Traumatic wounds include abrasions, lacerations, puncture wounds, and amputations. In an abrasion, the skin is scraped, with partial loss of the skin surface. In a laceration, the skin is torn, causing jagged, irregular edges; the severity of a laceration depends on its size, depth, and location. A puncture wound occurs when a pointed object, such as a knife or glass fragment, penetrates the skin. Traumatic amputation refers to the removal of part of the body, a limb, or part of a limb.
When caring for a patient with a traumatic wound, first assess his ABCs—airway, breathing, and circulation. It may seem natural to focus on a gruesome injury, but a patent airway and pumping heart take first priority. Once the patient's ABCs are stabilized, you can turn your attention to the traumatic wound. Initial management concentrates on controlling bleeding, usually by applying firm, direct pressure and elevating the extremity. If bleeding continues, you may need to compress a pressure point. Assess the condition of the wound. Management and cleaning technique usually depend on the specific type of wound and degree of contamination.

Equipment
Sterile basin • normal saline solution • sterile 4″ × 4″ gauze pads • sterile gloves • clean gloves • sterile cotton-tipped applicators • dry sterile dressing, nonadherent pad, or petroleum gauze • linen-saver pad • optional: scissors, towel, goggles, mask, gown, 50-ml catheter-tip syringe, surgical scrub brush, antibacterial ointment, porous tape, sterile forceps, sutures and suture set, hydrogen peroxide.
Preparation of equipment
Place a linen-saver pad under the area to be cleaned. Remove any clothing covering the wound. If necessary, cut hair around the wound with scissors to promote cleaning and treatment.
Assemble needed equipment at the patient's bedside. Fill a sterile basin with normal saline solution. Make sure the treatment area has enough light to allow close observation of the wound. Depending on the nature and location of the wound, wear sterile or clean gloves to avoid spreading infection.

Implementation
  • Check the patient's medical history for previous tetanus immunization and, if needed and ordered, arrange for immunization.
  • Administer pain medication, if ordered.
  • Wash your hands.
  • Use appropriate protective equipment, such as a gown, a mask, and goggles, if spraying or splashing of body fluids is possible.
For an abrasion
  • Flush the scraped skin with normal saline solution.
  • Remove dirt or gravel with a sterile 4″ × 4″ gauze pad moistened with normal saline solution. Rub in the opposite direction from which the dirt or gravel became embedded.
  • If the wound is extremely dirty, you may use a surgical brush to scrub it.
  • With a small wound, allow it to dry and form a scab. With a larger wound, you may need to cover it with a nonadherent pad or petroleum gauze and a light dressing. Apply antibacterial ointment if ordered.
For a laceration
  • Moisten a sterile 4″ × 4″ gauze pad with normal saline solution. Clean the wound gently, working outward from its center to about 2″ (5 cm) beyond its edges. Discard the soiled gauze pad and use a fresh one as necessary. Continue until the wound appears clean.
  • If the wound is dirty, you may irrigate it with a 50-ml catheter-tip syringe and normal saline solution.
  • Assist the physician in suturing the wound edges using the suture kit, or apply sterile strips of porous tape.
  • Apply the prescribed antibacterial ointment to help prevent infection.
  • Apply a dry sterile dressing over the wound to absorb drainage and help prevent bacterial contamination.
For a puncture wound
  • If the wound is minor, allow it to bleed for a few minutes before cleaning it.
  • For a larger puncture wound, you may need to irrigate it before applying a dry dressing.
  • Stabilize any embedded foreign object until the physician can remove it. After he removes the object and bleeding is stabilized, clean the wound as you'd clean a laceration or deep puncture wound.
For an amputation
  • Apply a gauze pad moistened with normal saline solution to the amputation site. Elevate the affected part, and immobilize it for surgery.
  • Recover the amputated part, and prepare it for transport to a facility where microvascular surgery is performed.
Special considerations
  • When irrigating a traumatic wound, avoid using more than 8 psi of pressure. High-pressure irrigation can seriously interfere with healing, kill cells, and allow bacteria to infiltrate the tissue.
  • To clean the wound, you may use normal saline or hydrogen peroxide (its foaming action facilitates debris removal). However, peroxide should never be instilled into a deep wound because of the risk of embolism from the evolving gases. Be sure to rinse your hands well after using hydrogen peroxide.
  • Avoid cleaning a traumatic wound with alcohol because alcohol causes pain and tissue dehydration. Also, avoid using antiseptics for wound cleaning because they can impede healing. In addition, never use a cotton ball or cotton-filled gauze pad to clean a wound because cotton fibers left in the wound can cause contamination.
  • After a wound has been cleaned, the physician may want to debride it to remove dead tissue and reduce the risk of infection and scarring. If this is necessary, pack the wound with gauze pads soaked in normal saline solution until debridement.
  • Observe for signs and symptoms of infection, such as warm red skin at the site or purulent discharge. Be aware that infection of a traumatic wound can delay healing, increase scar formation, and trigger systemic infection, such as septicemia.

  • Observe all dressings. If edema is present, adjust the dressing to avoid impairing circulation to the area.
Complications
Cleaning and care of traumatic wounds may temporarily increase the patient's pain. Excessive, vigorous cleaning may further disrupt tissue integrity.

Documentation
Document the date and time of the procedure, wound size and condition, medication administration, specific wound care measures, and patient teaching.