11/12/2011
CLOSED WOUNDS
Most closed wounds are caused by external forces, such as falls and motor vehicle accidents. Many closed wounds are relatively small and involve soft tissues; the black eye is an example. Others, however, involve fractures of the limbs, spine, or skull and damage to vital organs (see page 44, Fig. 19) within the skull, chest, or abdomen. Massive injury to soft tissues—such as muscles, blood vessels, and nerves—can be very serious and can result in lasting disabilities.
Signs and Symptoms
Pain and tenderness are the most common symptoms of a closed wound. Usual signs are swelling and discoloration of soft tissues and deformity of limbs caused by fractures or dislocations. Suspect a closed wound with internal bleeding and possible rupture of a body organ whenever powerful force exerted on the body has produced severe shock or unconsciousness. Even if signs of injury are obvious, internal injury is probable when any of the following general symptoms are present:
Cold, clammy, pale skin, very rapid but weak pulse, rapid breathing, and dizziness.
Pain and tenderness in a part of the body in which injury is suspected, especially if deep pain continues but seems out of proportion to the outward signs of injury.
Uncontrolled restlessness and excessive thirst.
Vomiting or coughing up of blood or passage of blood in the urine or f***s.
Emergency Care
Carefully examine the victim for fractures and other injuries to the head, neck, chest, abdomen, limbs, back, and spine. If an internal injury is suspected, get medical care for the victim as soon as possible. If a closed fracture is suspected, immobilize the affected area before moving the victim. Carefully transport him in a lying position and give special attention to preventing shock. Also, watch the victim's breathing and take measures to prevent either blockage of the airway or stoppage of breathing. Do not give fluids by mouth to a victim suspected of having internal injury, regardless of how much he complains of thirst.
When a relatively small closed wound occurs (such as a black eye), put cold applications on the injured area. The applications will help to reduce additional swelling and may slow down internal bleeding.