But some incised wounds instead of being immediately dressed and bound up, demand that immediate attention should be paid to the hemorrhage. We may usually know whether the bleeding is arterial, venous or capillary. If the wound is open, blood from an artery will spurt out in jets and is of a bright red color. Unless the artery is very small a surgeon will be needed, but you may be required to act very promptly to suppress for a time a dangerous flow of blood. If a large artery is cut or punctured the hemorrhage may be fatal in a short time. The application of heat or cold, and the elevation of the part injured, may suffice in slight cases, but in these severe cases other means are necessary.
First endeavor to arrest the rapid flow of blood by pressure upon the wounded artery with your thumb. Then if the wound is in a limb let some one tie a handkerchief loosely around the limb, and if you know the course of the artery have the knot directly over it and between the heart and the wound. Then put a stick in under and twist the handkerchief so that it is tight enough to compress the artery. The hemorrhage can thus be checked until the surgeon arrives. If the wound is over a bone in the head or body, the bleeding may probably be checked by binding on a hard compress where the artery is cut, thus making direct pressure upon it. A ligature upon a limb ought not to remain very tight more than an hour.
If the hemorrhage is from a leg below the knee it may be checked by putting a firm roll of cotton in the flexed joint, and pressing the lower part of the leg against the thigh; this will compress the artery.
Contused wounds are not often attended with serious hemorrhage. If there is in the bruised part only slight subcutaneous laceration, nature may soon repair the injury. But if there is considerable contusion indicated by the ecchymosis where small blood vessels have been lacerated and the blood extravasated into celular tissue, causing the dark discolored spots and other evidences of severe injury, there will be subsequent inflammation, perhaps suppuration, demanding treatment. A proper mode of dressing at first is to bind on a compress saturated with a four per cent. solution of carbolic acid, and for the fever and inflammation one drop doses of ext. veratrum may be given.
But in all cases where wounds are severe the services of a physician will be required.
A PUNCTURED WOUND signifies one made with a sharp pointed instrument, the external opening being small compared to its depth. It is a good rule in these cases to leave a free vent for any discharge that may be set up. The danger in these cases is from serious injury to the deep seated parts, and from suppuration which may burrow and extend still deeper if there is not free exit for the pus.
One mode of treating POISONED punctural wounds (serpent bites, &c.), which of course are peculiarly dangerous, is by applying cups over the wound.
Any wound that suppurates much or sloughs causes a cavity to be filled up, and the process by which the wounds and sores heal is called granulation, and cicitrization. The wound is gradually filled up to the surrounding level by new tissue appearing in the form of small red granules bathed in pus. Healthy granulations on an exposed or flat surface rise nearly even with the surrounding skin, and often a little higher, but when they are much higher, and take on a growing action, they are what is called proud flesh. Their growth may be checked by the application of active astringents; nitrate of silver or burnt alum may be used, or adhesive straps may be applied. The skin with which it is covered when healed is formed from the surrounding skin, and the process which is called CICITRIZATION does not go on well except when the granulations are nearly level with the adjacent skin. The centre of a sore has power to form new skin when there is a particle of live skin there, and for this reason skin is sometimes grafted in.
A patient suffering from a suppurating wound becomes enfeebled from the discharge of pus, and should have his strength kept up by nourishing food. A surgeon will always endeavor to prevent the retention and decomposition of discharges, and to protect from external contamination. He will direct the time and means of dressing the wounds, but the nurse must remember that decomposed animal matter acts as a virulent poison introduced into the system as it may be through any abrasion of the skin. All instruments used about a wound must be thoroughly cleansed before being put away. Dressings which have been next the wound should be burned; those which are to be washed should be disinfected. Avoid soiling your own hands with discharges; protect with a bit of plaster every place where there is any cut, or scratch, or sore. If you fear that any virus has got in where there is any sore, or where the skin is broken, touch it with carbolic acid.