Improvised wound management - Revision history

ClaireLewis: /* See Also */

2019-08-15T18:28:02Z

Rossdonaldson1 at 03:12, 17 May 2019

2019-05-17T03:12:40Z

← Revisión anterior		Revisión del 03:12 17 may 2019
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	==Procedure<ref>Auerbach, Paul S., et al. Auerbach's Wilderness Medicine. Elsevier, 2017.</ref>==		==Procedure<ref>Auerbach, Paul S., et al. Auerbach's Wilderness Medicine. Elsevier, 2017.</ref>==
	==Hemostasis==		===Hemostasis===
	*Direct pressure dressings should be first line care to obtain hemostasis		*Direct pressure dressings should be first line care to obtain hemostasis
	*Vasoconstricting sprays (1 mL of 1 : 1000 aqueous epinephrine in 400 mL normal saline) or gels (1 mL of 1 : 1000 aqueous epinephrine mixed with a tube of K-Y Jelly) are useful for superficial wounds		*Vasoconstricting sprays (1 mL of 1 : 1000 aqueous epinephrine in 400 mL normal saline) or gels (1 mL of 1 : 1000 aqueous epinephrine mixed with a tube of K-Y Jelly) are useful for superficial wounds
	*Tourniquets should only be used in cases of severe extremity bleeding when direct pressure fails		*Tourniquets should only be used in cases of severe extremity bleeding when direct pressure fails

	==Anesthesia==		===Anesthesia===
	*If available, use standard infiltration (e.g. lidocaine or bupivacaine) or topical anesthetics (LET [4% lidocaine, 0.1% epinephrine, and 0.5% tetracaine])		*If available, use standard infiltration (e.g. lidocaine or bupivacaine) or topical anesthetics (LET [4% lidocaine, 0.1% epinephrine, and 0.5% tetracaine])
	*When standard options are unavailable, alternatives can be considered:		*When standard options are unavailable, alternatives can be considered:
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	***Vapocoolant sprays (ethyl chloride) are ineffective		***Vapocoolant sprays (ethyl chloride) are ineffective

	==Irrigation==		===Irrigation===
	*Use sterile water or normal saline if available		*Use sterile water or normal saline if available
	*Non-sterile water is still preferable to no irrigation at all		*Non-sterile water is still preferable to no irrigation at all

	==Closure==		===Closure===
	*Glues		*Glues
	**Ideal method in the wilderness as it precludes need for anesthesia and is less painful than suturing		**Ideal method in the wilderness as it precludes need for anesthesia and is less painful than suturing
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	==References==		==References==
	<references/>		<references/>




	[[Category:Procedures]]		[[Category:Procedures]]
	[[Category:Environmental]]		[[Category:Environmental]]

Rossdonaldson1 at 03:12, 17 May 2019

2019-05-17T03:12:09Z

@@ Línea 1: / Línea 1: @@
-==Indications==
+==Overview==
-Improvisation of wound care may be necessary when in the wilderness or when there is a lack of access to traditional medical supplies
+===Principles of Care<ref>Auerbach, Paul S., et al. Auerbach's Wilderness Medicine. Elsevier, 2017.</ref>===
 *Hemostasis
 *Anesthesia
@@ Línea 8: / Línea 6: @@
 *Closure
 ==Hemostasis==
 *Direct pressure dressings should be first line care to obtain hemostasis
@@ Línea 64: / Línea 72: @@
 ***Dental Floss
-==Reference==
+==Complications==
-Auerbach, Paul S., et al. Auerbach's Wilderness Medicine. Elsevier, 2017, ClinicalKey, www-clinicalkey-com.ezproxy2.umc.edu/#!/content/book/3-s2.0-B9780323359429000462?scrollTo=%23hl0001084.
 [[Category:Environmental]]

Rossdonaldson1: /* Reference */

2019-05-17T03:09:56Z

Reference

← Revisión anterior		Revisión del 03:09 17 may 2019
Línea 66:		Línea 66:
	==Reference==		==Reference==
	Auerbach, Paul S., et al. Auerbach's Wilderness Medicine. Elsevier, 2017, ClinicalKey, www-clinicalkey-com.ezproxy2.umc.edu/#!/content/book/3-s2.0-B9780323359429000462?scrollTo=%23hl0001084.		Auerbach, Paul S., et al. Auerbach's Wilderness Medicine. Elsevier, 2017, ClinicalKey, www-clinicalkey-com.ezproxy2.umc.edu/#!/content/book/3-s2.0-B9780323359429000462?scrollTo=%23hl0001084.

