Lemons Guide to Wound Care (Page 1 of 2)

Great post, thanks. (shuffles off to make an appointment for tetanus shot)

One extra tip - when grinding, don't rely on safety goggles. Use a full-face shield. It sounds like overkill until you're grinding bigger ports on your rotary engine end housing and feel a shaving bounce off your cheek and into your eye. Then a week later on a Friday night the shaving (that you thought had fallen out) starts irritating you so bad you have to have your fiance drive you to the ER. Once there the emergency room technician says "I can't do anything but give you this numbing medication. Go see an eye specialist on Monday." You have to work Saturday and Sunday but can't do a damn thing because you have goop oozing out of your eye. Monday morning your eye is feeling fine (and numb) and you go and see the eye doc. He looks and looks and says "I see the rust ring, but the shaving appears to have fallen out." but you never knew because your eye was numb. So you pay the eye doc his $200 (after insurance[/i]) and you pay the ER $400 (after insurance[/i]) and you wonder to yourself. "How the f#$% did that expensive piece of junk get in my eye? I was wearing goggles!"

Just a tip.

curious, what's wrong with Silvadene? I used it a lot when I got road rash back in my cycling days. Current science dictate otherwise? Guess I should google it, huh?

curious, what's wrong with Silvadene? I used it a lot when I got road rash back in my cycling days. Current science dictate otherwise? Guess I should google it, huh?

Disclaimer:  I am a physician.  However, during the course of this post I'll be offering free advice.  Take it for what it's worth ($0.00) and at your own risk.  There is no guarantee that the recommendations I'm about to give will work in your situation.

This post is in direct response to some of the more alarming injuries detailed in the Most Severe Build Injury? thread.  It will cover some basic wound care and infection avoidance techniques.  Again, apply at your own risk.  If you try to die, don't blame me.

Topic #1 - Bad Lacerations:

If you're getting cut to the point where you can see bone, or at least the periosteum covering the bone, please:

1)  Stick a finger on it... then figure out how badly it's bleeding.  If the wound is spraying or pumping or otherwise somehow projecting blood forcibly out of the wound instead of just steadily oozing - worry more.  Keep direct pressure on the cut.  That means one - ONE - finger directly on the source of the spray.  No light dabbling, no palms over the area unless the cut is just that big.  And then KEEP THE FINGER IN PLACE until you get somewhere with help.  Spraying wounds require an ER visit, period.

If the wound is steadily oozing, as most of them do, hold direct pressure (again, just one finger if possible) for at least five minutes.  Picture a radiator leak - if you get the right stuff to the right spot, it will stop.  The body needs at least five minutes to get the right stuff to the leak to really get it to stop.  Yeah, a temporary fix can be achieved in less time, but the leak (ie bleeding) is likely to return.  Then follow point #5.

2) Make DAMN sure your tetanus shot is up to date.  Tetanus is relatively rare these days, therefore if it happens, many docs won't put the picture together if/when someone gets sick.  It's a disease we're all taught about but never see.  We all seem to be in a high risk group, so just avoid the problem by getting the vaccine.

3) Watch joint mobility, especially in fingers.  The tendonous insertions (where the tendons connect to make things move) are funky on the finger.  If, for example, you can't flex your last knuckle, you have a problem.  Common sense, but sometimes folks think, "I can't move it because of pain" even when they're tough and "it doesn't actually hurt all that much" so they let it go.  A fresh tendon injury is fixable.  One that is more than 24h old is much MUCH trickier.

4) Any redness/swelling/increase in pain or for God's sake FEVER means at least a doctor's trip and possibly an EC visit.  Bone-deep injuries (like the kind described by JThw8) are a HUGE infection risk... and bone infections in particular are NOT fun.  They require at least 6 weeks of IV antibiotics.  They suck. 

5) Strategies to avoid infection:  wash the hell out of the wound.  There are good studies that show that tap water is as good as anything found in an ER or OR.  Furthermore, there are more studies that show that the more you irrigate (wash) your wound, the lower the infection risk.  You also need to worry about water pressure; get at least 5-8 pounds per square inch of pressure.  So stick your wounds under a tap on full blast and you'll be fine.

6) Go buy yourself this: 2x2 gauze pad from http://www.medexsupply.com/wound-care-g … 1378.html. Then cover those with electrical tape or duct tape or whatever.  That way you'll have something sterile/clean next to the wound.

Topic #2 - Burns

1) Wash the hell out of them.  See #5 above.  But use cool water.  DON'T put ice straight on a burn, you'll just end up with two type of thermal burns instead of one.

2) Petrolatum ointment (aka Vasalene) works wonders.  Apply liberally.  Also: keep the burn out of the sun and keep it clean.

3) Do NOT use Silvadene.  If you have any around, throw it out.  If you don't know what Silvadene is, never mind.

4) Point #4 applies here as well.

Good luck Lemoners!  I am not available for consults or questions.  I am available for stickin' a finger on it around the paddock, if necessary.

(And for those of you who are still confused, I'm a doctor who is a wife... Not a wife of a doctor.)