Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section IV: Trauma

General Principles

General Principles

Wound Dressing Wilderness Perspective

Barriers to Healing

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Environmental: • Cold - shell/core effect • Wet - breaks down healing tissue • Altitude - hypoxia Medical: • Diabetes - restricted peripheral perfusion • Ischemia - swelling or tight splints • Smoking - vasoconstriction and hypoxia

Xeroform Bioclusive

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High-risk wounds with exposed soft tissue, bone, or other deep structures are best dressed with a moist, antibacterial surface next to the wound. Drying will further damage tissue. Covered xero- form or silver-impregnated dressings are ideal, but a dressing soaked with dilute povidone-iodine solution will suffice. The surface in contact with the open wound should begin sterile and should remain that way for as long as possible. The bandage should not impair circulation or prevent wound examina- tion. Meeting these criteria on a wet and dirty expedition or evacuation can be quite a challenge. Typical first-aid kit adhesive tape and white roll- er gauze perform poorly in the backcountry or marine environment. Newer dressings designed for long-term care of open wounds offer medical practitioners some good options for backcountry use. A sterile, trans- parent, semi-permeable membrane can be left in place for several days. Semi-permeable mem- branes are also combined with colloidal dressings to absorb exudates, 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. 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 an elastic bandage. It is water resistant, self-amalgamating, and reus- able. However, it does not store or perform well in extremely hot conditions.

General Principles

Wound Dressing Wilderness Perspective

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Colloidal dressings: • Absorbs exudate • Keeps wound moist and warm Vet Wrap: • Elastic, self amalgamating • Water resistant • Can be used for bandage or splint, reusable

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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. Since 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 like eyelids and ears. Wounds over or involving joints should be splinted if conditions and travel allow.

General Principles

Wet to Dry Dressing

Covered with Tegaderm clear membrane

Gauze damp with 1% povidone iodine solution

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