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Wilderness Medical Society - snowmass 2005 (Page 193)

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Wilderness Medical Society - snowmass 2005
23
Chapter 6
WOUND MANAGEMENT

Recommendations are considered Category 1B, except where indicated 1A or 2, by the
WMS Panel of Expert Reviewers.

I. GENERAL INFORMATION
Assume contamination of open wounds and treat accordingly. The major goals are: 1)
stop blood loss; 2) clean the wound and keep it clean; 3) promote healing and reduce
discomfort; and 4) minimize loss of function. Most wilderness first aid kits contain
simple bandages and compresses only. Improvisation and the use of substitute materials
are often required. Wilderness wounds are at risk for tetanus. Ensuring current tetanus
immunization prior to participation in wilderness activities is encouraged.
II. GUIDELINES FOR ASSESSMENT AND TREATMENT
Wear fluid barrier gloves when contacting blood or other body fluids. Improvised
personal protection could include, for example, a plastic food bag or piece of garment to
minimize contact with the victim's blood, and sunglasses or ski goggles to protect your
eyes.
Even heavy bleeding can be controlled with pressure techniques in nearly all
instances. Initially, apply direct digital pressure over the bleeding vessels and elevate the
wound. Alternately, stop severe bleeding by placing two fingers, held together, into the
wound. This temporary stasis is continued through the use of an internal pressure
dressing made by taking a moist wad of gauze or clean cloth and packing it firmly into
the wound. This is held in position with strips of gauze or tape. These strips are not
circumferentially tight, but just cover and hold the packing gauze in place. Pressure
points alone are not effective as a primary technique to control bleeding, but may be
useful as an adjunct. Arterial tourniquets are rarely necessary and, if used, they must be
released approximately every five minutes, while continuing to apply direct wound
pressure, to assess the continued need for the tourniquet. Assessment of continued
bleeding can be accomplished within 1 second of release. However, continuous
tourniquet application is preferred to allowing additional heavy blood loss. (See
Controversy section below).
Contusions: During the first 48 hours, contusions may be treated with cold
compresses or cold-water immersion, and a compression dressing, to limit expanding
hematomas and to aid in pain relief. Apply cold for one half hour every two hours with
due regard to possible cold injury. After 72 hours, apply heat in the same manner to
promote healing. Topical heat ointments or creams can cause skin irritation, and their use
is discouraged. Large contused areas with marked swelling cause severe pain and
disability and may signal a large amount of blood loss or a significant underlying injury.
Evaluate such patients for shock and other possible injuries and treat accordingly. Do not

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