Acute wounds

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

The healing process and speed of recovery from such wounds are usually predictable. As long as the wound is properly cared for and there is a conducive environment for healing and avoiding infection, the recovery process can be accelerated and the chances of scar hyperplasia can be reduced.

Symptoms

When an acute wound occurs, the patient will experience pain, swelling or bleeding. At this stage, 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 recommended by medical healthcare professionals to avoid infection. If the wound becomes red, swollen, or has an abnormal odor, it should be diagnosed immediately.

Treatment

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

• Control bleeding

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

• Debridement

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

• Use a dressing or close the wound

  Some wounds require a professional skin adhesive, sterile tape or suture to close the edges. With other wounds, a dressing can be applied 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.

• Antibiotics and other drugs

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

Common Acute Wounds

• Surgical wound

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

• Trauma or tear wound

  A traumatic wound is a sudden, unplanned injury to the skin and can range from minor to severe.
  The types of acute wounds include those caused by surgery, trauma, or burns:

  • Bruises: skin rubs against a rough surface and causes a wound (for example, scraping against asphalt).

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

  • Skin tears: skin is hit hard by an object resulting in a jagged wound.

  • Cut injury: skin is scratched by a sharp blade causing a surface incision.

• Burns

  Burn wounds caused by heat, chemicals, radiation, or electric current cause damage to the skin. Statistics in the United States suggest that three to four thousand people die every year due to burns.

  • Cause of burn

    • Flame

      Direct contact with an external source of ignition, such as a gas explosion, fire, boiler explosion, etc.

    • Hydrothermal/heat source

      Direct contact with an external heat source, such as hot water, hot soup, car radiator, locomotive exhaust pipe, etc.

    • Chemical

      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 (for example, due to high voltage electricity or lightning strike). Electric burns are usually severe emergencies and while visible damage may not be obvious, internal organs, muscles and nerves are likely already damaged.

  • 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; even if the wound heals, it will leave scars.

    • 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 affect the epidermis and the dermis. The characteristics are red or mottled skin. Skin functions, sweat glands, hair follicles, etc. may be impaired and may require skin grafting. Healing requires more than 3 weeks and noticeable scarring will remain.

    • 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
      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.

  • Symptoms of burns

    • Severe burns can cause cell necrosis or even death. When the skin is damaged, the body has less protection from its outermost layer and is easily invaded by external bacteria, increasing the risk of infection.

    • When 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 excessive, it could be susceptible to complications.

    • In addition, patients over 60 years old or with inhalation bruises are at higher risk.

  • Treatment of burns

    • Infusion therapy

      A large area of burn will increase the permeability of blood vessels, while a large amount of exudate and a reduction in blood volume of effective circulation may cause "burning and scalding." Large amounts 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, which tends to increase the chances of bacterial invasion. 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- or third-degree burn will require more than 3 weeks to heal, which may leave a hypertrophic scar. To shorten the wound healing time and reduce scarring, debridement surgery may be needed.

Acute Wound Dressing Application

• Pay attention to the meaning and purpose of dressing change

  Wound healing is optimal when an appropriate dressing is used and the frequency of changing dressings is managed to reduce the risks of infection.

• Pay attention to wound comfort

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

• Observe the wound frequently and replace the dressing properly

  Each time the dressing is changed, it is important to observe changes to the wound, such as its color and the presence/absence of purulent or odorous exudate. The frequency of changing the dressing should be appropriately managed — too-frequent changes will damage the granulation tissue on the wound and affect its growth.