Cut, scrape & wound

(Survival manual/6. Medical/e) Skin)
From<
http://www.find-cures.com/Treating_Wounds.html >

How to treat Minor Cuts
1.  Stop the bleeding
2.  Clean the wound

3.  Home care for scrapes and cuts
4. Options for closing wounds
5.  Prevent infection
6.  Promote healing
7.  Identifying secondary infection
8.  Typical (Secondary) skin infections

1.  Stop the bleeding
The first priority is to stop the wound bleeding. Follow these simple steps:
•  Try to calm and reassure the injured person.
•  Apply firm pressure directly to the wound, ideally using a clean cloth or towel. You can also use a finger if nothing else is available.
•  If the blood seeps through the cloth or towel, add more pressure.
•  Remove pressure when the bleeding stops, usually in five to ten minutes.

 When to seek medical help
You may need to seek medical help to stop the bleeding. You should seek immediate medical attention if:
•  The bleeding does not stop in ten minutes. [I’ve had this happen a couple of times, the cut needed stitching.]
•  You see bright red and spurting blood (this means that an artery has been severed).

 2.  Clean the wound
It’s very important to carefully clean a wound. Proper cleaning removes any foreign material, reduces the risk of secondary infection and minimizes any potential scarring.
To clean the wound:
•  Rinse the wound with clear water. Running tap water can be used.
•  Remove any foreign material in the wound (such as dirt, gravel or glass) by using tweezers if necessary.
•  Ideally, clean the wound with a sterile gauze.
•  Avoid using cotton wool.
•  If the bleeding restarts, apply firm pressure.
•  Most first aid kits include sterile or antiseptic wipes which can be used to clean the wound.

 When to seek medical help
If you are unable to remove all foreign objects, you should seek medical help in thoroughly cleaning the wound.

 3.  Home care for scrapes and cuts
Most scrapes and cuts can be cared for at home.
Scrapes often cover large areas, but they are superficial. When caring for a scrape, make sure to remove any embedded grit or dirt.
Small cuts can be cared for at home if the edges of the cut are close together. Make sure to remove any foreign material from the cut, stop the bleeding and cover the cut with a bandage or dressing.

When to seek medical help
You may need to seek medical attention for a cut or scrape. Call your doctor if:
•  The wound needs sutures. A wound needs sutures if it is deep, if fat protrudes from it, if the wound is over half an inch long or if it is a gaping wound.
•  You are unable to remove dirt, debris or dead tissue.
•  You can’t stop the bleeding.
•  The wound is a puncture.
•  The wound occurs on the face, eyelids, lips, or neck.
•  The edges of the wound are badly torn
•  A tetanus shot is required.
•  You are uncomfortable or unable to deal with the situation.

 4.  Options for closing wounds
There are many ways to close wounds, and the best option will depend on the type and severity of the wound itself.
•  Skinstrips are tape-like strips that hold the skin together. These are appropriate for small cuts that occur on parts of the body where there is very little tension or movement that could pull the wound apart (e.g. torso, thigh).
•  For deeper cuts, sutures (or stitches) are used to sew the edges of the cut together. They are very useful for closing wounds that have occurred on parts of the body where there is a lot of movement (e.g. hands).
•  Steri-strips or butterfly strips are used to close wounds on the face in those instances where stitches may leave a scar. Steri-strips are thin and sticky, and usually fall off after a few days.
•  Skin glue is a special adhesive that sticks together the edges of the wound and seals the skin for protection. Skin glue is not as effective on areas where there is a significant amount of skin movement.

5.  Prevent infection
Once you have stopped the bleeding and cleaned the wound, you will want to prevent infections from developing. The most effective strategy is to apply a topical antibiotic to the wound and cover it with a dressing.

You can help prevent infection by:
•  Applying a topical antibiotic, such as Neobiotic ointment to the wound. Topical antibiotics should be applied with each dressing change, or two to three times a day if the wound is left uncovered.
•  Cover the wound to keep it moist and to protect the topical antibiotic.
Studies show that applying a topical antibiotic can promote healing in 8 days, as opposed to 13 days for wounds left untreated. The use of mercurochrome and tincture of iodine was not as effective. These products resulted in healing over 13 and 15 days respectively. 

6.  Promote healing
You can promote healing and minimize the potential for scarring by covering the wound. Scientific studies show that keeping an injured area moist:
•  promotes the growth of new tissue,
•  lessens the potential for infection,
•  minimizes scarring, and
•  lessens the chance of further injury to the cut or scrape.
Many different sizes and types of wound dressings are available. Dressings should be changed daily or when they become wet or dirty.

Although covering a wound is generally the best choice, there are times when it’s appropriate to leave a wound uncovered. A scrape on a knee or elbow, for example, can often be left to heal uncovered after cleaning and applying a topical antibiotic.

