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How to Deal With Open Wounds When Help is Not on the Way
19 May 2016, 17:57,
#1
How to Deal With Open Wounds When Help is Not on the Way
http://www.backdoorsurvival.com/how-to-d...en-wounds/

How to Deal With Open Wounds When Help is Not on the Way

If there is one area that I feel singularly unprepared for it is with dealing with physical trauma following a disruptive event. Basic first aid? Sure, I can handle that and have a decent first aid kit to back me up. But serious wounds, broken bones, and other physical traumas? Not so much.

The thing about physical traumas, and especially open wounds, is that they can occur anytime including right in your own home. An accident in the kitchen or the yard can begin with a bloody mess and end with an unwelcome infection. Who wants that?

How to Deal With Open Wounds - Backdoor Survival

As far as I am concerned, the moment is now. It is time to become educated and to start learning how to deal with more serious medical matters. To help us along, I welcome contributing author Joe Alton who is allowing me to share his expertise on how to deal with open wounds.

The Open Wound

Years ago, we held the first suture class for non-medical people in the preparedness community. Our purpose in doing this was to provide education that might be useful in a post-apocalyptic setting. We felt that teaching people medical skills may save some lives in long-term survival scenarios. To us, any unnecessary death in times of trouble is one too many.

Nowadays there are a lot of folks that put on these classes. The main goal, however, is not simply to learn the mechanics of throwing a stitch but to develop the judgment necessary to understand when a wound should be closed and, more importantly, when it should be left open.

When the medically-responsible person evaluates a wound, the following question must be asked: What am I trying to accomplish by stitching this wound closed?

Your goals when performing wound closure are simple. You close wounds to:

Repair the defect in the body’s armor
Eliminate “dead space” that can lead to infection
Promote healing.
Provide a pleasing cosmetic result (less scarring).

Sounds like every wound should be closed, doesn’t it? Unfortunately, it’s more complicated than that. Closing a wound that should be left open can do a lot more harm than good, and could possibly put your patient’s life at risk.

Take the case of a young woman injured in a “zipline” accident. She was taken to the local emergency room, where 22 staples were needed to close a large laceration. Unfortunately, the wound had dangerous bacteria in it, causing a serious infection which spread throughout her body. She eventually required multiple amputations.

We learn an important lesson from this tragic case: Namely, that the decision to close a wound is not automatic but involves serious considerations.
Infected Cut

The most important of these is whether you are dealing with a clean or a dirty wound.

Most wounds you will encounter in a wilderness or collapse setting will be dirty. If you try to close a dirty wound, you sequester bacteria and dirt into your body. Within a short period of time, the infected wound will become red, swollen, and hot. An abscess may form, and pus will accumulate inside.

Here’s an article I wrote about infected wounds:

Infected Wounds

The infection may spread to the bloodstream and, when it does, you have caused a life-threatening situation. Leaving the wound open will allow you to clean the inside frequently and observe the healing process. It also allows inflammatory fluid to drain out of the body. Wounds that are left open heal by a process called “granulation”; that is, from the inside out. The scar isn’t as pretty, but it’s the safest option in most cases.

Other considerations when deciding whether or not to close a wound are whether it is a simple laceration (straight thin cut on the skin) or whether it is an avulsion (areas of skin torn out, hanging flaps).

If the edges of the skin are so far apart that they cannot be stitched together without undue pressure, the wound should be left open. If the wound has been open for more than, say, 6-8 hours, it should be left open; even the air has bacteria, and the injury may already be colonized.

IF you’re certain the wound is clean, you should close it if it is long, deep or gapes open loosely. Also, cuts over moving parts, such as the knee joint, will be more likely to require stitches.

Remember that you should close deep wounds in layers, to prevent any un-approximated “dead space” from occurring. Dead spaces are pockets of bacteria-laden air or inflammatory fluid in a closed wound that may lead to a major infection. An exception to this is a puncture wound from an animal bite. These are loaded with germs and should never be sutured.

If you are unsure, you can choose to wait 72 hours before closing a wound to make sure that no signs of infection develop. This is referred to as “delayed closure”. Some wounds can be partially closed, allowing a small open space to allow the drainage of inflammatory fluid. Drains, consisting of thin lengths of latex, nitrile, or even gauze, should be placed into the wound for this purpose. Of course, you should place a dressing over the exposed area as it can get messy.
Improvised Butterfly Closure with Duct Tape

If you must close a wound, use the least invasive method.

