In the big food chain, big meateaters munch smaller meateaters and humans find themselves, except for an occasional bear attack, comfortably at the top of the order and ready to eat anything. But then there's the invisible world of microorganisms in which you might be the food of invading germs. Doorways to that world are invitingly opened when you get scraped, sliced, hacked, or otherwise disturbed along the natural barrier, your skin, that stands between you and bacteria, viruses and parasites. Open wound care needs to accomplish three things: 1) stop dangerous blood loss, 2) prevent infection, and 3) promote healing.

If you're not the one bleeding, before contacting another person's blood or other body fluids, you should put on surgical gloves. Human blood may provide a home for many nasties you don't want in your body. Almost all bleeding can be stopped with pressure from your gloved hand applied directly to the open wound, and elevation of the wound above the bleeder's heart. Without gloves you're at the mercy of the germ gods. You can safely allow many small wounds to bleed to a stop which, in many cases, helps clean them.

Heavier bleeding wounds are best stopped with sterile gauze, but when in desperate need you can stuff whatever's available into the wound and apply pressure to that. Direct pressure should not be applied to heavily bleeding neck wounds (which may shut off the airway) or eye wounds (which may lead to blindness). Neck and eye wounds require careful pinching closure of the wound until the bleeding stops.

WOUND CLEANING
Open wounds should be properly cleaned in order to prevent infection and promote healing. The best method of wound cleaning is mechanical irrigation and the best irrigation fluid is clean fresh water or a solution of diluted povidone-iodine. You can carry povidone-iodine solution in your first aid kit or prepare it by adding an ounce of povidone-iodine to a liter of the cleanest fresh water you can find. Shake it up and wait at least five minutes to allow the iodine time to disinfect the water completely. A teaspoon of salt dissolved in this solution increases its effectiveness. (Warning: This solution is not safe to drink.) Draw the solution up into an irrigation syringe. Hold the syringe two to four inches above the wound and perpendicular to the wound, and push down on the plunger forcefully. The wound should be tipped allowing the solution to run out. Repeat until at least half a liter of solution has been forced through the wound. If visible contaminants are left embedded in the wound, they should be carefully removed with tweezers. The tweezers should be disinfected before use. Then continue irrigation with the second half of the liter of solution.

Without an irrigation syringe, you can put the solution is plastic bag, punch a pinhole in the bag, and squeeze the solution out forcefully. Or you can melt a pinhole in the center of the lid of a water bottle with a hot needle, and squeeze the water out forcefully. Irrigation has proven a better method of wound cleaning than scrubbing or soaking unless you're dealing with a scrape and not a cut in which case a good scrub still works best. Scrubbing of abrasions should be vigorous and often requires three to four people . . . one to scrub and several to hold the patient down. Scrubbing can be accomplished with clean fresh water and a gauze pad, but detergents are better, helping to lift out germs and debris. Good agents for scrubbing include Ivory Soap, Green Soap Sponges, Betadine Scrub, Hibiclens and Klenz Gel Blu. But any soap will do. If detergents are used, follow scrubbing with a thorough flushing with clean fresh water.

WOUND CLOSURE
After cleaning small wounds, facial wounds, or scalp wounds, if they gape open, they can be closed with closure strips. If hair gets in the way, it can be carefully clipped short, but it should not be shaved off. Begin by smearing a line of tincture of benzoin compound, if you have any, along both sides of the wound. Benzoin is an irritant so take care to keep it out of the wound. Let the benzoin dry for about 30 seconds. Benzoin's stickiness will help keep the closure strips in place. Touch the closure strips only on their ends. Apply one to one side of the wound and another to the opposite side. By using the opposing strips as handles, you can pull the wound edges together, pulling the skin as close as possible to where it should lie naturally, but without pulling the wound tightly shut.

Large dirty wounds, wounds caused by animal bites and wounds that open a joint space are best left open. They are difficult to clean well enough to prevent infection. Exceptionally dirty wounds should be packed open with sterile gauze to allow them to drain until a physician can be consulted.

WOUND DRESSING
Open wounds heal better and faster if they are kept slightly moist. Begin by applying an antibiotic ointment over the closed cut or scrape. Dress the wound with a non-adherent sterile dressing, making sure it completely covers the wound. Dressings that stick to the wound will slow the healing process. Finish with a protective gauze pad which you tape in place or wrap in place with a roll of stretch gauze. Small wounds can be covered with Spenco 2nd Skin which protects, moisturizes, and soothes.

Relatively recent additions to open wound management include micro-thin film dressings such as Tegaderm and Bioclusive. They have special value if you're going to stay in the woods. They allow air to pass through, so they speed healing, and they are waterproof, so they don't wash off, and they are see-through, so you can watch the wound for signs of infection as it heals.

WOUND INFECTION
Check all wounds regularly for signs of infection. Signs of infection include 1) increasing pain, redness, and swelling, 2) draining of pus from the wound, 3) appearance of red streaks just under the skin near the wound, and 4) systemic fever.

If you see signs of infection, open the wound back up and let it drain. You may need to encourage opening and draining by soaking the wound in disinfected, slightly-salty hot water. Pack the wound with sterile gauze to keep it open, and re-clean and re-pack the wound at least twice a day. Consult a physician as soon as possible.

Long-term care of infection is aided by the appropriate use of antibiotics. A physician should be consulted concerning which antibiotics should be used, and how they should be used. Follow the physician's instructions implicitly.

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