherent pad, or petroleum gauze ▪ linen-saver pad ▪ Optional: goggles, mask, gown, scissors, 50-mL catheter-tip syringe, antibacterial ointment, porous tape, sutures and suture set, clippers, surgical scrub brush.
Preparation of Equipment
Place a linen-saver pad under the area to be cleaned. Remove any clothing covering the wound. If necessary, clip hair around the wound with scissors to promote cleaning and treatment.
Gather needed equipment at the patient’s bedside. Fill a sterile basin with normal saline solution. Make sure the treatment area has enough light to allow close observation of the wound. Depending on the nature and location of the wound, wear sterile or clean gloves to avoid spreading infection.
Implementation
Check the patient’s medical history for previous tetanus immunization and, if needed and ordered, arrange for immunization.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.5
Explain the procedure to the patient.
Perform a comprehensive pain assessment using techniques appropriate for the patient’s age, condition, and ability to understand.6
Administer pain medication as ordered, following safe medication administration practices.7
Put on other personal protective equipment, such as a gown, mask, and goggles, if spraying or splashing of body fluids is possible.
For A Traumatic Puncture Wound
If the wound is minor, allow it to bleed for a few minutes before cleaning it to help remove possible contaminates from the wound.
For a larger puncture wound, you may need to irrigate it before applying a dry dressing. The doctor may request a radiologic study to rule out foreign matter remaining in the wound.
Stabilize any embedded foreign object until the doctor can remove it. After he removes the object and bleeding is stabilized, moisten a sterile 4″ × 4″ gauze pad with normal saline solution. Clean the wound gently, working outward from its center to about 2″ (5 cm) beyond its edges. Discard the soiled gauze pad and use a fresh one, as necessary. Continue until the wound appears clean.
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