First aid treatment for closed wounds

When considering a wound, there are many types of it and some of the wounds are likely to occur underneath the skin with an intact overlying skin. These wounds which does not expose to the outside environment, but are present underneath the skin is known as ‘closed wounds’ as opposed to the ‘open wounds’ that will expose the underlying soft tissues and sometimes bones to the external environment. In such instances, the damage done to the soft tissues as well as the blood vessels will go unnoticed and at times if enough vigilance is not paid, undiagnosed as well.



In most instances, closed wounds will be the result of blunt trauma such as a ‘seat belt injury’ during a car accident, assault by a stick or else using any other blunt object or even by a blow during a boxing fight…etc. Such high intensity impact will give rise to a bursting of the blood vessels underneath that portion of the skin and due to the pressure being distributed to a wider area than in a sharp injury; the overlying skin would be kept intact, although it might sustain bruises. But, there will be certain characteristics that can be seen in a site with a closed wound and some of these would be,

*Discoloration of the overlying skin : At times, the skin would initially become bluish in color and will later turn much lighter into a yellowish green area. Gradually the color will become normal and the underlying mechanism for this color change would be the bleeding that occurs underneath the skin which forms a hematoma. Due to bodies mechanism of re-absorbing the blood, such clots will gradually recede and will disappear totally.

*Pain : Usually, a close wound will be painful and it may be due to the underlying soft tissue damage as well as the stretching that occurs due to the hematoma formation.

*Swelling : Due to bleeding and other extravasations takes place in to a enclosed space, there is a tendency to develop a swelling at the wound site.

When considering these signs, it is evident that a person who provides first aid could only do very few, when it comes to a closed wound. As the overlying skin is intact, it is unlikely that the trauma exerted over the site would be enough to cause a life threatening injury, but, taking chances would not be the best idea when you can’t see the wound.

Thus, following measures need to be taken in giving first aid to a victim of a closed wound.

*Application of direct pressure, preferably with ice wrapped in a cloth, for several minutes, in order to arrest the bleeding as well as to reduce the swelling. Two mechanisms will act on providing this support and the coldness of the ice making the blood vessels constrict as well as the pressure occluding damaged blood vessels as well as soft tissues are the two main mechanisms.

*Elevation of the affected region will also support in reducing the pressure as well as the re-absorption process and it should be practiced as and when appropriate.

Apart from these measures, if the victim is not alert, basic life support measures may need to be adopted in few instances.