If you can approximate the cut edges of skin with butterfly closures, it is better than puncturing the skin again and again with sutures or staples. Use an adhesive such as tincture of benzoin to hold the tapes in place. Even Super-Glue may be a better option in certain cases, and is used routinely in underdeveloped countries like Cuba with good effectiveness.

Irrigating the Wound

The safest method, though, is to leave that questionable wound open.

Using a 60-100cc irrigation syringe, flush the area aggressively with a dilute solution of Betadine (Povidone-Iodine) or sterilized saline solution. If you don’t have commercial sterile solutions, studies show that clean drinking water can keep a wound clean in an austere environment.

Place a sterile moist (not soaking wet) dressing in the wound and then cover with a dry sterile gauze dressing. Replace the dressing at least daily, more often if possible.

If you have antibiotics, this may be a good time to use them. Check out the link in this article about infected wounds to see which are most useful.

About hydrogen peroxide, undiluted Betadine, or Alcohol as a cleaning agent for open wounds: If it’s all you have, it’s ok for the first cleaning before you place the dressing. These substances, however, tend to dry out newly forming cells and may actual hinder healing. As such, stick with milder solutions or clean drinking water for long-term wound care.

Learning how to suture is a useful skill. Knowing when to suture, however, is much more important.

Joe Alton, M.D., aka Dr. Bones “Doom and Bloom” Survival Medicine

Takeaway: Many Wounds Should Be Left Open

Before now, I was under the false impression the all serious wounds should be closed up or sutured to prevent infection. Little did I know that closing a wound, especially while out in the field, should be carefully evaluated if there is any hint of dirt or bacteria. Sometimes, closing a wound will foster an infection and make it worse. Who knew?

Here is the takeaway for determining whether a wound should be left open:

1. If the wound has been open for longer that 6 to 8 hours, leave it open. During that period, bacteria will have had time to work its way through the body, potentially causing a massive infection.

2. If the flaps of the wound cannot be closed without using a lot of pressure, leave it alone.

3. To repeat: dirt and bacteria will cause an infection if allowed to fester in a closed up wound. If there is any suspicion of such, leave the wound open!

The Final Word

After digesting Joe’s advise on open wounds, I pulled out my copy of his book, The Survival Medicine Handbook (written by Joe and his wife, Amy) to see what else it had to say on the subject.

Note: this is a big fat book of over 500 pages. I keep in next to my desk and use it as a reference, but I have not read it cover to cover.

In chapter six, I found lot of information on open wounds including photos and extensive details on the use of commercial hemostatic agents (such as Quickclot and Celox) and suture instructions for those hopefully rare times when suturing will be needed.

The book also mentions something I already knew and that is that it is a good idea to apply some triple antibiotic ointment to a healing wound or, as I prefer, raw honey, lavender oil or to Melaleuca (tea tree) essential oil. Lavender, especially, is something I always carry with me in my portable survival kit (see 8 Essential Items: The Perfect Portable Survival Kit).

At the end of the day, I am more than a little bit discouraged by how ignorant I am about wound control and other physical traumas. That said, as with everything preparedness related, there is always something new to learn and of course, it is never too late to start.

Enjoy your next adventure through common sense and thoughtful preparation!
Gaye
If at first you don't secede, try, try again!
Reply
19 May 2016, 18:29,
#2
RE: How to Deal With Open Wounds When Help is Not on the Way
Another related article: Wound Care in the Field

Surgeons divide wounds into four categories: clean, clean-contaminated, contaminated, and dirty/infected. The differences between each class are determined by the amount of bacterial contamination expected in the wound.

The first two categories are for patients in a hospital. A clean wound occurs when prepared (cleansed) skin is opened in a controlled fashion and no internal organs are entered. Hernia repair is a good example. Clean-contaminated wounds also happen in operating rooms, as when an internal organ is operated upon under controlled circumstances, often with antibiotic coverage. A good example is an appendectomy.

Contaminated wounds include open fresh traumatic injuries or surgery with bacterial contamination from an internal organ. Slashing your hand with the same knife you have been using to clean fish or game would be a good example of the former.
Dirty and infected wounds contain dead tissue, pus, foreign material (e.g. wood, grass, etc.), gross contamination (e.g. dirt, manure) or contaminated wounds that have received no treatment in the first hours after injury.