 7.  Identifying secondary infection
You should examine the wound carefully to ensure that secondary infection has not developed. Signs of infection generally emerge a few days after the injury and include:
•  red, swollen or warm skin surrounding the wound
•  discharge and pus from the cut or scrape
•  a red line moving up the limb from the wound
•  fever.
If you suspect secondary infection, seek medical help.

 Staph infections are the most common Bacterial Skin Infections, and can lead to impetigo (see below) elsewhere on the skin. Prescription and over-the-counter topical antibiotics have been shown to be as effective at treating localized infections as oral antibiotics – and they have fewer side effects.

Strep infections are often indicated by a red line (lymphangitis) leading from the wound. Strep infections can also produce cellulitis (see below), which is a tender swollen redness on the skin. Oral antibiotics provide an effective treatment.

8. Typical (Secondary) skin infections
See also, (Survival manual/6. Medical/c)Disease/streptococcal infections)

Cellulitis
Cellulitis is an infection that involves the outer layers of the skin. It is commonly caused by bacteria known as beta-hemolytic streptococcus or Staphylococcus aureus. You may experience pain, swelling, tenderness, warmth, and redness in the infected area. If you have a severe case of cellulitis, you may experience fever, tiredness, and a lowering of blood pressure. If left untreated, pus may form and cells may die in the infected skin area. Cellulitis can involve any part of the body but most often affects the leg. It typically results from an injury to the skin, such as scratches or animal bites—these allow bacteria to enter the body and cause an infection. An additional cause of cellulitis is skin breakdown around the anal area, typically seen in children. This can lead to redness, swelling, and painful bowel movements.

Oral antibiotics are used to treat mild cellulitis; more severe cases must be treated with intravenous antibiotics in a hospital. Antibiotics that may be used include cephalosporins, dicloxacillin, clindamycin, or vancomycin. Swelling can be lessened by elevating the affected area, such as the legs or arms. To stop cellulitis from occurring again, it is important to keep applying lotion to the skin and to maintain good skin cleanliness.

Impetigo
Impetigo is a contagious skin infection commonly caused by Staphylococcus aureus. Although this infection may occur in adults, it is most often seen in children aged 2 to 5 years and is usually spread through direct contact with another person who has the infection. You may experience tenderness, itching, sores, or blisters that can rupture and form honey-colored crusts. It can affect different parts of the body such as the face, arms, or legs. It also can affect moist parts of the body, such as the armpits, neck folds, and diaper areas.

Impetigo can be treated with a topical ointment or oral antibiotic. Mupirocin is a typical ointment that may be prescribed by your doctor. Oral antibiotics such as penicillins or cephalosporins are used for more severe infections. To prevent the spread of the infection to other parts of the body, avoid scratching the blisters or sores. Because impetigo is commonly seen in children, it may be helpful to cut the fingernails and cover the affected areas of the body with bandages or gauze. It also is important to prevent the spread of infection to other individuals in close contact by not sharing things such as blankets, linens, toys, or clothing.

Folliculitis
Folliculitis is a general term used to describe an infection of the hair follicles commonly caused by Staphylococcus aureus, resulting in red pimples. You may experience redness, tenderness, or swelling of the affected area. It also can spread to the deeper parts of the hair follicles and pus can form, also known as furuncles or boils. Carbuncles is a term used to describe a group of infected hair follicles. Folliculitis, furuncles, and carbuncles can be seen on any part of the body with hair, such as the face, scalp, thighs, underarms, and groin area. This includes areas that are bearded or shaved.

Mild folliculitis can be treated with topical antibiotics, such as erythromycin, clindamycin, or mupirocin. More severe infections, such as carbuncles and larger furuncles, may require a surgical cut and drainage of the affected area. After drainage, it is important to clean the area with antibacterial soap; then you should apply the antibiotic ointment to the affected area of the skin. If needed, your doctor may prescribe oral antibiotics such as cephalosporins or dicloxacillin. Keep in mind that your doctor may recommend monthly treatments with mupirocin ointment if you have folliculitis that occurs repeatedly.

General Management of Skin Infections
With antibiotic treatment, signs and symptoms of skin infections begin to improve after approximately 2 to 3 days. If your skin infection does not improve or gets worse (especially if you develop a fever or the infection spreads), notify your doctor right away. If you are prescribed topical or oral antibiotics, be sure to finish the full course of antibiotics unless otherwise directed. Keep in mind that the length of treatment will differ depending on the type and severity of the infection. Lastly, as is true among all skin infections, you should keep the affected area or wound clean with good skin hygiene.

For further information on Cuts and Scrapes see:
Mayo Clinic:  <http://www.mayoclinic.com/health/first-aid-cuts/FA00042>, and
WebMD:  <http://www.webmd.com/allergies/itch-relief-11/cuts-scrapes>

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