Wilderness Medical Society snowmass 2005 Page 326
Telfa). Secondary infections are dealt with as they arise. A final approach is to apply a full-strength antiseptic
solution, followed by a powdered topical antibiotic, such as tetracycline. An "alternative medicine" technique
that has been reported to me to be effective is to apply Tibet Red Flower Seed Oil (brand "Dragon" is
authentic) four times a day, noting that the application will cause burning pain for a short period of time. No
method has been supported by any prospective trial.
Despite the best efforts at primary irrigation and decontamination, the wound may heal slowly, with
moderate to severe soft tissue inflammation and ulcer formation. All devitalized tissue should be debrided
regularly using sharp dissection. This should be continued until a bed of healthy granulation tissue is formed.
Wounds that appear infected should be cultured and treated with antibiotics as previously discussed.
The patient who demonstrates malaise, nausea, and low-grade fever may have a systemic form of coral
poisoning or be manifesting early signs of a wound infection. It is prudent at this point to search for a
localized infection, procure wound cultures or biopsy specimens as indicated, and initiate antibiotics pending
confirmation of organisms. If the patient is started on an antibiotic and does not improve, a supplemental trial
of a systemic glucocorticoid (prednisone 80 mg tapered over 2 weeks) is not unreasonable. In the absence of
an overt infection, the natural course of the wound is to improve spontaneously over a 4- to 12-week period.
