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

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Wilderness and Rescue Medicine

Clean the skin surface with antiseptic or soap and nick the pus pocket. In the field this procedure is reserved for those cases where the pus pocket is obvious and superficial. Do not attempt to incise anything in the deeper layers of the skin or soft tissue.

take you days away from medical help, consider obtaining formal authorization and instructions from a medical practitioner. Although the routine use of prophylactic antibi- otics is controversial, and often of limited benefit, it should be considered for high-risk wounds in settings where surgical follow-up may be delayed for days or weeks. Deep punctures, open fractures, and multiple bites (especially to the hand) are good examples. To be most effective, antibiotics should be administered within 2 hours of injury. Any evidence of systemic infection should be considered a medical emergency. Broad-spectrum antibiotics should be started immediately. Some oral medications can be just as effective as those given by injection and are easily used by wilder- ness EMRs and EMTs with the proper authoriza- tion. Urgent evacuation is required. Septic shock is an anticipated problem. Burns For field management, we need to know the depth and extent of burns, as well as their location. The extent is described in terms of body surface area (BSA), and critical locations include hands, feet, genitalia, and the respiratory system. The circu- latory system can also be affected because burns can cause rapid fluid loss, resulting in shock. Hypothermia is an anticipated problem in large burns.

General Principles

A superficial abscess like this 2 cm lesion in the axilla could be safely incised with a scalpel or sharp knife.

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Applying heat to the infected area will increase circulation and help the body fight the infection locally. Use as much heat as your patient can comfortably tolerate against normal skin for 30 minutes at a time, as often as five to six times a day. Heat can be applied in the form of hot soaks or through contact with a warm rock or hot water bottle.

General Principles

Local Infection

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Treatment: • Incise and drain superficial abscess.

• Irrigate and dress. • Allow for drainage. • Hot soaks 4 x a day

General Principles

Burns

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• Antibiotics • Evacuation

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“Field treatment may improve s/sx, but continue to monitor for systemic infection.”

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Drainage and heat applications often cure a wound infection, but antibiotics are considered to be part of the ideal treatment whenever surgical care is unavailable. Although not usually within the scope of practice for emergency medical responders (EMRs) and EMTs in the urban con- text, these drugs may be a worthy addition to your wilderness treatment protocols. If your duties

Partial Thickness • Intact sensation • Red and inflamed • Blisters

Full Thickness • Reduced sensation • No blisters • Black or leathery

Superficial • Intact sensation • Red - inflamed • No blisters

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Estimates of irregular burns can be made using the entire palmar surface of the patient’s hand, which is about 1% of the body surface area. The