The Rossendale Rambler

Wounds to the skin and/or the underlying soft tissue may be of two main types:

1. Open where there is a break in the skin or mucous membrane, which allows blood to escape and infective organisms to enter.

2. Closed where there is bleeding under the skin, which in time becomes apparent as bruising. Though blood is not spilt it is still lost to the circulation. It is internal bleeding.

Types of Wounds

1 Incised - A clean cut from a sharp knife or broken glass, bloodvessels are cut straight across, so there may be profuse bleeding, and there may be damage to, even severing of, underlying structures such as tendons.

2 Abrasion - This is a superficial wound in which top layers (graze) of the skin are scraped off, leaving a raw tender area. This type of wound is often caused by a sliding fall or a friction therefore is often in danger of infection from contamination.

3 Laceration - An open jagged wound such as would be caused by a sharp edge such as a tin can. The skin and underlying tissue is torn and there is often a high risk of infection.

4 Contusion - A blunt blow or punch can rupture capillaries beneath (Bruise) the skin. Skin may split, severe bruising may indicate deeper damage, fracture or internal injury.

5 Puncture Wound - These are usually small wounds but are a most worrying type as germs and dirt can be carried far into the body. The infection risk is high. This type of wound is usually caused by standing on a nail or being stabbed.

6. Gun Shot Wound - A bullet or other missile may drive into or through the body causing serious internal injury.

Haemorrhage (Escape of blood from blood vessels)

The cells of the body are supplied with oxygen and nutrients via the blood stream. Thus the blood must be kept circulating in order to maintain that supply. The blood pressure is the "force" which maintains the circulation of blood.

Types of bleeding

These are the three types:

Arterial - Arterial blood is bright red in colour and spurts from the wound in time with the pulse.
Venous - Venous blood is dark red, because it is less oxygenated.
Capillary - Capillaries blood oozes from the wounds in minor cuts and abrasions.
Haemorrhages may be classified as external or internal.

Once an assessment of the casualty has been made, priority must be given to arresting major haemorrhage. It may not be possible to stop the bleeding completely, but the time gained may keep the casualty alive long enough for him to reach expert help.

External Haemorrhage

Apply direct pressure (if no foreign bodies are present) over the wound with the hand or squeeze the edges if it is a cut. Preferably sterile dressing should be applied, or if unavailable, use a handkerchief which has been ironed, placing the inside over the wound, and padding over it to minimise the risk of infection. Always but always reassure the injured. If the wound is manageable and there are foreign bodies present which can easily be removed, do so. If the wound is dirty, clean it by rinsing lightly under running water, or use an antiseptic wipe. If any foreign bodies are deeply embedded, leave them alone. DO NOT remove knife blades, pieces of wood, metal or any such foreign body. Make a ring pad and place over the protruding object and bandage over the ring. Do not use a tourniquet unless you are trained to do so. Do not cover the wound in such a way that bleeding can not be seen easily.

Internal Haemorrhage

Any shocked person who has suffered an injury must be assumed to have internal bleeding until proven otherwise. Lay the patient down and elevate the legs if possible, loosen clothing, cover with blanket, summon urgent expert help. Dial 999. Never give a patient with major injuries anything by mouth.

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