Additional Wound Care

Additional Wound Care

Injuries such as open chest wounds (commonly referred to as sucking chest wounds), abdominal wounds, and impaled objects require specific care. The ability to properly apply dressings and bandages to these wounds is critical.

Open Chest Wounds: Signs and Symptoms

Bullets, knife blades, shrapnel, or other penetrating objects can cause an open chest wound.

If you are not sure the wound penetrated the chest wall completely, treat the wound as though it were an open chest wound.

Signs and Symptoms Include:

-Sucking or hissing sounds coming from a chest wound

-Frothy blood appearing from air bubbles coming from the wound

-Shortness of breath or other difficulty breathing

-Coughing up blood

-Possible bluish, ashen, or gray tint of lips or fingertips

-Signs and symptoms of shock (they are losing blood)

Open Chest Wounds: Seal and Dress

You must seal an open chest wound to stop air from entering the chest cavity and collapsing the lung. A dressing alone is insufficient. The following s outline the management of an open chest wound.

1: Evaluate the casualty. Check for both entry and exit wounds. Use your hands to check the casualty’s back for bleeding and wounds.

2: Wipe off excess blood or sweat being careful not to remove clothing stuck to the wound

WARNING: The edges of the sealing material should extend at least 2 inches beyond the edge of the wound. If the edges do not extend 2 inches or more beyond the wound, then the material may be sucked into the wound. If the dressing appears to be pushed out of bulging, lift one corner of the seal to ‘burp’ or relieve the pressure and then reseal.

3: If you have the IFAK, place the wrapper from the emergency bandage over the wound, holding it firmly in place.

4: Tape down all four sides of the sealing material. If the sealing material cannot be taped down, maintain pressure on the dressing so that the sealant will not slip.

5: Use the emergency bandage to secure the sealing material. The dressing must be tight enough to ensure the sealing material will not slip.

6: Allow the casualty to assume a position of comfort, which is normally on their injured side. Treat for shock. Continue to monitor. Annotate care provided on the Casualty Card. The casualty is now ready for transport unless further medical assessment is required.

WARNING: If an object is protruding from the chest wound, DO NOT remove it. Stabilize the object, and seal the wound.

Wounds with Impaled Objects

1: Evaluate the casualty. Use your hands to check the casualty for BOTH entry and exit wounds. Expose the wound by removing, tearing, or cutting the clothing.

2: ONLY remove the object if the impaled object is obstructing the casualty’s airway. Otherwise leave the impaled object in place since the object will help control bleeding.

3: Using the gauze from the IFAK, secure the impaled object at BOTH the entrance and exit sites of the wound. Doing this will prevent the impaled object from moving and causing further damage.

4: Using the emergency bandage from the IFAK, cover the gauze securely. Wrap the emergency bandage around the impaled object. Leave the impaled object exposed to ensure it’s easily seen by medical personnel.

5: Allow the casualty to assume a position of comfort and treat for shock. Continue to Monitor. Annotate care provided on the Casualty Card. The casualty is now ready for transport unless further medical assessment is required.

Abdominal Wounds

Deep abdominal wounds can be caused by penetrating objects such as bullets, knives, or shrapnel from an explosion. Sometimes a deep abdominal wound can cause the intestine or other internal organs to protrude from the wound.

Dressing Abdominal Wounds

1: Evaluate the casualty. Use your hands to check the casualty for both entry and exit wounds. Expose the wound by removing, tearing, or cutting the clothing.

2: IMMEDIATELY position the casualty on the back with knees up (flesed). This position helps prevent further exposure of the abdominal organs, relaxes the abdominal muscles, decreases pain, and controls shock.

3: If the intestines or organs are lying on the ground, pick them up with a clean, DRY dressing and place them on top of the casualty’s abdomen near the wound.

DO NOT use your bare hands to pick up the organs or intestines

DO NOT probe, clean, or remove foreign objects from the abdominal wound

DO NOT place the intestines or organs back into the abdominal cavity. Doing this may cause further injury and infection.

4: Cover the exposed intestine or organs with a clean, MOIST dressing. Using the emergency or compression bandage from the IFAK, cover the wound and secure the bandage loosely. Ensure you tie the tails of the bandage in a nonslip knot on the outer edge of the dressing. DO NOT tie the knot directly over the wound. 

5: Allow the casualty to assume a position of comfort, which is normally with the casualty on their back with their knees up (flexed). Treat for shock. Annotate care provided on the Casualty Card. The casualty is now ready for transport unless further medical assessment is required.

WARNING: NEVER place the intestines or organs back into the abdominal cavity, and DO NOT tie the bandage knots directly over the wound. These actions can cause further injury or infection to the casualty.

Bandaging Eye Wounds

Eye injuries commonly occur after exposure to projectiles, lacerations, facial bone fractures, explosions or falls. They are easy to overlook because of darkness, blood, debris, etc… Treatment at the point of injury is paramount. 

1: If eye injury is noted or suspected, apply a rigid eye shield over the injured eye ONLY (not a pressure patch) and secure it with tape/bandage wrap to prevent further injury. If a rigid eye shield is not available, any eyewear can be used as an alternative (sunglasses).

2: For impaled objects, apply dressing around the object and secure it in place. DO NOT remove the object from the eye.

3: If the eye is out of the socket, protect the eye and the socket with a styrofoam cup or another object of similar nature. NEVER place the eye back into the socket since this may cause further injury and infection.

4: Allow the casualty to assume a position of comfort and treat for shock. Annotate care provided on the Casualty Card. The casualty is now ready for transport unless further medical assessment is required.