			[[Category:Environmental]]

Rossdonaldson1: Rossdonaldson1 moved page Improvised Wound Management to Improvised wound management

2019-05-17T03:07:59Z

Rossdonaldson1 moved page Improvised Wound Management to Improvised wound management

← Revisión anterior	Revisión del 03:07 17 may 2019
(Sin diferencias)

Drueff: Created page with "==Indications== Improvisation of wound care may be necessary when in the wilderness or when there is a lack of access to traditional medical supplies ==Principles of Care== *..."

2019-04-25T17:06:10Z

Created page with "==Indications== Improvisation of wound care may be necessary when in the wilderness or when there is a lack of access to traditional medical supplies ==Principles of Care== *..."

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==Indications==
Improvisation of wound care may be necessary when in the wilderness or when there is a lack of access to traditional medical supplies

==Principles of Care==
*Hemostasis
*Anesthesia
*Irrigation
*Closure

==Hemostasis==
*Direct pressure dressings should be first line care to obtain hemostasis
*Vasoconstricting sprays (1 mL of 1 : 1000 aqueous epinephrine in 400 mL normal saline) or gels (1 mL of 1 : 1000 aqueous epinephrine mixed with a tube of K-Y Jelly) are useful for superficial wounds
*Tourniquets should only be used in cases of severe extremity bleeding when direct pressure fails

==Anesthesia==
*If available, use standard infiltration (e.g. lidocaine or bupivacaine) or topical anesthetics (LET [4% lidocaine, 0.1% epinephrine, and 0.5% tetracaine])
*When standard options are unavailable, alternatives can be considered:
**Injections
***antihistamines (e.g., 1 mL of 5% diphen-hydramine in 4 mL NS for injection)
***Sterile Water
***Bacteriostatic normal saline (alone or 0.2 mL epinephrine 1 : 1000 mixed into a 20 mL vial of NS containing benzyl alcohol 0.9%)
***Opioids
**Topicals
***Ice can be effective to decrease pain before needle injection but can be detrimental to crushed tissue in a wound
***Vapocoolant sprays (ethyl chloride) are ineffective

==Irrigation==
*Use sterile water or normal saline if available
*Non-sterile water is still preferable to no irrigation at all

==Closure==
*Glues
**Ideal method in the wilderness as it precludes need for anesthesia and is less painful than suturing
**Cyanoacrylate (“superglue”)
***Most commonly used as it is readily accessible
***Disadvantage is more frequent wound dehiscence due to lower tensile strength compared with sutures
****Petroleum-based ointments and salves, including antiseptic ointments can weaken glue increasing risk of dehiscence
****Using cyanoacrylate on wounds under tension, such as over joints, can also increase risk for dehiscence
**Other glues such as wood glue, panel adhesive, hobby cement, and various native (e.g., plant) substances may be used but may cause irritation, increase dehiscence risk, or contain toxins

*Staples
**use if available (cannot be improvised)

*Binding and Taping
**Useful for shallow, non-gaping wounds
**Reduce need for anesthesia
**Any tape may be used
**Tapes do not stick well on areas that are hairy, wet, prone to perspiring, or that are under tension
***Fortification of tape closure with glue, bandaging, or more tape can mitigate this effect

*Improvised Sutures
**Needles
***Swaging a Hypodermic Needle (may be done at bedside or in advance)
****Thread suture from sharp end of needle to hub end
****After suture appears on hub end, break the hub off
****pull the suture through the needle so that only a small amount remains within the needle
****Use pliers to crimp the needle at the hub end to hold suture in place
***Alternatively, insert hypodermic needle through both wound edges and thread suture from sharp end to hub. Then retract needle leaving the suture in place and tie
**Suture Material
***Fishing Line
***Horse hair
***Silk or Linen Thread from clothing
***Agave fibers or other plant material
***Dental Floss

==Reference==
Auerbach, Paul S., et al. Auerbach's Wilderness Medicine. Elsevier, 2017, ClinicalKey, www-clinicalkey-com.ezproxy2.umc.edu/#!/content/book/3-s2.0-B9780323359429000462?scrollTo=%23hl0001084.

← Revisión anterior		Revisión del 18:28 15 ago 2019
Línea 76:		Línea 76:

	==See Also==		==See Also==
			*[[Wound care dressing basics]], [[laceration repair]]

	==External Links==		==External Links==