• Choose a category
• All
• Classic-Fiction

By Root 760 0

most wounds. I would not use this for an open fracture. Of course, freshly boiled water would be more reliable than nonsterile bottled water or water that you have previously drawn up in a clean milk jug, but it is better to wash a soiled wound immediately if you have clean water available than to take the time to boil and then cool water, leaving a heavily contaminated wound in its dirty state. You could always re-rinse the wound with sterilized water. The length of time that the cleanser is in contact with the wound and the degree of flushing that takes place will determine the number of bacterial contaminants remaining and thus have a significant effect on wound infection rates, so spend several minutes on this step. Of course the examiner/caregiver should scrupulously wash his hands and any instruments used to probe the wound beforehand. Thoroughly cleaning the wound will usually result in resumption of bleeding. When cleaning is finished, pressure can again be applied.

A foreign body remaining in the wound can be a focus of infection and prevent healing, so it is imperative that care is taken to rid the wound of any particles that may be present. A large syringe or squirt bottle can be used to administer a stream of water into the wound under a little pressure in order to thoroughly clean it and dislodge particulate matter. Chain-saw wounds may require debridement (cleaning and removal) of the margins with a scalpel to remove seared tissue as well as particles and clothing fibers, as searing prevents the wound edges from closing together in healing.

Boil or sterilize equipment such as a scrub brush or tweezers before removing all foreign material from the wound. (Cleaning instruments with alcohol and/or soap and water would be better than nothing.) Blood clotted in the wound must also be removed by scrubbing, as dried blood serves as a foreign body in this setting. After thorough cleansing with soap and water, if a wound is to be sutured, Betadine (if available) could be swabbed on the skin in pinwheel fashion, from the skin at the wound edges out to two or three inches away from the wound.

Anesthesia is certainly desirable prior to any painful manipulation or procedure, and if possible should be mercifully administered prior to any vigorous cleaning. Even the most stoic among us can appreciate pain relief, even if it is only temporary. So a vial of lidocaine (1 percent or 2 percent) and a syringe to administer it may be part of your wilderness medical kit. If the lidocaine has epinephrine mixed in, it will help a lot to keep the wound from bleeding as you try to suture it, but you must not use epinephrine in a wound on an extremity such as a finger or toe, as it could result in necrosis (tissue death). On the face or scalp epinephrine is a welcome additive, since these wounds tend to bleed so freely that you can scarcely see what you are sewing without it.

In addition to elevating the wound above the level of the heart, you may use limited tourniquet banding with a wide strip. (In the ER I might use a blood-pressure cuff pumped up to the point at which it stops the bleeding). This should be temporary, to maintain a bloodless field for closure only. Carefully and slowly infiltrating the margins of a wound with a few milliliters of an anesthetic solution, a learned technique, will result in control of bleeding and pain (for closure). Then you must give the anesthetic a few minutes to be absorbed before commencing your repair. Whether you use anesthetic or not it would be wise to administer pain medicine of some kind, either orally or by injection, since the wound will throb even after the repair is done.

Wound closure is a key factor in healing and infection rate as well. Wounds left open will be infected to some extent. The six-hour rule for closure is followed for minor wounds; that is, if care is sought within those limits the wound can be cleaned and sutured with impunity.

Closure may involve suturing (sewing) or may be as simple as using Dermabond (superglue), Steri-Strips, or staples made for this purpose.