Acute wounds

Acute wounds

Acute wounds are common types of wounds in daily life and may occur in various parts of the body. These include accidental bruising, such as cuts, lacerations, burns, etc., or surgical suture wounds as well.

The healing process and speed of recovery from such wounds are usually predictable. As long as the wound is properly cared for, avoiding infection and providing a good healing environment, the recovery process can be sped up and the chance of scar hyperplasia can be reduced.

The symptoms of acute wounds

When an acute wound occurs, the patient will experience pain, swelling or bleeding. At this time, the wound should be kept clean. If this is done during homecare after discharge, the dressing should be changed according to the time and frequency which is recommended by medical healthcare professions to avoid infection. If the wound becomes red, swollen, or has an abnormal odor, it should be diagnosed immediately.

The treatment of acute wounds

The appropriate nursing method is determined by the location and severity of the wound.

1. Control bleeding
If there is a large amount of bleeding in the wound, quickly confirm the bleeding position and apply pressure until the bleeding stops.

2. Debridement
If the wound is not clean, the debris, dust and necrotic tissue should be removed from the wound to prevent infections.

3. Use a dressing or close the wound
Some wounds require a professional skin adhesive, sterile tape or suture to close the edges, and some wounds can apply the dressing on the wound. This depends on the location and severity of the wound, as well as the professional judgment of the healthcare professional. The appropriate nursing method is determined by the location and severity of the wound.

 4. Antibiotics and other drugs
In some cases, for typical wound infections, such as wounds contaminated with debris, medical healthcare professions will use antibiotics to control infections or use drugs directly to treat pain and swelling, such as tetanus.

 

Common acute wounds

1.Surgical wounds

  Surgical wounds are skin incisions which are made by medical professionals for therapeutic purposes usually formed in an operating room or    sterile environment with clean wounds and neat edges.
  Healing conditions are better than other types of wounds. For example: caesarean section wounds.

2.Trauma or tear wound

  A traumatic wound is a sudden, unplanned injury to the skin and can range from minor to severe.

 Types of acute wounds include those caused by surgery, trauma, and burns.
 (1) Wiping bruises:The skin rubs against a rough surface and causes 
a wound, for example: scraping against asphalt

 (2)Lacerations:The skin is pricked by a sharp object, for example:  stepping on a nail

 (3) Skin tears:The skin is hit hard by an object resulting in a jagged  wound

 (4) Cut injury:The skin is scratched by a sharp blade causing a surface incision

3.  Burns 

Burn wounds caused by heat, chemicals, radiation or electric current cause damage to the skin. According to statistics, three to four thousand people die because of burns in the United States each year.

(1)   Causes of burns
• Flame burns:
  Direct contact with external sources of ignition, such as gas explosions, fires, boiler explosions, etc.

• Hydrothermal/heat source burns:
  Direct contact with external heat sources, such as: hot water, hot soup, car radiators, locomotive exhaust pipes, etc.

• Chemical burns
  Direct contact with chemicals such as strong acids, strong bases, ammonia, etc.

• Electric shock
  A large amount of current passes through the body, causing muscle necrosis, causes include: high voltage electricity and lightning strikes.    Electric burns  are usually severe emergencies and while visible damage may not be obvious, internal 
organs have already been damaged, such as muscles and nerves.

(2) Depth of burn
Burns are divided into four levels according to the "depth" of skin damage. Burns above the "deep second degree" cause damage to the dermis and even if the wound heals it will leave scars.

[First-degree burns]

·           First-degree burns are considered mild compared to other burns. They result in pain and reddening of the epidermis. They usually recover quickly, within a week, without scarring.

[Second-degree burns]

·            Second-degree burns affect the epidermis and the dermis. The characteristics are red or mottled skin. Skin function may be impaired, like sweat glands, hair follicles, etc., and may require skin grafting. Healing requires more than three weeks and noticeable scarring will remain.

[Third-degree burns]

Third-degree burns (full thickness burns) go through the dermis and affect deeper tissues. They result in white or blackened, charred skin that may be numb.

They injure the subcutaneous tissue or deeper, leaving the dermis necrotic. The wound cannot heal itself. It will leave a thick scar, resulting in functional barriers, debridement and skin.

[Fourth-degree burns ]

Fourth-degree burns 

In addition to full-thickness skin, these burns go deeper to the muscle or bone layer, and the skin is coke-like, requiring multiple debridement and skin graft or flap reconstruction. Sometimes these burns require amputation.

 (3) Symptoms of burns
    - Severe burns can cause cell necrosis or even death. When the skin is damaged, the body has less protection from the outermost layer                
and  is easily invaded by bacteria in the external environment, increasing the risk of infection.

    - When the blood vessels are destroyed, inflammation and swelling occur in the burned area and excessive exudate will cause edema.
    - Burns can also cause dehydration, resulting in reduced blood volume and, if the affected area is too large, it will even be susceptible to

      complications.
- In addition, patients are at higher risk if they have any of the following conditions: over 60 years old or inhalation bruises.

(4) Treatment of burns

    - Infusion therapy
      A large area of burns will increase the permeability of blood vessels, and a large amount of exudate and a decrease in blood volume                   of 
effective circulation may   cause "burning and scalding." A large amount of water and electrolytes are needed as replenishment at

      this time. If there are symptoms of low blood volume, an   urgent blood transfusion is needed.

   - Initial treatment

     The skin loses its original protective function and this tends to increase the chance of bacterial invasion. Medical healthcare professionals

     will use the appropriate dressing to wrap the wound according to its depth. If the wound is in the extremities, the brachial artery and the           finger artery cannot receive blood flow and an immediate "eschar incision" will reduce the pressure.

   -Surgical treatment
    A deep second and third degree burn will require more than three weeks to heal, which may leave a hypertrophic scar. In order to 

    shorten the wound healing time and reduce scarring, debridement surgery is needed, or it is necessary to take the disease. Skin grafting is

    performed on skin that is self-healthy.

Acute wound dressing application

1. Pay attention to the meaning and purpose of dressing change:

   Choosing proper dressing, change dressing properly and its frequency can reduce infection and is an important condition to ensure wound 

   healing.

2. Pay attention to wound comfort

   Maintaining proper moistness of the wound helps to shorten wound healing time.

3. Observe the wound frequently and replace the dressing properly

    Each time the dressing is changed, changes to the wound, such as the color, and the presence or absence of purulent or odorous exudate, 

    should be carefully observed. The frequency of changing the dressing should be appropriate. Changing the dressing too frequently will 

     damage the granulation tissue on the wound and affect its growth.

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