Lesson 8:

Wounds & Wound Infections Emergency Reference Guide p. 75-87

Objectives

• Define serious bleeding

• Demonstrate control of bleeding, direct pressure,

pressure points, tourniquets

• Define abrasions contusions, lacerations & blisters

• Demonstrate wilderness treatment for abrasions,

lacerations & blisters

• Describe signs/symptoms & treatment for

wound /skin infections

Objectives (cont’d.)

• Describe personal/camp hygiene and role in preventing infections

• Demonstrate proper wound cleaning techniques

• Describe care for common ear/nose/teeth problems

• Describe care/prevention of bites (i.e.

ticks/snakes/mosquitoes)

• Describe when evacuation is required due to

wounds/infections

Wounds & Infections

Overview

• Goals for management include:

– Stopping bleeding

– Cleaning (improves comforts/decrease

infections)

• Clean all wounds. Wear gloves, wash

before & after giving care

• Change dressings often

• What types of wounds are there?

Wounds

What at the Types of Wounds?• Contusions

(i.e. bruises)

• Abrasions (i.e. “road rash”)

• Lacerations (i.e. knife cuts)

• Avulsions (i.e. torn away skin)

• Puncture wounds (i.e. gunshot, stick, etc.)

Checking & Caring for Bleeding

• Look for signs/symptoms of serious blood loss:

– Arterial bleeding=spurting blood when heart

beats

– Venous bleeding=smooth, rapid flow

• Quick scan of patient is enough to find serious

bleeding.

• Check under bulky clothes to assess bleeding

• Check under person lying on material that might

absorb/hide bleeding

Practice:

Applying Direct Pressure

• Cover wound with sterile dressing, if

possible

• Apply pressure directly to the wound

• If dressing soaks through, add more, do

not remove any dressing

Direct Pressure

Pressure Points

• Sometimes direct pressure is not enough

– Find nearest pressure point (i.e. inside of

arms, groin area)

– Apply pressure to pressure point to slow flow

– Apply direct pressure to wound as well

• In case of neck/head bleeding, try to pinch

wound instead (risk of cutting off air supply)

Using a Tourniquet• Can be used on arm/leg if blood less is

still uncontrolled using previous

techniques

• Use only, if risk of death due to blood loss

• Rarely needed.

• If used:

– Apply & keep on continuously

– If care 2+ hrs away, release every 2 hours to

assess continued need. Remove, if possible

– Continued use may result in loss of limb

Tourniquet Demonstration

Tourniquet Demonstration (cont’d)

Which Technique is Best?

• An arrow from hunting mishap impales

victims thigh

• ATV overturns, person is ejected.

Depression found in skull with significant

bleeding

• Chainsaw jumps log, and cuts into an

unprotected leg

• When can a tourniquet be released?

Wound Cleaning, Closing,

Dressing• After controlling bleeding, proper cleaning &

closing helps prevent infection

• Wash hands, use gloves, if possible

• Wash/rinse dirty wounds. Plan on having at least

1 liter potable water

• Ideally, use irrigation syringe to increase water

flow rate

• Possible substitutes for irrigation syringe

– Biking water bottle

– Clean plastic bag with pin hole in bottom

Cleaning/Dressing Wounds

• If cleaned within 10 min., abrasions can be

treated with layer of antibiotic ointment &

sterile bandage

• If cared for later:

– Scrub clean with gauze pad, soap and water

– Irrigate with water

– Apply antibiotic ointment

– Apply sterile dressing

Lacerations/Punctures

• Wash skin around lacerations/punctures

before irrigating

• Punctures need considerable irrigation,

since dirt may be deep (especially with

animal bites)

Eye Injuries

Eye Injuries

• Lodged objects

– Clean water rinse from nose to ear

– Lift object out gently with corner of gauze

• Embedded objects

– Stabilize object

– Do not attempt to wash out

– Evacuate patient on stretcher

Dressing and Bandages

Guidelines for Dressings &

Bandages

• Dressing is primary covering. Should be

sterile, non adherent, porous

• Wounds heal faster/less scarring, if kept

moist with antibiotic

• Dressing should completely cover wound

• Change every 24 hours (transparent film

dressings may be left in place)

• If dressing is stuck, soak with water before

removing

Guidelines for Dressings &

Bandages (cont’d.)

