the free flow of blood washes out many of themicroorganisms (germs) that cause infection.LACERATIONS.—These wounds are torn,rather than cut. They have ragged, irregular edges andmasses of torn tissue underneath. These wounds areusually made by blunt (as opposed to sharp) objects. Awound made by a dull knife, for instance, is more likelyto be a laceration than an incision. Bomb fragmentsoften cause lacerations. Many of the wounds causedby accidents with machinery are lacerations; they areoften complicated by crushing of the tissues as well.Lacerations are frequently contaminated with dirt,grease, or other material that is ground into the tissue.They are therefore very likely to become infected.PUNCTURES.—Punctures are caused by objectsthat penetrate into the tissues while leaving a smallsurface opening. Wounds made by nails, needles, wire,and bullets are usually punctures. As a rule, smallpuncture wounds do not bleed freely; however, largepuncture wounds may cause severe internal bleeding.The possibility of infection is great in all puncturewounds, especially if the penetrating object has tetanusbacteria on it. To prevent anaerobic infections,primary closures are not made in the case of puncturewounds.AVULSIONS.—An avulsion is the tearing awayof tissue from a body part. Bleeding is usually heavy.In certain situations, the torn tissue may be surgicallyreattached. It can be saved for medical evaluation bywrapping it in a sterile dressing and placing it in a coolcontainer, and rushing it—along with the victim–to amedical facility. Do not allow the avulsed portion tofreeze, and do not immerse it in water or saline.AMPUTATIONS.—A traumatic amputation isthe nonsurgical removal of the limb from the body.Bleeding is heavy and requires a tourniquet (whichwill be discussed later) to stop the flow. Shock iscertain to develop in these cases. As with avulsedtissue, wrap the limb in a sterile dressing, place it in acool container, and transport it to the hospital with thevictim. Do not allow the limb to be in direct contactwith ice, and do not immerse it in water or saline. Thelimb can often be successfully reattached.Causes of WoundsAlthough it is not always necessary to know whatagent or object has caused the wound, it is helpful.Knowing what has caused the wound may give yousome idea of the probable size of the wound, its generalnature, the extent to which it is likely to becomecontaminated with foreign matter, and what specialdangers must be guarded against. Of special concernin a wartime setting is the velocity of wound-causingmissiles (bullets or shrapnel). A low-velocity missiledamages only the tissues it comes into contact with.On the other hand, a high-velocity missile can doenormous damage by forcing the tissues and bodyparts away from the track of the missile with a velocityonly slightly less than that of the missile itself. Thesetissues, especially bone, may become damage-causingmissiles themselves, thus accentuating the destructiveeffects of the missile.Having classified the wound into one or more ofthe general categories listed, the Corpsman will have agood idea of the nature and extent of the injury, alongwith any special complications that may exist. Thisinformation will aid in the treatment of the victim.MANAGEMENT OF OPEN SOFT-TISSUEINJURIESThere are three basic rules to be followed in thetreatment of practically all open soft tissue injuries: tocontrol hemorrhage, to treat the victim for shock, andto do whatever you can to prevent infection. These willbe discussed, along with the proper application of firstaid materials and other specific first aid techniques.HemorrhageHemorrhage is the escape of blood from thevessels of the circulatory system. The average adultbody contains about 5 liters of blood. Five hundredmilliliters of blood, the amount given by blood donors,can usually be lost without any harmful effect. Theloss of 1 liter of blood usually causes shock, but shockmay develop if small amounts of blood are lost rapidly,since the circulatory system does not have enough timeto compensate adequately. The degree of shockprogressively increases as greater amounts of bloodescape. Young children, sick people, or the elderlymay be especially susceptible to the loss of even smallamounts of blood since their internal systems are insuch delicate balance.Capillary blood is usually brick red in color. Ifcapillaries are cut, the blood oozes out slowly. Bloodfrom the veins is dark red. Venous bleeding ischaracterized by a steady, even flow. If an artery nearthe surface is cut, the blood, which is bright red incolor, will gush out in spurts that are synchronized withthe heartbeats. If the severed artery is deeply buried,4-30
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