The classification system is useful because it predicts the chance of an injured area becoming infected. Infection rates by classification are:

• clean: 1.5-3.9%
• clean contaminated: 3.0-4.0%
• contaminated: 8.5%
• dirty wounds: 28-40%

Obviously, the dirtier your wound the greater likelihood of a subsequent infection. This is especially true if you suture up the wound and trap the contamination inside. Bacteria in a warm, closed space feed on bloody injured tissue and are able to multiply rapidly. Using chemical bulldozers they are able to spread into the surrounding healthy tissues causing an infected wound that is red and drains pus. If drainage doesn’t occur they can spread through tissue planes causing fasciitis, the so-called flesh eating disease, or spread throughout your entire body causing fatal infection.

With proper cleansing and antibiotics a contaminated wound can frequently be closed without infection but even surgeons in a hospital will usually leave a dirty wound open initially. This allows the fluid and bacteria to drain from the wound and antibiotics to kill the invading bacteria. After the wound has been repeatedly cleansed and treated with antibiotics, closure can be accomplished with little chance of infection.

Within six hours - The following are suggestions for treatment of a wound which occurs when you are some distance from medical care. They are based on one easy question:

Can you get to qualified medical care within six hours? If the answer is yes I would recommend:

a) Stop the bleeding with pressure on the wound.

b) Once bleeding has stopped, gently clean out any gross debris, such as wood particles and rocks, but don’t do it so vigorously that it restarts the bleeding. Also remember that this area may be very painful so don’t torture yourself or your injured companion. If you carry local anesthetics in your medical supply kit now is the time to use them. You can inject with a needle but it can also be effectively used by dripping some into the wound. When it numbs the site a little, wet a gauze with the rest and place it in the wound. After a few minutes the wound will be less painful and easier to clean.

c) Place a sterile gauze or clean piece of cloth into the opening and wrap the site with gauze or an ace wrap. If it is near a joint, try to immobilize the joint to prevent further bleeding and pain.

d) Transport expeditiously to a hospital. Don’t take any antibiotics unless it is going to be a long trip. The hospital personnel will likely sample the wound for bacteria and prescribe appropriate antibiotics. If you have a long transport and carry antibiotics, cephalexin or ciprofloxacin would be good choices.

e) If there hasn’t been a lot of blood loss and the person isn’t nauseated, give them some pain medication for the trip.

Over six hours - If you cannot get to medical care in six hours or are in a really isolated area:

a) Stop the bleeding by pressure on the wound.

b) Once bleeding has stopped, gently clean out any gross debris, such as wood particles and rock, but don’t do it so vigorously that it restarts the bleeding. In this circumstance try harder to physically remove the materials. If you have access to a lot of water, irrigate the area thoroughly. The water won’t be sterile but shouldn’t be grossly dirty or contaminated. Again, do not clean so vigorously that you restart any bleeding, and make use of any local anesthetics as directed above.

c) Place sterile gauze or clean cloth into the wound as deep as you can without causing undue pain. Cover the site with more gauze pads, and wrap the site with gauze or an ace wrap. If it is near a joint, try to immobilize the joint to prevent further bleeding and pain.

d) This wound will seep a lot of fluid and the dressing may need to be changed frequently in the first 48 hours. Make an effort to cleanse the site with water and then replace the gauze pack. Removing the pack will help to remove a lot of the debris that you couldn’t easily get out initially. After several days the wound will not be nearly as painful and the dressing change will be easier to do.

e) If you have antibiotics go ahead and take them in this circumstance. Topical antibiotic ointments such as Bacitracin, Triple Antibiotic, or Bactroban could also be helpful. I would place some on the gauze that is placed into the wound.
If there has been extensive blood loss, an open fracture exists, or there are other serious associated injuries (head, chest, abdomen) begin expeditious transport to medical assistance or use any available communication to summon help to the scene.

If this is simply a contaminated laceration and you have adequate dressing supplies, you may continue to treat the wound in an open fashion. It will heal on its own in two to four weeks. It may leave a wider scar than desired, but you can later find a plastic surgeon who will revise it.

You may have watched a movie called The Professional in which our hit man/hero bravely dealt with a gunshot wound in his chest. In true Rambo fashion, lacking anesthesia, he sutured up the bleeding edges and continued his fight. He was later killed by the bad (worse) guys saving a surgical team the need to try and save him from his infected wound. A bullet containing oil and gunpowder passing through cloth and dirty skin creates a grossly contaminated wound. Closing the skin over trapped blood, dead tissue, and foreign material creates a buffet table for bacteria.

