When you hear of wounds, the images that first come to mind are that of cuts, lacerations or scrapes, with all the bleeding and broken tissues, but it is also possible to have closed wounds.
A closed wound refers to internal injury where there is no break in the continuity of the skin and its tissues. These wounds are most commonly caused by forceful impact of a blunt object to the skin. Although the skin is not broken, the tissues beneath it may have been extensively crushed. Closed wounds can range from simple bruised to major internal lacerations or puncture caused by crushing forces, fractured bones, or the rupture of internal organs. Depending on the closed wound, it can lead to minor to severe, life-threatening bleeding.
When providing first aid for fractures or blunt trauma, always consider the possibility of closed wounds such as:
A contusion is more commonly known as bruises. These bruises are usually accompanied by bleeding for a few hours after the injury. It may result in swelling of the wound site, usually within 24 to 48 hours after the injury or immediately after. Swelling occurs as the blood collects beneath the skin layers or in the damaged tissues. A hematoma or blood clot almost always forms beneath the surrounding tissues, resulting in a characteristic “blue or black” mark. A classic example is the so-called black eye. Initially, the injured part appears blue or reddened but gradually changes color into brownish yellow as the tissues heal. You can easily handle this incident if you have your formal first aid training.
Large bruises may indicate severe blood loss and may also suggest extensive tissue damage or fractures. Closely monitor the individual for signs of shock.
Internal Punctures and Lacerations
You may have not heard of it before, but actually internal tissues can get punctured. As a first aider, you should be mindful of such injuries. Usually, internal punctures and lacerations result from broken bones. The sharp ends and fragments of the bone can puncture or cut through the internal body tissues. The spleen, kidneys, lungs, liver, and heart may be lacerated by a broken rib. The bladder can be lacerated or punctured after a hip fracture, although very rarely. In fact, any fractured bone can cause damage to its surrounding muscles, nerves, organs, blood vessels, and other soft tissues.
Crush Injuries and Ruptures
Standard first aid and CPR training will help you to be prepared if you ever come up with this incident. Forceful impact applied to the skin can be transmitted to underlying tissues, even if the skin remains intact. In some cases, the only indication of the injury is a simple bruise. This force can cause the internal organs to rupture or to be crushed and bleed internally. It is also possible for the contents of the organ to leak into the body cavities, leading to tissue damage and severe inflammation.
In case of crush injuries, you should be ready to provide first aid for shock. Usually, anti-shock garments are used to prevent shock due to internal bleeding. These can all happen even without major external signs and symptoms. The individual may just suddenly show signs of shock.