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2017 HCHB_digital

Cuts, Abrasions and

Cuts, Abrasions and Blisters This topic deals with minor cuts, abrasions (grazes) and blisters. For information about more serious wounds, see Wound Care. Most cuts, abrasions and blisters can be treated with simple first aid. Wounds are best covered with breathable dressings that encourage moisture retention. This allows them to heal faster with less scarring. Initial assessment First look at the wound if possible, as long as it is easy to do so without making it worse. Immediately refer any severe wounds or ones that are bleeding profusely to a doctor or pharmacist. Run through the Refer to pharmacist questions (opposite page) and decide who else needs referring. For all other customers, discuss the appropriate treatment options. Cuts Cuts are usually caused by sharp objects such as knives or shards of glass slicing into the skin. Depending on the cause, they can either be minor or severe. • Apply pressure to the cut with a clean dressing pad, cloth, or non-linting tissue. • Elevate the wound if necessary to stop the bleeding. • Seek immediate medical attention if the wound is serious, extensive, or won’t stop bleeding after 15 to 20 minutes of continuous pressure. »» Do not remove blood-soaked dressings but keep putting new ones on top and renewing the pressure. • Once the bleeding has subsided or stopped, apply wound closure strips and cover minor cuts with a dressing strip or dry non-stick wound pad. »» Before applying a dressing, make sure the cut is clean. Clean carefully with warm water, saline, or a low-toxicity antiseptic solution if necessary, but be careful not to encourage further bleeding. Apply a topical antiseptic (see Wound Care for detailed information). »» Cuts heal faster if the edges of the wound are brought together with wound closure strips. »» Cover deeper cuts with island or film dressings and seek medical advice as stitches may be needed. • Some people may require a booster tetanus shot if the wound is considered a high tetanus risk and it has been more than five years since their last vaccination. • Seek medical attention if the cut was caused by a dirty object and is unable to be cleaned properly. Abrasions Abrasions (grazes) occur when the upper layers of the skin get damaged and broken, usually as a result of friction or rubbing against a hard rough surface. They commonly happen in children and on more thin-skinned, bony parts of the body (eg, knees, ankles and elbows). • Since abrasions usually contain particles of dirt, gently rinse the area clean using tap water, saline solution, or a low-toxicity antiseptic solution. »» Tweezers may be used to remove surface debris but seek medical attention if anything is embedded in the wound or the wound is particularly dirty and is unable to be cleaned properly. TREATMENT OPTIONS Wound type Dressing Dressing feature Blisters Cuts and abrasions Natural / herbal products / supplements Hydrocolloid dressings (Compeed Blister Pack range, Coverplast Hydrocolloid Heel Blisters, Nexcare Blister Waterproof Plaster) Dressing strips (Elastoplast, Nexcare) Dry, non-stick wound pads (Cutilin, Melolin, Telfa) Blister prevention (Scholl range, Spenco range) Saline 0.9% (GP Wound Wash Saline) Dressing strips (Elastoplast, Nexcare) Wound closure strips (Leukostrip, Steri-strips) Dry non-stick pad dressings (Cutilin, Melolin, Telfa) Dry self-adhesive pad island dressings (Cutiplast Sterile, Primapore, Tegaderm with pad) Film dressings (Cutifilm Plus, Opsite Flexigrid, Tegaderm) Dressings impregnated with honey (ApiNate Dressing) Topical antiseptics (see Wound Care for detailed information) Honey, trypsin, St John’s wort, zinc cream, vitamin A cream, calendula ointment Hydrocolloid dressings keep the blister moist, easing pain and protecting from further damage and infection. Dressing strips protect the injured area. Dry, non-stick pads absorb any discharging fluid without sticking to skin. Blister prevention dressings either cushion an area prone to rubbing or prevent friction. Normal saline (sodium chloride 0.9% solution), tap water, or a low-toxicity antiseptic solution may be used to clean wounds. Dressing strips protect an injured area. Wound closures keep wound edges together to help healing and reduce scarring – the strips are hypoallergenic. Island dressings are self-adhesive and have a non-stick wound pad. Film dressings are made of a clear waterproof film which is applied and left on until the dressing falls off, leaving the wound moist and undisturbed. Waterproof and bacteria-proof island and film dressings are also available. Topical antiseptics reduce the risk of infection. Lignocaine, a