Don’t make the same mistake. Pack it open, avoid the infection, and let it heal cleanly.

By Bill Glade, M.D. Via: backwoodshome.com

The use of sugar to enhance wound healing

I received a copy of Hugh Coffees book "Ditch medicine" and in it I found an interesting chapter on the use of sugar as a treatment of infected wounds.

Quote: Sugar has been called a non-specific universal anti-microbial agent. Based on its safety, ease of use and availability. As with any wound the wound is first irrigated and debrided. Hemostasis is obtained prior to the application of the sugar since sugar can promote bleeding in a fresh wound.

A wait of 24 to 48 hours before the application of sugar is not unusual. Once bleeding is under control, deep wounds are treated by pouring granulated sugar into the wound, making sure to fill all cavities. The wound is then covered with a gauze sponge soaked in iodine solution. In a few hours the granulated sugar is dissolved into a "syrup" by body fluid drawn into the wound site.

Since the effect of granulated sugar upon bacteria is based on osmostic shock and withdrawl of water that is necessary for bacterial growth and reproduction. So to continually inhibit bacterial growth, the wound is cleaned with water and repacked at least one to four times daily. Or as soon as the sugar becomes diluted with more solute (sugar) to re-concentrate the aqueous solution in the environment of the solution. Unquote.

I was taught to mix Betadine with the sugar. Irrigate the wound with sterile water once it becomes syrupy, then repack the wound with Betadyne sugar again. Repeat as necessary.

That little medical tidbit came from a short class I took with a Canadian Paramedic who works in the remote wilderness of the Canadian Rockies.

Also learned it in class. http://www.medicalcorps.org/class.htm Also learned how to rehydrate an unconscious person using a nasogastric tube either through the nose or rectally from that same Canadian Paramedic.

Cool stuff. Problem is, you don't want to use it except in the most extreme of circumstances and you're on your own for an extended period. Too much liability.

73 de KE4SKY
In
"Almost Heaven" West Virginia
USA
Reply
8 February 2021, 18:30,
#3
Heart  RE: How to Deal With Open Wounds When Help is Not on the Way
(19 May 2016, 17:57)Jonas Wrote: http://www.backdoorsurvival.com/how-to-d...en-wounds/

How to Deal With Open Wounds When Help is Not on the Way

If there is one area that I feel singularly unprepared for it is with dealing with physical trauma following a disruptive event. Basic first aid? Sure, I can handle that and have a decent first aid kit to back me up. But serious wounds, broken bones, and other physical traumas? Not so much.

The thing about physical traumas, and especially open wounds, is that they can occur anytime including right in your own home. An accident in the kitchen or the yard can begin with a bloody mess and end with an unwelcome infection. Who wants that?

How to Deal With Open Wounds - Backdoor Survival

As far as I am concerned, the moment is now. It is time to become educated and to start learning how to deal with more serious medical matters. To help us along, I welcome contributing author Joe Alton who is allowing me to share his expertise on how to deal with open wounds.

The Open Wound

Years ago, we held the first suture class for non-medical people in the preparedness community. Our purpose in doing this was to provide education that might be useful in a post-apocalyptic setting. We felt that teaching people medical skills may save some lives in long-term survival scenarios. To us, any unnecessary death in times of trouble is one too many.

Nowadays there are a lot of folks that put on these classes. The main goal, however, is not simply to learn the mechanics of throwing a stitch but to develop the judgment necessary to understand when a wound should be closed and, more importantly, when it should be left open.

When the medically-responsible person evaluates a wound, the following question must be asked: What am I trying to accomplish by stitching this wound closed?

Your goals when performing wound closure are simple. You close wounds to:

Repair the defect in the body’s armor
Eliminate “dead space” that can lead to infection
Promote healing.
Provide a pleasing cosmetic result (less scarring).

Sounds like every wound should be closed, doesn’t it? Unfortunately, it’s more complicated than that. Closing a wound that should be left open can do a lot more harm than good, and could possibly put your patient’s life at risk.

Take the case of a young woman injured in a “zipline” accident. She was taken to the local emergency room, where 22 staples were needed to close a large laceration. Unfortunately, the wound had dangerous bacteria in it, causing a serious infection which spread throughout her body. She eventually required multiple amputations.