• Bandages hold dressing in place. Should

be snug, but not so tight cuts off circulation

• Bandages need not be sterile. Can be

improvised (i.e. cotton strips, etc.)

• Do not cover rings or anything that can cut

off circulation

• Check bandages often

Wound Closing & Dressing

• When holding laceration open to irrigate, it

should be closed with closure strips, or

tape after cleaning

• Closing (< ½” wide):

– Apply closure strips on alternating sides

– Use as handles & pull wound close,

– Apply antibiotic ointment

– Cover with dressing

Wound Closing & Dressing (cont’d.)

• If wound > ½” wide:

– Do not close

– Evacuate & have a professional close wound

Leave open large dirty wounds, wounds that

expose bone, tendons, ligaments, wounds

caused by animal bites

After irrigating, cover with sterile dressing

Pack exceptionally dirty wounds with moist, sterile

dressings & allow them to drain.

Care/Prevention of Friction

Blisters/Chafing

• Friction blisters result from aggressive

rubbing of outer skin against inner skin

• May feel better when drained of fluid

• Controlled drainage is far better than

allowing them to rupture on their own

• Chafing occurs from excess friction, often

in groin area, between thighs

Blisters

Blister Prevention

• Wear proper fitting boots

• Break in boots before heavy usage

• Wear inner pair of socks (i.e. sock liners)

• Wear gloves to protect hands

• Care for issue when “hot spot” develops

(note: use moleskin to cover blisters/hotspots)

• Keep feet dry (change into dry socks)

• Encourage group to care for problem early

Preventing Chafing

• Wear loose fitting clothing. Helps to

ventilate perspiration.

• Apply lubricating ointment, baby powder,

cornstarch to chafe-prone areas before

starting

• Change out of wet clothing before hiking

Care for Blisters

• Care for blisters when still just “hot spots”

• Clean around site

• Sterilize point of needle/knife point & open

blister enough to allow fluid out -edge of blister

• Keep outer skin intact

• Wash with soap & water

• Apply dressing to cover & reduce further

friction damage

Caring for Ear Problems

• Do not use force to dislodge something

from the ear. If small, try rinsing it out

• Outer ear infections hurt, if earlobe is

pulled. If pain persistent, seek medical

care

• Middle ear infections often result in vertigo

& cold symptoms. Seek medical care

Nose Bleeds

Nosebleeds

• Not serious unless, they bleed from the

back & go down the throat

– Posterior nose bleeds require immediate evac

• Control bleeding by pinching bridge of

nose. Keep head in normal, upright

position

• Nose bleeds from trauma may be brisk,

but usually stop in 10-15 minutes

Nosebleeds (cont’d.)

• Spontaneous nosebleeds frequently

reoccur. Takes 10 days to fully heal.

Refrain from blowing nose

• Blood flowing down throat when leaning

forward is serious, requires immediate

evacuation

Caring For Teeth Issues

• If a filling falls out, pain usually occurs

from cold/hot food or tongue hits spot

• Infected tooth symptoms are pain, swelling

of gum and cheek near tooth.

Discoloration of the gum may be visible

• A knocked out tooth may be salvaged by

placing back in socket. Get to dentist

ASAP.

Ears/Nose/Teeth Scenarios

• What items in your pack can be used to

treat:

• Ear problems?

• Nose problems?

• Teeth problems?

Ears/Nose/Teeth Scenarios

• Ears: water for rinsing, cooking oil to suffocate

bugs, vinegar or alcohol (e.g. rubbing) for outer

ear infections

• Nose: gauze for bleeding, antibiotic ointment for

cuts, cold packs to slow blood flow, cell phone to

start evacuation procedures

• Teeth: oil of cloves for pain, temp filling material

(i.e. candle wax, sugarless gum), milk to

preserve lost tooth, cold packs, salt and warm

water to rinse infected tooth area

Caring for and Preventing Bites

from Inspects/Snakes

• Insects/snakes prevalent in wild areas

• Common insect bites mosquitoes, ticks,

bees, wasps. Nuisance, but may also carry

disease risk

• Venomous snakes in US include pit vipers

& coral snakes. Risk of death is low

• Name some diseases from inspect bites

Insect Transmitted Diseases

• West Nile Virus (mosquitoes)

• Rocky Mountain Spotted Fever (ticks)

• Colorado tick fever (ticks)

• Q fever (ticks)

• Lyme disease (ticks)

• Tetanus (ticks/snakes)

Fact or Fiction?