local anaesthetic, helps reduce pain. Honey improves skin healing and reduces odours, exudate, pain and risk of infection. Topical trypsin cleanses necrotic wounds and enhances healing. Ointment containing St John’s wort has been shown to improve wound healing and reduce scar formation. Other natural ingredients may also help healing. Because the good stuff can also be the rough stuff Also available in a 25g pack Page 48 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION • Apply a topical antiseptic to the area before covering minor abrasions with a sterile dressing strip or non-stick wound pad. »» Cover more extensive abrasions with island or film dressings to keep the area moist and undisturbed. Blisters Blisters are fluid-filled sacs which form when the skin has been damaged (either by friction, rubbing, poor-fitting shoes, heat, cold or chemical exposure), if the skin is crushed or pinched (eg, blood blister) or as a result of a medical condition (eg, chickenpox). • Most blisters heal themselves after three to seven days. • There is controversy over whether blisters should be popped and drained; however, most experts agree that small blisters are best left intact if possible. »» The blister fluid protects the delicate skin underneath, promoting healing. »» The roof of the blister provides a natural barrier to bacteria and protects against infection. »» Hydrocolloid plasters are good at relieving blister pain. »» If pain persists, a clean, sharp needle sterilised over an open flame or with boiling water may be used to carefully prick the blister near its edge. Press the blister carefully to allow the fluid to drain but leave the overlying skin intact. Hydrocolloid dressings offer the best healing and protection. »» If the blister is already broken, clean with warm water and allow to dry. »» Apply the hydrocolloid dressing. This will cushion the damaged skin, prevent further damage, aid healing and prevent infection. Leave the dressing on until it falls off by itself. »» If hydrocolloid plasters are not available, a dressing strip (plaster) or dry non-stick wound pad may be used to protect the area from further damage. • People with diabetes or poor circulation are at a higher risk of infection from even minor foot wounds and should be referred to a doctor. Advice for customers Cuts and abrasions • Use tap water or a saline solution to clean the wound. Apply a topical antiseptic. Seek medical advice if the wound is extensive or difficult to clean. • Watch for signs of infection (eg, redness spreading out from the wound or yellow drainage from the area) and seek medical advice if this occurs. • Do not pick scabs off as the wound heals – this can cause scarring. Keep scabs moist with film dressings. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment or a caregiver's history may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, immunosuppression, diabetes)? • Is there severe bleeding? • Is the wound extensive, deep or dirty? • Are there any foreign objects embedded in the cut, or unable to be removed easily? • Does the customer have fever or flu-like symptoms? • Is the affected area very red and angry-looking, really painful or is pus present? • Has the person had a tetanus vaccination in the past five years? • Is the person elderly or very young? • Does the customer have any known allergies to any topical agents, eg, iodine? »» Do not wear untested socks on a long walk and never wear unwashed socks. Follow the manufacturer’s instructions for laundering. »» Consider applying moleskin, hydrocolloid plasters or other types of protective plasters to specific areas prone to rubbing prior to long walks. Blisters • Watch for signs of infection (eg, redness spreading out from the wound or yellow drainage from the area) and seek medical advice if this occurs. • Wear proper fitting shoes to avoid blisters on the feet. »» Ensure the heel does not slip during walking. »» Select socks that fit the foot without being too tight or too loose and choose ones made of soft wicking fabric. Make Crystaderm the first choice for first aid No known bacterial resistance 1 Effectively treats mild to moderate acne Prevents infection in cuts and scrapes, school sores (impetigo), body piercings, insect bites and burns Reference: 1. Lipsky, B. A., and Hoey, C., Topical Antimicrobial Therapy for Treating Chronic Wounds, 2009, 49:1541-1549. Crystaderm® First Aid Cream (Hydrogen Peroxide 1% w/w, 10g, 15g and 25g) is a General Sale Medicine for the treatment and prevention of minor skin infections such as acne, cuts, scrapes, burns or school sores. AFT Pharmaceuticals, Auckland. TAPS 1733HA. Page 49

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