WOUNDS and BURNS
GOALS OF WOUND MANAGEMENT:
Achieve hemorrhage control (haemostasis)
Minimize risk of infection
Promote optimal healing
Reduce discomfort and minimize disability
Minimize loss of function
Optimize cosmetic outcome
Refer for definitive care when needed
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
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
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.
A BURN is any injury caused by heat, cold, electricity, chemicals, gases, friction and radiation (including sunlight). [ARC 2016]
CLASSIFICATION: assess/classify the depth:
● SUPERFICIAL: redness, swelling, possible blisters
● PARTIAL THICKNESS: redness, swelling, blisters, severe pain
● FULL THICKNESS: charring/blackness, “leathery appearance” no pain
TOTAL BODY SURFACE AREA ASSESSMENT (TBSA):
● Rule of 9’s Diagram Below
● Rule of Palms ( The Patient hand represents 1% of their TBSA)
COOL: use the cleanest running water available for a minimum of 20 minutes. Let pain be your guide on when to stop.
CLEAR: remove all watches, rings, bracelets. If clothing has become stuck to skin, cut around the burn site- don’t tear it off!
COVER: use cling-wrap (or something similar) to cover the burn site once the cooling process is complete. Apply longitudinally.
Pre-empt onset of shock- treat for environment.
Manage pain- mild analgesia (eg: paracetamol if appropriate) or
impregnated dressings (eg: Burn-Aid)
DO NOT use ice to cool; DO NOT break blisters.
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