Encyclopedia of Health and Medicine

366 Emergency and First Aid
• Change the bandage daily or when it gets wet,
applying free antibiotic ointment with each
bandage change.
• Continue to treat the laceration until its edges
completely heal together (typically 7 to 10
days).
A laceration that is jagged or longer than 1 ⁄2
inch, or whose edges do not stay together,
requires medical treatment. These are the recommended
steps for the first responder to take to
help protect the wound until the person can
receive such treatment:
• Stop the bleeding; apply a bandage or other
covering and hold it firmly enough to exert
pressure.
• When the bleeding stops place gauze or tape to
hold the bandage in place. Do not remove the
bandage. If bleeding persists, add more bandage.
• Immobilize the area of the laceration to minimize
and further damage.
Minor lacerations often heal well with selftreatment.
When the edges of a laceration will not
stay together on their own, the wound needs
sutures (stitches). A jagged or deep laceration may
require debridement, a procedure in which a doctor
or physician’s assistant numbs the area with a
local anesthetic and trims away all loose tissue and
cleans out any debris that contaminates the
wound. The provider may suture the wound if it is
clean enough or allow it to heal on its own, a
process called granulation in which new tissue
grows from the inside to the outside of the
wound.
See also ABRASIONS; ANTIBIOTIC MEDICATIONS; AVUL-
SION; SCAR.
open fracture A FRACTURE in which the broken
BONE protrudes through the surface of the SKIN,
creating an open wound that may bleed profusely.
There is high risk for the bone ends to significantly
damage nerves, BLOOD vessels, and other tissues in
the area around the fracture.
Site and situation assessment Open fractures
result from significant trauma as may occur in
MOTOR VEHICLE ACCIDENTS, industrial accidents in
which a heavy object falls on the person, falls, or
collisions (such as when bicycling, skiing, or skateboarding).
A person who has an open fracture
may have multiple injuries or there may be multiple
people involved in the accident who have various
injuries. Possible site hazards that present risk
of injury for responders, particularly the responder
first to arrive, include downed power lines,
unstable terrain or structures, and traffic.
Responder personal protection measures Latex
gloves, which the responder should put on before
approaching the injured person, are essential for
personal protection from bloodborne pathogens as
nearly always there is moderate to heavy bleeding
from open fractures.
First response actions Necessary actions from
the first responder may include BLEEDING CONTROL,
fracture stabilization, and comforting the injured
person. Open fractures are serious injuries and
moving the person is likely to require technical
expertise as well as multiple rescuers. Often the
most important role for the first responder is to
keep the injured person calm, warm, and dry until
rescue and emergency medical personnel arrive.
Follow-through Open fractures require urgent
medical treatment and surgery to clean the injury
and repair the fracture and damage to the surrounding
tissues.
See also BODY SUBSTANCE ISOLATION; LACERATION;
SHOCK; SYMPTOM ASSESSMENT AND CARE TRIAGE.
puncture wound An injury in which an object
penetrates through the SKIN and into the underlying
structures, sometimes deeply, with the wound
closing with the object’s withdrawal. There may
be little or no external bleeding with a puncture
wound. However, the risk for INFECTION is
extremely high. First aid measures include rinsing
debris and BLOOD from the wound and applying a
bandage to protect it from exposure to further
pathogens. A health-care provider should evaluate
the wound promptly as it might be necessary to
incise it (cut it open under sterile conditions) to
clean it and irrigate it with antibiotic solution. The
health-care provider is also likely to prescribe
ANTIBIOTIC MEDICATIONS to treat bacterial INFECTION.
The injured person should receive a tetanus toxoid
booster if the last one was more than 10 years
ago.