WOUNDS and BURNS​

 

GOALS OF WOUND MANAGEMENT:

1. Achieve hemorrhage control (haemostasis)

2. Minimize risk of infection

3. Promote optimal healing

4. Reduce discomfort and minimize disability

5. Minimize loss of function

6. Optimize cosmetic outcome

7. Refer for definitive care when needed

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Evacuation: Consider: Related to patient comfort and logistical considerations- should be considered for any patient

showing signs of localised infection Rapid: Any patient with signs of systemic infection

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WOUND ASSESSMENT: What kind of dirt is it...???

●  CLEAN: a simple wound (eg: cut produced by a blade) in an area of the body with low bacterial count, treated shortly after the wound occurred.

●  DIRTY: a wound in an area with a high bacterial count (eg, axilla, groin) or presenting late (approx 48 hours after wounding)

●  CONTAMINATED: a wound impregnated with organic soil (swamps, jungle), fecal material, or a wound already infected.

WOUND ASSESSMENT: What’s in there...???

●  It’s important to consider the characteristics of wound debris before cleaning.

●  LARGE PARTICLES: without electrical charge (eg: glass, gravel) are largely inert

and unlikely to contribute to wound infection or to impair healing

●  ORGANIC SOILS: (eg: swamp, jungle) hold ionic charge and interfere markedly with

leukocyte function = less bacteria required to start an infection!

●  DIRT: has soil and silica in it- both cause inflammatory responses!

●  FAECAL MATTER: high bacterial content = need to dilute and remove ASAP

●  MARINE: sea water has a high bacterial count = need to clean with fresh water

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WOUND CLEANING: How and with what...?

●  Irrigate, Irrigate....Irrigate!

●  High-pressure irrigation (6–12 psi) is recommended to lower wound infection rates (especially in the case of open fractures).

●  Irrigation should be performed as quickly as possible after the incident.

●  In a wilderness setting, potable water is the preferred solution for wound irrigation.

●  If irrigation is performed, additives SHOULD NOT be used (eg: betadine, iodine, etc)

●  Additives may be added for post-care for irrigated wounds that are considered contaminated.

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A BURN is any injury caused by heat, cold, electricity, chemicals, gases, friction and radiation (including sunlight). [ARC 2016]

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CLASSIFICATION: assess/classify the depth:

●  SUPERFICIAL: redness, swelling, possible blisters

moderate pain

●  PARTIAL THICKNESS: redness, swelling, blisters, severe pain

●  FULL THICKNESS: charring/blackness, “leathery appearance” no pain

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TOTAL BODY SURFACE AREA ASSESSMENT (TBSA):

●  Rule of 9’s Diagram Below

●  Rule of Palms ( The Patient hand represents 1% of their TBSA) 

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TREATMENT:

1. COOL: use the cleanest running water available for a minimum of 20 minutes. Let pain be your guide on when to stop.

2. CLEAR: remove all watches, rings, bracelets. If clothing has become stuck to skin, cut around the burn site- don’t tear it off!

3. COVER: use cling-wrap (or something similar) to cover the burn site once the cooling process is complete. Apply longitudinally.

4. Pre-empt onset of shock- treat for environment.

5. Manage pain- mild analgesia (eg: paracetamol if appropriate) or

   impregnated dressings (eg: Burn-Aid)

6. DO NOT use ice to cool; DO NOT break blisters.

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EVACUATION: Consider: Partial thickness burn greater than 10% of TBSA; Any full thickness burn Rapid: Major burns of the hand, face, feet or genitals; burns with inhalation injury; electrical burns; circumferential burns; burns to a medically ill patient

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