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# Wounds
## Wound care steps:
* Stop the bleeding with pressure.
* Clean the wound thoroughly as soon as you can. The better you
clean it, the less likely it is to become infected. For larger
wounds, give some kind of pain medicine before you clean and care
for the wound. Inject lidocaine around the wound and just below
the skin inside it. Or give another pain medicine and allow time
for it to work.
* Dress or close the wound, or for a small wound, leave it open to
heal.
(DIR) bleeding
(DIR) lidocaine
## Clean all wounds
> Any wound, big or small, can become infected. Clean every wound
> well.
Wash your hands well with soap. Then wash the wound with 1 to 4
liters of flowing water. You do not need antiseptics, some of which
can slow healing down. If the wound looks dirty, use soapy water and
then rinse that off with plain water.
Lift up any flaps of skin to clean underneath. For deep wounds,
squirt the inside of the wound with a bulb syringe, letting the water
run out.
(IMG) Bulb syringe
Or take the needle off a syringe and squirt water into the wound.
Or just run lots of clean water over and into the wound.
Wash out anything left inside the wound, especially dirt, wood, or
other rough material. You may need to use a piece of sterile gauze
or clean fabric to clean out the wound, then rinse thoroughly.
## Caring for wounds
As the wound heals, make sure it stays clean to prevent infection.
If it gets dirty, clean the wound with lots of water. Covering the
wound with a bandage, sterile gauze, washed banana leaf, or very
clean piece of cloth will help keep it clean. Putting honey on the
wound also helps prevent infection. Change the bandage daily, and if
it becomes wet or dirty. It is better to have no bandage than one
that is dirty or wet.
Watch for signs of infection such as increasing redness, pain, heat,
swelling, bad smell or pus at the site of the wound. For any of
these signs, clean the wound well.
You may need to gently pull open the wound to clean it. Watch that
the infection does not spread to other parts of the body.
(DIR) sepsis
## Closing wounds
A small wound is best left alone to heal. It should not need
stitches. The most important thing is to keep wounds clean.
A wound that is more than 12 hours old should be cleaned and left
open to heal.
A larger wound that comes together well will heal better if it is
closed.
To close a shallow, clean wound, use butterfly bandages, glue, or
stitches.
Butterfly bandage
Use a butterfly bandage for a small cut. The skin around the wound
must be clean and dry for the bandage to stick.
(IMG) Butterfly bandage
Glue
Super Glue or Krazy Glue (cyanoacrylate, a powerful adhesive) is
easier to use than suture and works just as well for most wounds.
Use it when you can clearly see how the two sides of the wound should
go together. It may not work as well on hands or joints because they
move so much. Do not use glue near the eyes or mouth. Super Glue
may irritate the skin.
(IMG) Super Glue
* Make sure the wound is clean and the skin around it is dry.
* Push the sides of the wound together. Keep fingers well away
from the wound so they do not stick to the glue. A helper can use
a couple of clean sticks to hold the sides together.
* Squeeze a line of glue along the closed edges of the wound.
* Hold the wound closed for 30 seconds. Then add another layer of
glue. Wait another 30 seconds or so, and then add a third layer.
Each layer should cover a little more of the surrounding skin than
the last.
The glue will wear away on its own. By then the wound should be
healed.
Stitches (sutures)
A cut will benefit from stitches if it is shallow and long, or if the
edges of the skin around the cut do not come together by themselves.
Line up the edges. The edges of the wound should come up slightly
above the skin instead of tucking into the wound.
Make the depth and the length of the stitch the same on each side of
the wound.
If you do not have suture or a curved suturing needle, sharpen a
sewing needle. Boil the needle, some silk or nylon thread, and a
small pair of pliers for pulling the needle through tough skin.
1. Put the stitch through the cut, not under the cut.
(IMG) Stitch through the cut
2. Tie a secure knot.
(IMG) Tie a secure knot
3. Make enough stitches to close the whole cut.
(IMG) Make enough stitches
A deep wound should get a couple of stitches inside the muscle with
dissolvable suture before sewing the skin together. If you cannot do
this then do not close the wound.
(DIR) deep wounds
Leave stitches in place for about one week (10 days for a leg or
joint wound). Then cut each stitch and pull it out. If you spend
some time sewing clothes, you will find that your skill to suture
wounds improves as well.
How to tie a strong knot:
(IMG) Tying a strong knot
* First tie a simple knot and pull skin together.
* Tie a second simple knot over the first one.
* Tie a third simple knot over the second one.
* Tie a fourth simple knot over the third one.
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