Summer Is the Season for Wounds

June 4th, 2012


By , BSN, RN

Even though summer doesn’t officially start until June 20, for most of us, summer starts with Memorial Day. So, we are several days in now and I find myself thinking about injuries and illnesses that are more often seen in those summer months. Bare feet, summer camp, days at the beach, climbing trees, water skiing, and all those other things that come with warm weather have their own kinds of injuries.

Today, we are going to start talking about wounds. Everything from sliding across the asphalt after falling from a skateboard to have a surgical procedure: the disturbance to the skin is considered a wound.

The skin is the body’s largest organ, composing one-sixth of the total body organisms. It is a sensory organ for pain, temperature, and touch. Injury to the skin poses risks to safety and can trigger complex healing responses.

A wound, whether intentional or not, is a disruption to the normal anatomical structure and function of the skin. It is very important to understand that all wounds are not created equal and understanding the type of wound the victim has sustained is integral to providing appropriate care.

Open and Closed Wounds

Wounds are frequently described according to how they are acquired or by the object that caused them. The first two types we are going to look at are open and closed wounds.

An open wound is one involving a break in the skin or mucous membranes. It is, by the nature of being “open” caused by trauma whether intentional such as having surgery or a venipuncture or unintentionally such as being shot. Open wounds are classified by type, as follows:

  • Abrasion – This is a surface scrape. It is wound often resulting from falling (skinned knees and elbows), sliding into third without proper clothing or that previously mentioned skateboard debacle. These are painful wounds due to the exposure of superficial nerves. Deeper tissues are not involved but there is a risk for infection from exposure to contaminated surfaces, such as the street or other outdoor objects.
  • Laceration – These go deeper than just the surface. Tissues are torn apart, often from accidents involving items such as broken glass, tools, or knife wounds (yes, when you cut yourself in the kitchen that is a laceration). The wound is usually created by a contaminated object. The edges are often jagged and the depth of the wound determines other complications.
  • Puncture – Penetration of the skin, and often the underlying tissues by a sharp instrument defines this type of wound. Stepping on a nail is an unintentional variety of this class of injury, having your blood drawn with a needle is an intentional puncture. Depending on the source the chances for infection vary.
  • Penetrating – This is a wound which involves breaks in the epidermal skin layer, as well as dermis and deeper tissues and organs. They are usually accidental and if they aren’t there may be a crime involved. Most obvious examples that come to mind involve a stabbing or shooting incident. There is a high risk for infection because the foreign object is likely contaminated. The wound may cause internal and external hemorrhage and damage to organs can cause temporary or permanent loss of function.
  • Incision – These are open wounds caused by a clean, sharp-edged object such as a knife, razor, or scalpel. They can be intentional, as in having surgery, or accidental. They are usually painful

Closed wounds involve no break in the skin. They occur when part of the body is struck by a blunt object; or when there is twisting, straining, or deceleration force against the body. Closed wounds may predispose the victim to internal hemorrhage and function of the injured body part is reduced. There are several types of closed wounds:

  • Contusion – In many cases this is a fancy name for a bruise. It is caused by a blow from a blunt object. The result is bleeding in underlying tissues. This type of wound can be more severe if an internal organ is contused, like often happens in car accidents. The wound may cause temporary loss of function of the body part.
  • Hematoma – This is a bigger version of a contusion where there is damage to a blood vessel due to some kind of blow that in turn causes blood to collect under the skin. It appears as a swelling, change in color, sensation, or warmth or mass that often takes on a bluish discoloration. A hematoma near a major artery or vein is dangerous because pressure from the expanding injury may obstruct blood flow.
  • Crush Injury – This type of injury occurs when a body part is subjected to a high degree of force or pressure, usually after being squeezed between two heavy objects. An example is hitting your finger with a hammer or closing it in a car door. These usually require emergency department evaluation, and surgery may be needed to fully correct and treat the problem. These injuries are always painful and can have sever complications such as fractures or compartment syndrome (increased pressure in an arm or leg that causes serious muscle, nerve, blood vessel, and tissue damage)

The body is remarkably protected from trauma by the skin, subcutaneous, and adipose tissue (that would be the use of fat). However, intentional or not, wounds still happen. A major component of nursing is tending to those wounds. To manage them effectively the nurse must understand the different types, their potential for pain, and their potential for infection. The scrape may only require a bandage or it may include a trip to the operating room.

Now I realize these kinds of injuries can occur year round. It just seems there are more scrapes, bumps, bruises, cuts, and every other kind of mishap in the fun-loving summer months. Tomorrow, we’ll take a look at how those wounds heal.

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