Wilderness and Rescue Medicine 8th Edition

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Wilderness and Rescue Medicine

Wound Infection In normal wound healing, the pain, swelling, red- ness, and inflammation decrease quickly within the first 2 or 3 days. If the wound becomes infect- ed, these signs and symptoms begin to increase instead. Pus develops as the cellular debris and edema fluid accumulate in the wound. Infection is a possibility in any wound at any time during the healing process but is most likely to develop within 2 to 4 days after injury. If a local infection spreads, it will ultimately enter the general circulation and cause a systemic infection. This is referred to as blood poisoning, lymphangitis , or sepsis . The symptoms of this whole-body inflammation include fever, skin redness, body aches, general malaise, and ulti- mately septic shock (a form of vascular shock). Even simple wounds like blisters that become infected present some risk of progressing to life- threatening sepsis.

General Principles

Traumatic Amputation • Wrap the part in sterile, moist, dressing. • Keep the part cool, transport with patient. • Control bleeding with direct pressure or tourniquet. • Do not complete partial amputations. • Splint the extremity. • Emergency evacuation. 21 *

© 2018 WMA

If the scene is more remote, replantation is not in the plan. Manage the stump as a high-risk wound; antibiotics, daily dressing changes, medical care when possible. Bury the dismembered tissue. In such cases, completing a partial amputation may be reasonable. Rabies Rabies is a viral infection nearly always fatal in humans. It is transmitted via the saliva of an infected animal, usually from biting or licking. It is most common in bats, dogs, and cats, and in mesopredators like raccoons, foxes, and skunks. Most of the time, an exposure is obvious. With bats, a bite or other exposure to saliva may go unnoticed. The mere presence of a bat inside a house may be reason enough to give rabies post- exposure prophylaxis (PEP) to the human inhab- itants. Consult the Centers for Disease Control and Prevention (CDC) or an experienced prac- titioner for advice. Because rabies vaccine may not be available in low resource areas, vaccination may be indicated before long voyages and travel in developing countries. Post-exposure prophylaxis consists of immedi- ate and vigorous wound cleaning with warmwater and soap, followed by irrigation with povidone- iodine solution. In animal bite wounds, the benefit of killing a potentially fatal virus justifies the risk of tissue damage caused by the soap or solution. The patient should then be urgently transferred to a medical facility equipped to provide rabies immune globulin and vaccine.

General Principles

Wound Infection

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Local Infection: • Increasing redness, pain, warmth, swelling • Most likely to develop days 2 –4 • Drainage or accumulation of pus (abscess) Systemic Infection: • Fever, malaise, regional swelling

• Lymphangitis (red streaks) • Vascular and volume shock

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© 2018 WMA

Treatment of Wound Infection If the infected wound has been closed with tape, sutures, or staples, it should be opened, irrigated, and allowed to drain. Avoid forcefully squeezing the purulent material from the wound or else you may drive bacteria through the protective barrier into healthy tissues. At some point in your past, you’ve probably seen a minor pimple become a large abscess because of this practice. If an abscess has formed in the dermis close to the surface, it can be safely opened with a sharp blade, and then irrigated and allowed to drain.