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

1 29

Section IV: Trauma

If a blister does form, it is important to remem- ber that a blister is a sterile wound until it breaks. The best treatment is to leave the overlying skin intact until healing can start. Small blisters can be covered with gel dressing. Larger ones usually cause some degree of disability unless you can take the pressure off. If the blister has formed in a challenging spot, like the back of the heel, you may have to drain it to allow the patient to keep moving. As in drain- ing an abscess, clean the skin around and over the blister with soap and water or antiseptic. Sterilize a sharp knife blade using flame or iodine. Make a small incision in the blister at the lower mar- gin and allow the fluid to drain out. Leave the skin over the blister intact to act as its own sterile dressing. Cover the area with antibiotic ointment and dress it as you might a hot spot. Like any open wound, it must be cleaned and dressed daily, and monitored for signs of infection. Avoid draining blood-filled blisters. Open blisters occur when a blister has broken into a non-sterile environment. An open blister should be treated like an abrasion. Cut away the dead skin and irrigate to remove debris. Cover the wound with antibiotic ointment and sterile dressings. Clean daily and monitor for infection. Fix the source of friction with padding or tape.

debridement, and irrigation has been shown to substantially reduce infection rates, especially when accomplished immediately after injury. Early wound closure with staples or sutures does not carry the same benefit and does not justify a high-risk evacuation to a hospital or clinic. Prophylactic antibiotics may reduce the risk of infection in some wounds and should be seri- ously considered in any high-risk wound. Like wound cleaning, early treatment will yield the best protection.

General Principles

Wounds and Burns Wilderness Perspective

33

High Risk Problem: • Large surface area burns

• Systemic infection (lymphangitis, fever) • Pain out of proportion to apparent injury • Uncontrolled bleeding or fluid loss • Respiratory involvement in burn • Rapidly progressing local infection • Distal ischemia

*

©2018WMA

General Principles

Blisters

32

Specialized Dressings • Maintain moisture and sterility • Protect from abrasion • Relieve pain

©2018WMA

Risk Versus Benefit in Wound Care

Early wound cleaning is a low-risk procedure for a high-risk problem. Conscientious inspection,