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
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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
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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:
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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:
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Hand washing
Hand sanitizers
Healthy eating and hydration
Body washing
• Group:
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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:
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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?