Management of Incised Wounds

What is an incised wound?
(Austin and Crawford et al., 2009, pp. 108-109) Describes an incised wound as a clean cut by a sharp edged object,  usually caused by a bladed instrument. These wounds are particularly susceptible in cutting across nerves and blood vessels casing nerve damage and bleeding profusely.

Management of the wound.
Due to the possibility of profuse bleeding from a severed blood vessel, as a first responder we need to act quickly.

Stop the bleeding.

1. PPE to be warn upon arrival to the casualty.
2. Apply sterile gauze on the wound, this is to help stem the blood flow. If blood soaks through, apply a second layer. 
3. If the wound is on a limb, rise the wound above the heart to allow gravity to slow the flow of blood to the wound.
4. Alternately if the above method of slowing the blood doesn't work, you can apply pressure to the femoral or brachial artery to slow the blood flow. As a last resort a tourniquet can also be applied above the wound.

Clean and dress the wound.
Once the bleeding has stopped, it is necessary to clean and dress the wound to promote healing and remove the chance of infection.

1. To clean the wound, rinse it out with sterile water. This will remove dirt.
2. Using a medical cleaning wipe, clean over the wound to remove any germs or bacteria surrounding the wound.
3. Cover the wound with fresh gauze and apply a bandage.

Advice for the casualty. 

Here, some gentle advice can be given for promoting recovery . Change the dressing daily and look for signs of infection (Redness, tenderness, and pus). If the wounds does not seem to be healing correctly, or even healing at all, then it would be advisable to consult a GP.(ehow, 1999)

Seizures

Seizures are caused by abnormal electrical activity in the brain which can happen suddenly (Nlm.nih.gov, 2013), or contain warning signs in the form or an Aura. Although unpleasant, this gives the patient time to prepare themselves for an imminent seizure (Epilepsy.com, 2010). If this happens, best practice would be to get the patient on to the floor before the seizure (during the aura) to remove any risk of further injury by falling. There are many different types of seizures with many different characteristics, however are commonly separated into muscular contractions and absence.

Seizures commonly have a burn time of between 30 seconds and 2 minutes, (Webmd.com, 2000), depending on the type of seizure. If however, the seizure lasts for a period of more than 5 minutes, or the patient has many smaller seizures without becoming concious, then this is considered a medical emergency (Nlm.nih.gov, 2013). If however the patient has no reason for the start of the seizure (no diagnosis, or this is their first seizure) this is also to be considered a medical emergency and an ambulance is to be called (www.sja.org.uk, 2012).

Here are a few simple steps into caring for those during a seizure.

Muscular

1. Make the area safe, remove any objects such as furniture.
2. Note the time the seizure has started.
3. Support the head with a towel, jacket or pillow. Do not restrain the head.
4. Allow the seizure to finish.
5. Place in the recovery position and maintain the airway.
6. Note duration of the seizure, if longer the 5 minutes, call 999 for emergency assistance.
7. Be calm and reassuring to the patient through out.

Absense

1. Guide the person from any danger and remove anything that could cause harm eg: a hot drink.
2. Be calm and reassuring with the patient.
3. Explain to them anything them may have missed.

A small insight into the causes of a pulmonary embolism

A pulmonary embolism (PE) is a potentially life threatening condition, caused by a blockage in the pulmonary artery in the lungs (NHS Choices, 2011). Symptoms of a PE come in different forms such as coughing, feeling faint breathlessness and chest pains (NHS Choices, 2011), however it may not contain any symptoms in which case may be very hard to detect (Patient.co.uk, 2012).

Normally the clot that causes PE does not originate in the lungs, but is most likely from a clot caused by deep vain thrombosis (DVT), that has broken off and traveled through the body and became lodged within the pulmonary artery (Nhlbi.nih.gov, 2011).

The symptoms of a PE may differ depending on the size of the embolism in question. Coughing up blood, breathlessness and chest pains are all common, however a large embolism my cause shock and sudden collapse. In some cases, small embolisms may not produce any symptoms (Bupa.co.uk, 2012).