• To treat mosquito bite itch, use topical OTC agent, avoid

scratching

• Products containing DEET are most effective. Use

concentration above 30%

• Combination of permethrin on clothing & insect repellant

on skin prevent 50% of bites from mosquitoes & ticks (caution: do not use permethrin directly on skin)

• There is no effective repellant from light infestations for

flies, gnats, mosquitoes

• In US, ticks carry at least 8 pathogens. Tick must feed

for several hours to several days before transmitting

them

Fact or Fiction? (cont’d.)

• Perform body check for ticks twice daily when hiking or

camping, and immediately remove any ticks found?

• Covering a tick with petroleum jelly is effective way to

remove it?

Prevention Strategies

• Avoid exposure during prime biting times,

usually at dawn & dusk

• Have adequate netting on doors/windows

• Set camps well away from standing water

• Use repellant on skin/clothes/sleeping

bags

Snakebites

Venomous Snakes

• Snakebites are puncture wounds, may cause

infections including tetanus, may inject venom

• Signs/Symptoms of venomous bite:

– One or more fang bites

– Localized pain

– Swelling, possibly of entire limb

– Nausea, vomiting, tingling

– Shock

– Necrosis (tissue death)

Care for Venomous Snakebite

• Gently wash bite

• Splint bitten extremity, keep bite at approx height

of heart

• DO NOT cut or suck bite

• DO NOT apply constricting band or cold for pit

vipers

• Apply elastic roller bandage for coral snakes

• GO FAST for help

• Snakebites must be evaluated by a medical

professional

Treating & Caring for Wound

Infection

• Signs & Symptoms:

– Any wound can become infected

– Increasing pain, redness & swelling

– Increasing heart rate

– Pus that smells foul, increases, gets darker

– Appearance of red streaks just under skin

– Systemic fever

Treating & Caring for Wound

Infection (cont’d.)

• Maintain up to date series of shots to

prevent tetanus

• For any large bruised area, bites, or

poisoning, outline affected area in pen &

indicate time of occurrence

Treating & Caring for Wound

Infection (cont’d.)

• Adequate cleaning, dressing and bandaging can

prevent most infections

• Re-clean wound with water

• Allow the wound to re-open & let it drain.

• Encourage drainage by soaking area in water as

hot as tolerable. Afterward, pack wound in moist

sterile dressing

• Re-clean & repack wound twice a day

• Re-apply antibiotic ointment

• Monitor for signs of infection

Personal & Site Hygiene

• Break into 2 groups:

Group 1:

• Make a list of personal hygiene practices

to prevent infection

Group 2:

• Make a list of “site” hygiene practices to

help prevent infection

Personal & Site Hygiene (cont’d.)

• Personal:

– Hand washing

– Hand sanitizers

– Healthy eating and hydration

– Body washing

• Group:

– Do not sleep with food or scented items near

– Avoid cooking & sleeping in same clothes

– Keep site clean of food debris

– Setup separate areas for cooking, food storage

– Bathroom should be at least 200 feet away

Guidelines for Evacuation

• GO SLOW for any person with wound that

cannot be closed

• GO FAST for any person with wound that is:

– Heavily contaminated

– Opens a joint space

– Involving tendons or ligaments

– Caused by an animal bite

– Is deep &/or on the face

– Involves impalement

– Was caused by crushing

– Is infected, or does not improve in 12 hours

Scenario

• It’s April, your group is biking to camp at

dusk, you see kayakers near rapids. One

kayaker is lying face up on the shore.

Victim is injured by debris in the river after

being ejected.

Questions???

What else could you add to your

First Aid Kit?