Outward Bound Wilderness First-Aid Handbook by Jeffrey Isaac

Author:Jeffrey Isaac
Language: eng
Format: epub
ISBN: 9780762792788
Publisher: Falcon Guides

Properly cleaning a wound can take quite a bit of time, especially if it’s very dirty. Go out in the sun or use your headlamp so you can see what you’re doing. Make yourself comfortable and take the time to do a good job.

Cover the cleaned wound with sterile dressings to prevent contamination. The bandage should not impair circulation or drainage, or prevent wound examination. Meeting these criteria on a wet and dirty expedition can be quite a challenge. Typical first-aid kit adhesive tape and white roller gauze perform poorly in the backcountry or marine environment.

Newer dressings designed for long-term care of open wounds and stasis ulcers offer the medical officer some good options for backcountry use. A sterile, transparent, semipermeable membrane can be left in place for several days. Semipermeable membranes are also combined with colloidal dressings to absorb drainage, keep the wound moist, and prevent external contamination even in very wet and dirty situations. The dressings are expensive but far superior to the standard-issue first-aid supplies when medical care is delayed.

An inexpensive roller bandage known as “vet wrap,” originally developed for veterinary use, can be used for splints or to hold dressings in place far more effectively than tape or elastic wrap. It is water resistant, self-amalgamating, and reusable.

Abrasions and shallow wounds in which only the superficial layers of skin are affected can be dressed with antibiotic ointment alone, or with an easily removed sterile dressing. Because the most common anticipated problem with abrasions is infection, frequent cleaning and inspection is a priority. Antibiotic ointment can also be used alone in difficult-to-bandage places such as eyelids and ears.

Leaving the wound open and allowing it to drain is important. Do not pull the wound edges together with tape or try to suture the wound with your dental floss. Closing a wound in the field is likely to create a nice demonstration of the obstruction to infection principle (see chapter 1)!

Splint the extremity if the wound is over a joint or in another area of skin that is mobile. This will minimize the breakdown of the protective barrier. Unless it restricts travel, it will also make the patient more comfortable.

Wound Treatment

Dressing and Bandaging

Prevent contamination

Allow for drainage

Avoid causing ischemia

Allow for wound inspection

Keep warm; preserve and enhance perfusion

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