Title Wounds, Burns & Infections - Handbook 2024.pdf ✅

36 I NOLS WILDERNESS MEDICINE HANDBOOK I © 2024 NOLS WILDERNESS WOUND MANAGEMENT SHORT TERM CARE I CONTROL BLEEDING Life-threatening bleeding is spurting, soaks clothing, pools on the ground, or is associated with missing body parts and altered mental status. TECHNIQUES TO CONTROL BLEEDING 1. Manual direct pressure and elevation: most commonly useful technique. Pressure with fingertips or gauze must be focused on the source of the bleeding. Elevation might help with bleeding control. 2. Wound packing: Pack (stuf) the wound with hemostatic gauze, plain gauze, or a clean cloth and then apply direct pressure. 3. Pressure dressings: Used to secure a dressing to free the hands for other tasks or secure dressing after bleeding is controlled. 4. Tourniquet: Should be wide (minimal width 1.5 in or 4 cm), padded, and ideally 1-2 in or 5 cm above the wound. EXTENDED CARE I PREVENT INFECTION AND PROMOTE HEALING 1. Clean the wound: • Wash your hands and put on your gloves. • Clean around the wound with soap and water and rinse with clean/disinfected water. • Remove any foreign matter with disinfected tweezers or gentle brushing out of the wound. • Irrigate the wound with disinfected water with pressure from a syringe or with high volume low pressure (half liter minimum). 2. Cover the wound with the cleanest dressing available and bandage. Keep wound moist with a dressing coated with antibiotic ointment or a transparent film dressing. Monitor CSM. 3. Keep the dressings clean and dry. In general change dressings at least once every 24 hours. SPECIFIC WOUND CONSIDERATIONS • Bruises can cause swelling, discoloration, and pain. • Abrasions can be painful. Cleaning may require scrubbing (to pain tolerance) and copious irrigation. Cover the wound with a dressing coated with a thin layer of antibiotic ointment or a transparent film dressing. • Lacerations: Bring the wound edges together with wound closure strips. If the cut gapes open and needs support to stay closed or if the cut is on the face, pack the wound open (moist to dry) and keep the wound moist during evacuation for stitches. • Avulsions: Irrigate under the flap. Secure in its normal position. • Amputations: Wrap the amputated part in a moist, clean dressing and seal in a plastic bag. Keep the part cool. Transport rapidly to the hospital with the patient. • Punctures: Wash the surface of the skin only. Do not close. Monitor for infection. • Impaled Objects: Remove objects that obstruct the airway. Remove an object impaled in a limb only if it - cannot be stabilized. - will easily fall out. - prevents transport. - prevents bleeding control. EVACUATION GUIDELINES I WOUNDS • Evacuate any patient with a wound that cannot be cleaned or closed in the field or is not healing. • Rapidly evacuate any patient with a wound that is heavily contaminated, opens a joint space, involves underly- ing tendons or ligaments, was caused by an animal bite, is on the face, has an impaled/embedded object, is an amputation, was caused by a crushing mechanism, or shows evidence of serious infection.