We learn an important lesson from this tragic case: Namely, that the decision to close a wound is not automatic but involves serious considerations.
Infected Cut

The most important of these is whether you are dealing with a clean or a dirty wound.

Most wounds you will encounter in a wilderness or collapse setting will be dirty. If you try to close a dirty wound, you sequester bacteria and dirt into your body. Within a short period of time, the infected wound will become red, swollen, and hot. An abscess may form, and pus will accumulate inside.

Here’s an article I wrote about infected wounds:

Infected Wounds

The infection may spread to the bloodstream and, when it does, you have caused a life-threatening situation. Leaving the wound open will allow you to clean the inside frequently and observe the healing process. It also allows inflammatory fluid to drain out of the body. Wounds that are left open heal by a process called “granulation”; that is, from the inside out. The scar isn’t as pretty, but it’s the safest option in most cases.

Other considerations when deciding whether or not to close a wound are whether it is a simple laceration (straight thin cut on the skin) or whether it is an avulsion (areas of skin torn out, hanging flaps).

If the edges of the skin are so far apart that they cannot be stitched together without undue pressure, the wound should be left open. If the wound has been open for more than, say, 6-8 hours, it should be left open; even the air has bacteria, and the injury may already be colonized.

IF you’re certain the wound is clean, you should close it if it is long, deep or gapes open loosely. Also, cuts over moving parts, such as the knee joint, will be more likely to require stitches.

Remember that you should close deep wounds in layers, to prevent any un-approximated “dead space” from occurring. Dead spaces are pockets of bacteria-laden air or inflammatory fluid in a closed wound that may lead to a major infection. An exception to this is a puncture wound from an animal bite. These are loaded with germs and should never be sutured.

If you are unsure, you can choose to wait 72 hours before closing a wound to make sure that no signs of infection develop. This is referred to as “delayed closure”. Some wounds can be partially closed, allowing a small open space to allow the drainage of inflammatory fluid. Drains, consisting of thin lengths of latex, nitrile, or even gauze, should be placed into the wound for this purpose. Of course, you should place a dressing over the exposed area as it can get messy.
Improvised Butterfly Closure with Duct Tape

If you must close a wound, use the least invasive method.

If you can approximate the cut edges of skin with butterfly closures, it is better than puncturing the skin again and again with sutures or staples. Use an adhesive such as tincture of benzoin to hold the tapes in place. Even Super-Glue may be a better option in certain cases, and is used routinely in underdeveloped countries like Cuba with good effectiveness.

Irrigating the Wound

The safest method, though, is to leave that questionable wound open.

Using a 60-100cc irrigation syringe, flush the area aggressively with a dilute solution of Betadine (Povidone-Iodine) or sterilized saline solution. If you don’t have commercial sterile solutions, studies show that clean drinking water can keep a wound clean in an austere environment.

Place a sterile moist (not soaking wet) dressing in the wound and then cover with a dry sterile gauze dressing. Replace the dressing at least daily, more often if possible.

If you have antibiotics, this may be a good time to use them. Check out the link in this article about infected wounds to see which are most useful.

About hydrogen peroxide, undiluted Betadine, or Alcohol as a cleaning agent for open wounds: If it’s all you have, it’s ok for the first cleaning before you place the dressing. These substances, however, tend to dry out newly forming cells and may actual hinder healing. As such, stick with milder solutions or clean drinking water for long-term wound care.

Learning how to suture is a useful skill. Knowing when to suture, however, is much more important.

Joe Alton, M.D., aka Dr. Bones “Doom and Bloom” Survival Medicine

Takeaway: Many Wounds Should Be Left Open

Before now, I was under the false impression the all serious wounds should be closed up or sutured to prevent infection. Little did I know that closing a wound, especially while out in the field, should be carefully evaluated if there is any hint of dirt or bacteria. Sometimes, closing a wound will foster an infection and make it worse. Who knew?

Here is the takeaway for determining whether a wound should be left open:

1. If the wound has been open for longer that 6 to 8 hours, leave it open. During that period, bacteria will have had time to work its way through the body, potentially causing a massive infection.

2. If the flaps of the wound cannot be closed without using a lot of pressure, leave it alone.

3. To repeat: dirt and bacteria will cause an infection if allowed to fester in a closed up wound. If there is any suspicion of such, leave the wound open!

