Applying First Aid Care – HLTAID004, HLTAID003, HLTAID001
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Scratches, grazes, bumps, bruises, burns, cuts, bites … our skin cops a battering on an almost daily basis, yet most of the time we hardly think anything of it.
For many of us, wound treatment simply involves washing off the dirt or blood, sticking on a plaster, going about our business and leaving our skin to do the rest.
This is often fine; skin is generally pretty good at fixing itself. But sometimes wounds can linger, stubbornly, for weeks, then months, and even years.
The truth is that while medicine has come a long way in the past few centuries, wound care has been left behind a bit, according to wound expert Allison Cowin, from the University of South Australia.
“We’ve been trying to treat wounds from the beginning of time and there have been many different types of things done to them with maggots and honey,” Professor Cowin said.
This is partly because the process of wound healing remains something of a medical mystery, involving many different cells and bodily processes that science is still trying to understand.
“So we just slap a dressing on it, slap a band-aid on, and really all we’re doing is trying to let the body heal itself,” Professor Cowin said.
When to get help
But often we neglect proper wound care. We leave wounds to fester in the hope they’ll eventually be OK, and we rarely seek medical attention even for a persistent wound.
This is an issue especially for the elderly, with Professor Cowin citing data suggesting as many as one in four people in residential aged care have a chronic, non-healing wound.
One of the big questions about wounds is when to seek medical help. Wound specialist Sue Templeton says there isn’t a hard and fast rule, but suggests that if a wound scares you, get a professional to take a look.
“If you look at that and go, ‘Oh my goodness’, then you should consider seeing a GP at the least,” says Ms Templeton, a nurse practitioner with the Royal District Nursing Service in South Australia.
Other red flags might be if the wound is still bleeding after 5 to 10 minutes, or if the laceration or puncture is so deep you can’t see the bottom of it.
With burns, the advice from St John’s NSW is to see a doctor if the burn is deep or if it’s larger than a 20 cent piece, if it involves the airway, face, hands or genitals, or if you’re unsure how severe the burn is.
Wound consultant Wendy White suggests the location and size of wounds are also key factors to consider.
“An abraded [or skinned] knee is very different to the same injury type but affecting, for example, half of your back,” she says.
“In fact, that’s very similar to losing skin from a large burn — there’s going to be a lot more fluid to deal with, and pain and discomfort, and larger wounds take longer to heal and increase the risk of infection.”
Just won’t heal
Another major warning sign that things aren’t going as they should be, is how long a wound has been lingering.
The first four weeks after an injury are what Ms White calls ‘the Golden Four Weeks’, during which the body should proceed through the normal process of healing.
If a wound hasn’t healed or improved by the end of that period, then there is an increased risk of chronic wound developing.
“There’s a transition period after these initial weeks where, by six weeks, if the wound remains open it becomes a different animal,” Ms White says.
“It becomes a bit trapped; the three words they use in the literature is ‘stagnant’, ‘stunned’ and ‘stalled,’ which interrupts the normal process of wound healing”.
Living with delayed healing, chronic wounds can have many consequences, none of them good.
People often isolate themselves when they have very bad wounds. So this increases their chances of depression, anxiety and stress, which in turn negatively impacts on their immune system, general health and their sense of wellbeing.
By that stage, a chronic wound needs medical help to address not only the wound, but also to explore why it’s not healing in the first place.
Clean and protected
But that is worst-case scenario.
For relatively simple wounds — like a cut earned while chopping tomatoes, a grazed knee from a tumble, or a scrape — the aim is to keep it clean and protected, Ms Templeton said.
Covering it with a sticking plaster, or similar, can help keep a wound clean and protect it from more damage in the first few days; but beware, these get soggy when exposed to water.
If there’s likely to be a lot of dirt in the wound, such as might happen with a graze, it’s best to carefully clean it out before covering.
There are also modern topical antiseptic cleansing and dressing products, which should be used for contaminated wounds to reduce the risk of infection, Ms White said.
But she warns against routine and widespread use of topical antibiotics.
“We know now that the microorganisms in the wound can become resistant very quickly to topical antibiotics,” she said.
Honey and saltwater
As for medicinal honey, Ms Templeton says, this could help for minor wounds. A number of studies have found it can be an effective wound dressing.
But she stresses that you need to buy the right type of honey, because regular store-bought honey could do more harm than good.
“Certainly with the designated proprietary wound honeys, each batch of honey is individually tested to ensure it meets a minimum antiseptic standard, which you might not get from a supermarket brand,” she said.
One common misconception about wound care is that salt water baths or seawater are good for healing.
Ms Templeton said someone with a major wound should actually avoid submersing it in seawater, because there’s a risk of contamination that could make things worse.
“There are a couple of specific bacteria that live in the ocean and certainly they can get into wounds from time to time and cause very nasty infections,” she said, stressing this is most relevant to people with large wounds like ulcers.
She also warns against salt baths, pointing out that this can expose the wound to bacteria from other parts of the body, which increases the risk of contamination.
Biggest misconception
But the biggest misconception about wounds is that all wounds heal.
She says if a wound isn’t improving in the first few weeks after an injury, in the sense of getting smaller, not hurting as much, not seeping as much, not as red or inflamed, then that should be a trigger to get medical help.
“The longer you leave it, you’re going to start to have a problem wound that doesn’t quite know what do to with itself, and the long-term consequences are that once a wound fails to heal in those first 30 days, it becomes increasingly difficult for the person that’s living with it.”
