Lesson 8:Lesson 8:

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

ObjectivesObjectives

• 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 Objectives (cont’d.)(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 & InfectionsWounds & InfectionsOverviewOverview

• 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?

WoundsWounds

What at the Types of 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 BleedingChecking & 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: Practice: Applying Direct PressureApplying 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 PressureDirect Pressure

Pressure PointsPressure 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 TourniquetUsing 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 DemonstrationTourniquet Demonstration

Tourniquet Demonstration Tourniquet Demonstration (cont’d)(cont’d)

Which Technique is Best?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, Wound Cleaning, Closing, DressingDressing

• 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 WoundsCleaning/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/PuncturesLacerations/Punctures

• Wash skin around lacerations/punctures before irrigating

• Punctures need considerable irrigation, since dirt may be deep (especially with animal bites)

Eye InjuriesEye Injuries

Eye InjuriesEye 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 BandagesDressing and Bandages

Guidelines for Dressings & Guidelines for Dressings & Bandages 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 & Guidelines for Dressings & Bandages Bandages (cont’d.)(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 & DressingWound 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 Wound Closing & Dressing (cont’d.)(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 Care/Prevention of Friction Blisters/ChafingBlisters/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

BlistersBlisters

Blister Prevention 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 ChafingPreventing 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 BlistersCare 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 ProblemsCaring 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 BleedsNose Bleeds

NosebleedsNosebleeds

• 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 Nosebleeds (cont’d.)(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 IssuesCaring 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 ScenariosEars/Nose/Teeth Scenarios

• What items in your pack can be used to treat:

• Ear problems?

• Nose problems?

• Teeth problems?

Ears/Nose/Teeth ScenariosEars/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 Caring for and Preventing Bites from Inspects/Snakesfrom 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 DiseasesInsect 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?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? Fact or Fiction? (cont’d.)(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 StrategiesPrevention 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

SnakebitesSnakebites

Venomous SnakesVenomous 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 SnakebiteCare 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 Treating & Caring for Wound InfectionInfection

• 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 Treating & Caring for Wound Infection Infection (cont’d.)(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 Treating & Caring for Wound Infection Infection (cont’d.)(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 HygienePersonal & 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 Personal & Site Hygiene (cont’d.)(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 EvacuationGuidelines 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

ScenarioScenario

• 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???Questions???

What else could you add to your What else could you add to your First Aid Kit?First Aid Kit?