The Final Word

After digesting Joe’s advise on open wounds, I pulled out my copy of his book, The Survival Medicine Handbook (written by Joe and his wife, Amy) to see what else it had to say on the subject.

Note: this is a big fat book of over 500 pages. I keep in next to my desk and use it as a reference, but I have not read it cover to cover.

In chapter six, I found lot of information on open wounds including photos and extensive details on the use of commercial hemostatic agents (such as Quickclot and Celox) and suture instructions for those hopefully rare times when suturing will be needed.

The book also mentions something I already knew and that is that it is a good idea to apply some triple antibiotic ointment to a healing wound or, as I prefer, raw honey, lavender oil or to Melaleuca (tea tree) essential oil. Lavender, especially, is something I always carry with me in my portable survival kit (see 8 Essential Items: The Perfect Portable Survival Kit).

At the end of the day, I am more than a little bit discouraged by how ignorant I am about wound control and other physical traumas. That said, as with everything preparedness related, there is always something new to learn and of course, it is never too late to start.

Enjoy your next adventure through common sense and thoughtful preparation!
Gaye

Take note Mick.

We prep....Just in case
Reply
8 February 2021, 18:33,
#4
RE: How to Deal With Open Wounds When Help is Not on the Way
(19 May 2016, 18:29)CharlesHarris Wrote: Another related article: Wound Care in the Field

Surgeons divide wounds into four categories: clean, clean-contaminated, contaminated, and dirty/infected. The differences between each class are determined by the amount of bacterial contamination expected in the wound.

The first two categories are for patients in a hospital. A clean wound occurs when prepared (cleansed) skin is opened in a controlled fashion and no internal organs are entered. Hernia repair is a good example. Clean-contaminated wounds also happen in operating rooms, as when an internal organ is operated upon under controlled circumstances, often with antibiotic coverage. A good example is an appendectomy.

Contaminated wounds include open fresh traumatic injuries or surgery with bacterial contamination from an internal organ. Slashing your hand with the same knife you have been using to clean fish or game would be a good example of the former.
Dirty and infected wounds contain dead tissue, pus, foreign material (e.g. wood, grass, etc.), gross contamination (e.g. dirt, manure) or contaminated wounds that have received no treatment in the first hours after injury.

The classification system is useful because it predicts the chance of an injured area becoming infected. Infection rates by classification are:

• clean: 1.5-3.9%
• clean contaminated: 3.0-4.0%
• contaminated: 8.5%
• dirty wounds: 28-40%

Obviously, the dirtier your wound the greater likelihood of a subsequent infection. This is especially true if you suture up the wound and trap the contamination inside. Bacteria in a warm, closed space feed on bloody injured tissue and are able to multiply rapidly. Using chemical bulldozers they are able to spread into the surrounding healthy tissues causing an infected wound that is red and drains pus. If drainage doesn’t occur they can spread through tissue planes causing fasciitis, the so-called flesh eating disease, or spread throughout your entire body causing fatal infection.

With proper cleansing and antibiotics a contaminated wound can frequently be closed without infection but even surgeons in a hospital will usually leave a dirty wound open initially. This allows the fluid and bacteria to drain from the wound and antibiotics to kill the invading bacteria. After the wound has been repeatedly cleansed and treated with antibiotics, closure can be accomplished with little chance of infection.

Within six hours - The following are suggestions for treatment of a wound which occurs when you are some distance from medical care. They are based on one easy question:

Can you get to qualified medical care within six hours? If the answer is yes I would recommend:

a) Stop the bleeding with pressure on the wound.

b) Once bleeding has stopped, gently clean out any gross debris, such as wood particles and rocks, but don’t do it so vigorously that it restarts the bleeding. Also remember that this area may be very painful so don’t torture yourself or your injured companion. If you carry local anesthetics in your medical supply kit now is the time to use them. You can inject with a needle but it can also be effectively used by dripping some into the wound. When it numbs the site a little, wet a gauze with the rest and place it in the wound. After a few minutes the wound will be less painful and easier to clean.

c) Place a sterile gauze or clean piece of cloth into the opening and wrap the site with gauze or an ace wrap. If it is near a joint, try to immobilize the joint to prevent further bleeding and pain.

d) Transport expeditiously to a hospital. Don’t take any antibiotics unless it is going to be a long trip. The hospital personnel will likely sample the wound for bacteria and prescribe appropriate antibiotics. If you have a long transport and carry antibiotics, cephalexin or ciprofloxacin would be good choices.

e) If there hasn’t been a lot of blood loss and the person isn’t nauseated, give them some pain medication for the trip.

