the free flow of blood washes out many of the
microorganisms (germs) that cause infection.
LACERATIONS.These wounds are torn,
rather than cut. They have ragged, irregular edges and
masses of torn tissue underneath. These wounds are
usually made by blunt (as opposed to sharp) objects. A
wound made by a dull knife, for instance, is more likely
to be a laceration than an incision. Bomb fragments
often cause lacerations. Many of the wounds caused
by accidents with machinery are lacerations; they are
often 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 objects
that penetrate into the tissues while leaving a small
surface opening. Wounds made by nails, needles, wire,
and bullets are usually punctures. As a rule, small
puncture wounds do not bleed freely; however, large
puncture wounds may cause severe internal bleeding.
The possibility of infection is great in all puncture
wounds, especially if the penetrating object has tetanus
bacteria on it.
To prevent anaerobic infections,
primary closures are not made in the case of puncture
AVULSIONS.An avulsion is the tearing away
of tissue from a body part. Bleeding is usually heavy.
In certain situations, the torn tissue may be surgically
reattached. It can be saved for medical evaluation by
wrapping it in a sterile dressing and placing it in a cool
container, and rushing italong with the victimto a
medical facility. Do not allow the avulsed portion to
freeze, and do not immerse it in water or saline.
AMPUTATIONS.A traumatic amputation is
the nonsurgical removal of the limb from the body.
Bleeding is heavy and requires a tourniquet (which
will be discussed later) to stop the flow. Shock is
certain to develop in these cases. As with avulsed
tissue, wrap the limb in a sterile dressing, place it in a
cool container, and transport it to the hospital with the
victim. Do not allow the limb to be in direct contact
with ice, and do not immerse it in water or saline. The
limb can often be successfully reattached.
Causes of Wounds
Although it is not always necessary to know what
agent or object has caused the wound, it is helpful.
Knowing what has caused the wound may give you
some idea of the probable size of the wound, its general
nature, the extent to which it is likely to become
contaminated with foreign matter, and what special
dangers must be guarded against. Of special concern
in a wartime setting is the velocity of wound-causing
missiles (bullets or shrapnel). A low-velocity missile
damages only the tissues it comes into contact with.
On the other hand, a high-velocity missile can do
enormous damage by forcing the tissues and body
parts away from the track of the missile with a velocity
only slightly less than that of the missile itself. These
tissues, especially bone, may become damage-causing
missiles themselves, thus accentuating the destructive
effects of the missile.
Having classified the wound into one or more of
the general categories listed, the Corpsman will have a
good idea of the nature and extent of the injury, along
with any special complications that may exist. This
information will aid in the treatment of the victim.
MANAGEMENT OF OPEN SOFT-TISSUE
There are three basic rules to be followed in the
treatment of practically all open soft tissue injuries: to
control hemorrhage, to treat the victim for shock, and
to do whatever you can to prevent infection. These will
be discussed, along with the proper application of first
aid materials and other specific first aid techniques.
Hemorrhage is the escape of blood from the
vessels of the circulatory system. The average adult
body contains about 5 liters of blood. Five hundred
milliliters of blood, the amount given by blood donors,
can usually be lost without any harmful effect. The
loss of 1 liter of blood usually causes shock, but shock
may develop if small amounts of blood are lost rapidly,
since the circulatory system does not have enough time
to compensate adequately.
The degree of shock
progressively increases as greater amounts of blood
escape. Young children, sick people, or the elderly
may be especially susceptible to the loss of even small
amounts of blood since their internal systems are in
such delicate balance.
Capillary blood is usually brick red in color. If
capillaries are cut, the blood oozes out slowly. Blood
from the veins is dark red.
Venous bleeding is
characterized by a steady, even flow. If an artery near
the surface is cut, the blood, which is bright red in
color, will gush out in spurts that are synchronized with
the heartbeats. If the severed artery is deeply buried,