Cuts and abrasions happen in the outdoors. It is as simple as being in an uncontrolled environment. Uneven ground. Pushing our limits. Knifes that are not quite sharp.
This chapter will be focused on basic principles. Guidelines to get you through until back at home or the medical facility. Whether the smallest of cuts or a larger wound, there are some common treatment goals in the initial management. We will first outline the guidelines, and then discuss in further detail.
Stop the bleeding.
Clean the wound of foreign objects & debris
Antiseptic or antibiotic ointment
Cover the wound to prevent further contamination
Change the dressing at least once a day; more if able
Watch for infection
Bleeding is not all bad. Bleeding cleanses a wound, pushing small microbes and contaminants out of the body. Just like a pressurized hose pushes objects out, preventing obstruction, bleeding removes some of the contaminants of a wound.
Too much of a good thing is often a bad thing. While a little bit of blood will likely not be missed by the body, a large amount can lead to hemorrhagic shock.
American College of Surgeons Classification Acute Hemorrhagic Shock
| Class I |
Class II |
Class III |
Class IV |
|
|---|---|---|---|---|
| Blood Loss |
<15% (<750 cc) |
15-30% (750-1500 cc) |
30-40% ( 1500-2000 cc) |
>40% (2000 cc) |
| Pulse | >100 bpm |
>100 bpm |
>120 bpm |
>140bpm |
| Blood Pressure |
Normal | Normal | Decreased | Really Decreased |
| Mental Status |
Slightly Anxious |
Mildly Anxious |
Anxious & Confused |
Confused to Lethargic |
After the initial bleed, gentle pressure with a bandage or cloth will typically help the bleeding stop. If a person nicks there chin while shaving, a small piece of tissue speeds up the clotting. Clotting is a combination of two agents in our blood, platelets and coagulation cascade. The platelets are cells that specifically bind together like a chain link fence to hold clot together. The body is attempting to form a damn to stop the bleeding. The clotting cascade are a combination of proteins that then form the clots. There are two pathways to the clotting cascade. One pathway recognizes external tissue like a cloth, and the gentle pressure helps hold the clot together until the pathway completes the process.
On very deep wounds or wounds that involve an artery, additional items can be used to control the bleeding. These will be discussed further in other chapters, but include hemostatic agents and tourniquets.
Often a wound in the outdoors will have grass, twigs, or other items in the wound. The presence and amount will depend upon the mechanism of injury. These foreign objects can contain microbes which can infect the wound.
The most common method to clean the wound is gentle washing with water. Soap is not necessary as this stage is used to rid the majority of the visible debris. The goal to is remove any dirt or foreign objects. Tweezers can be used to pull out smaller items.
Antiseptics reduce the number of infectious organisms within the wound. Antibiotic ointment in a moist material which prevents drying of the wound and also contains antibiotics. Do not confuse either of these with a disinfectant. A disinfectant are applied to non living objects such as a countertop or exam table; a disinfectant in not designed to be used on skin or living tissue.
Commercial antiseptics include povidone-iodine and chlorhexidine. Povidone-iodine is also called betadine. It is a liquid that is dark brown that will reduce the risk of infection. Chlorhexidine is the most common antiseptic now in use for cleaning the skin before an operation. Both are in forms that can be readily maintained in a first aid kit.
Two common household products can be used as antiseptics. Liquid bleach is sodium hypochlorite. It has long been used in medicine as Dakin’s Solution. It has been predominantly used in infected wounds. The other common household product is hydrogen peroxide. Dakin’s solution has different strengths, the strength dependent upon the degree of infection. Again, less is typically more or preferred. Quarter strength is typically used in the hospital for mild to moderate infected wounds.
| Full Strength |
Half Strength |
¾ Strength |
|
|---|---|---|---|
| Bleach |
6 tbsp / 95 cc |
3 tbsp / 48 cc |
1 tbsp + 2 tbsp / 24cc |
| Water (filtered / boiled) |
32 oz / 1 liter |
32 oz / 1 liter |
32 oz / 1 liter |
This is relatively straight forward. Now that the wound is dry and clean, the goal is to prevent further contamination. Gauze or clean cloth can cover the wound until it heals or medical attention can be reached.
By changing the dressing, it keeps the dressing clean. Continued use allows body fluids to accumulate, and be a possible source of infection. Dirt and sweat accumulate.
In addition, by removing the dressing, any devitalized tissue will be removed along with the dressing. This reduces the risk of infection.
All of the above are means to reduce the risk of infection. Infection will increase the healing time. Infection can progress to sepsis and death.
Infection at the wound can be noticed by inspection and smell. If the skin around the wound is getting redder or feels warmer, there is a possibility of infection moving outside the local wound. Drainage is common in a wound. Normal body drainage is serum and looks clear yellow. However, if the color changes to anything other than pale yellow, it is possibly due to infection. Thick mucous drainage is also a possible sign of infection.
Some infections have a strong smell, or are malodorous. Think of old milk or a rotten piece of meat. Any significant odor can be a sign of infection.
Medical attention should be sought at the first sign of infection or a soon as out of the wilderness. Medical attention can inspect a wound, obtain wound cultures, and start antibiotic coverage if warranted. If any concern of infection or delayed wound healing, it is better to be safe than sorry.
If you are of a certain age, you remember when peanuts were served on airlines. Rarely are peanuts passed freely now. We all know why; certain people have an allergy to peanuts.
Cuts and abrasions happen in the outdoors. It is as simple as being in an uncontrolled environment. Uneven ground. Pushing our limits. Knifes that are not quite sharp.
HISTORY OF FIRST AID KITS In many aspects of life, looking at the past can help us understand the future. The story of the first
REQUIRES BOTH TOOLS AND KNOWLEDGE