Over six hours - If you cannot get to medical care in six hours or are in a really isolated area:

a) Stop the bleeding by pressure on the wound.

b) Once bleeding has stopped, gently clean out any gross debris, such as wood particles and rock, but don’t do it so vigorously that it restarts the bleeding. In this circumstance try harder to physically remove the materials. If you have access to a lot of water, irrigate the area thoroughly. The water won’t be sterile but shouldn’t be grossly dirty or contaminated. Again, do not clean so vigorously that you restart any bleeding, and make use of any local anesthetics as directed above.

c) Place sterile gauze or clean cloth into the wound as deep as you can without causing undue pain. Cover the site with more gauze pads, and wrap the site with gauze or an ace wrap. If it is near a joint, try to immobilize the joint to prevent further bleeding and pain.

d) This wound will seep a lot of fluid and the dressing may need to be changed frequently in the first 48 hours. Make an effort to cleanse the site with water and then replace the gauze pack. Removing the pack will help to remove a lot of the debris that you couldn’t easily get out initially. After several days the wound will not be nearly as painful and the dressing change will be easier to do.

e) If you have antibiotics go ahead and take them in this circumstance. Topical antibiotic ointments such as Bacitracin, Triple Antibiotic, or Bactroban could also be helpful. I would place some on the gauze that is placed into the wound.
If there has been extensive blood loss, an open fracture exists, or there are other serious associated injuries (head, chest, abdomen) begin expeditious transport to medical assistance or use any available communication to summon help to the scene.

If this is simply a contaminated laceration and you have adequate dressing supplies, you may continue to treat the wound in an open fashion. It will heal on its own in two to four weeks. It may leave a wider scar than desired, but you can later find a plastic surgeon who will revise it.

You may have watched a movie called The Professional in which our hit man/hero bravely dealt with a gunshot wound in his chest. In true Rambo fashion, lacking anesthesia, he sutured up the bleeding edges and continued his fight. He was later killed by the bad (worse) guys saving a surgical team the need to try and save him from his infected wound. A bullet containing oil and gunpowder passing through cloth and dirty skin creates a grossly contaminated wound. Closing the skin over trapped blood, dead tissue, and foreign material creates a buffet table for bacteria.

Don’t make the same mistake. Pack it open, avoid the infection, and let it heal cleanly.

By Bill Glade, M.D. Via: backwoodshome.com

The use of sugar to enhance wound healing

I received a copy of Hugh Coffees book "Ditch medicine" and in it I found an interesting chapter on the use of sugar as a treatment of infected wounds.

Quote: Sugar has been called a non-specific universal anti-microbial agent. Based on its safety, ease of use and availability. As with any wound the wound is first irrigated and debrided. Hemostasis is obtained prior to the application of the sugar since sugar can promote bleeding in a fresh wound.

A wait of 24 to 48 hours before the application of sugar is not unusual. Once bleeding is under control, deep wounds are treated by pouring granulated sugar into the wound, making sure to fill all cavities. The wound is then covered with a gauze sponge soaked in iodine solution. In a few hours the granulated sugar is dissolved into a "syrup" by body fluid drawn into the wound site.

Since the effect of granulated sugar upon bacteria is based on osmostic shock and withdrawl of water that is necessary for bacterial growth and reproduction. So to continually inhibit bacterial growth, the wound is cleaned with water and repacked at least one to four times daily. Or as soon as the sugar becomes diluted with more solute (sugar) to re-concentrate the aqueous solution in the environment of the solution. Unquote.

I was taught to mix Betadine with the sugar. Irrigate the wound with sterile water once it becomes syrupy, then repack the wound with Betadyne sugar again. Repeat as necessary.

That little medical tidbit came from a short class I took with a Canadian Paramedic who works in the remote wilderness of the Canadian Rockies.

Also learned it in class. http://www.medicalcorps.org/class.htm Also learned how to rehydrate an unconscious person using a nasogastric tube either through the nose or rectally from that same Canadian Paramedic.

Cool stuff. Problem is, you don't want to use it except in the most extreme of circumstances and you're on your own for an extended period. Too much liability.

Here’s another one Mick. You know where you can stick you gunpowder.

We prep....Just in case
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