Wilderness and Rescue Medicine 8th Edition

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Wilderness and Rescue Medicine

Wound assessment is an important skill. Some wounds can appear simple, involving only the dermis and fat layers. On closer inspection, you may find that the fascia is interrupted, and deep structures are contaminated. A good field exami- nation may take some time and involve careful probing with instruments or fingers. You should consider all wounds to be high risk until proven otherwise.

High-Risk Wounds High-risk wounds are those that carry a signifi- cant risk of infection or are likely to cause func- tional problems during early healing. Wounds associated with life-threatening bleeding or criti- cal system injury are also considered high risk. Aggressive field treatment and early evacuation for debridement is ideal. Some examples of high- risk wounds are as follows: Grossly contaminated. Injuries with imbed- ded foreign material, such as gravel, sawdust, or clothing fibers harbor bacteria that is difficult to dislodge. Mangled. Wounds that involve crushed, shred- ded, or dead tissue provide a growth medium for bacteria. Deep. Wounds that penetrate the fascia to expose joints, tendons, and bones are difficult to clean adequately, and are prone to serious infection. Bites (from humans or other animals). Mouths harbor a wide variety of virulent organisms. Human and cat bites are among the worst. Any wound exposed to human or animal saliva con- stitutes a bite wound. Punctures. A small opening in the skin with a wound track that extends through several layers of tissue deposits bacteria in areas that are unable to drain properly.

Wounds involving deep structures like this knee laceration into the joint space are considered at high risk for infection. The fascia is easily identified as a tough, dull- white layer of tissue resembling unfinished fiber- glass. Underlying structures like tendon, bone, and joint surface appear shiny and white or yellow. Muscle underlying the fascia appears deep red, like a raw steak.

General Principles

Wrist laceration (below)

General Principles

Wound Assessment

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High Risk: • Penetrates fascia, involves deep structures • Critical system involvement • Contaminated, crushed, devitalized tissue

Knee laceration ( above )

• Open fractures • Deep punctures • Bite wounds (animal saliva)

These wounds are small, but penetrate far enough to lacerate tendon sheath and tendon. These are high - risk wounds.

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© 2018 WMA

“High -risk wounds are those that carry a significant risk of infection or are likely to cause functional problems during early healing.”

The depth of the wound in millimeters is far less significant than the layers penetrated. An eyelid laceration a few millimeters deep may

© 2018 WMA