First aid treatment of open soft tissue wounds and infections.




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  1. #1
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    Default First aid treatment of open soft tissue wounds and infections.

    See thread http://www.4x4community.co.za/forum/...385#post973385

    As a surgeon based on the coast I have to deal with infected marine- acquired soft tissue lacerations on a very regular basis. I hope members will find the basic and common sense advice herein helpful. If treated promptly and adequately on site, the need for medical attention and hospitalisation may be obviated.

    The particular emphasis placed on marine injuries does not detract from other wounds, as the same principles apply. Marine and coral injuries are particularly prone to infection as the marine environment carries a large load of harmful bacteria. This applies to injuries from coral as well as those emanating from any breach of the skin in the marine environment, such as a fall on the rocks, a laceration or scratch from a fish or fish hook or Sea Urchin.

    Stings from marine creatures such as coral, Blue Bottles or Jelly Fish often produce an itchy rash, swelling and local pain due to the toxin injected. Severe and even fatal allergic reactions can occur but are rare. Inactivation of the toxin is usually best achieved by immersing the body part in water as hot as can be tolerated. This denatures the protein in the toxin and neutralises its effect fairly rapidly but may need to be repeated. Please be sure to test the temperature first by immersing an unaffected hand in the hot water for a minute or so to make sure it is not too hot. Secondary infections can occur but are rare.

    The following measures apply to all potentially infected soft tissue injuries, marine or otherwise.

    1. EARLY and vigorous cleaning of the wound even with simple soap and water, but preferably with cooled boiled water containing a DILUTE antiseptic such as Savlon, Dettol or Betadine. Please do not make the antiseptic concentration too strong as this further damages the body tissues and lowers local immune defences to fight the infection.

    2. Try to remove all foreign particles as these can remain the nidus for further infection. Remove ALL pieces of coral and Sea Urchin spines as soon as possible, as after a day or two as they tend to soften and disintegrate and are difficult to remove completely even with a needle.

    3. If there appears to be some dead or badly damaged tissue, medical help and debridement is fairly urgent.

    4. I prefer Bactroban ointment to others and it should be applied onto and into the thoroughly cleaned wound. Mercurochrome is only suitable for superficial scratches that can be left open. Merthiolate differs only that is is in alcohol and should not be used as the alcohol causes further tissue damage.

    5. The wound should be irrigated and swabbed as in section 1, three times a day initially, re-applying the Bactroban. Many wounds should not be sutured initially because of the dangers of trapping infection within. At each dressing change carefully inspect the wound for any worrying signs of spreading infection.

    6.Elevation, if a limb is affected, is very important, to reduce swelling and the chances of a spreading infection.

    7.Most important is to seek medical attention early where appropriate, especially in a wound that appears to be at risk for a significant infection. This especially applies if there may be dead tissue.

    8. Antibiotics are deliberately mentioned towards the end. Beware of offering them to people you don't know, because if there is a adverse reaction they may hold you to account. If you feel an antibiotic is needed this should already be an indicator that a doctor needs to have a look. We carry broad spectrum antibiotics such as Augmentin ( beware of Penicillin allergy), Ciprobay or Avelon. Generics are fine. Often, in a severe case, antibiotics can be initiated whilst awaiting medical opinion. Antibiotics should never be a substitute for adequate wound care.

    Stan Weakley.
    Landcruiser 76SW.

    “Great journeys are memorable not so much for what you saw, but for where you camped”.

    At least "Once a year go someplace you have never been before" Delai Lama.

    TransAfrica 2015/2016 blog www.slowdonkey.com

  2. #2
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    Thanks Stan, that's an excellent addition to the offroad armoury! I think it is worth adding here that (and please correct me if I have the terminology wrong) in damp, tropical conditions, soft skin infections can fairly quickly turn into tropical ulcers, and get right down to the bone (I have had some nasty ones, with a real baddy while travelling by boat up the Zambezi with no way off the river for several days). We always carry Augmentin in our medical kit (none of my family has an allergy to penicillin) and it is worth mentioning that it is also useful should someone develop a dental abscess in a remote area. I'm glad to hear of your faith in Bactroban as I always have a couple of tubes in my medical kit.
    Question: What should the dilution ratio be of Dettol/Savlon to water?
    Last edited by Tony Weaver; 2011/11/26 at 05:26 PM.

  3. #3
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    Tropical ulcers are fearsome and take ages to heal. One sees many of them on the locals but I do not have much experience in treating them. I am sure general principles apply.

    Dilution of antiseptics? There are not usually instructions on the label. Rather on the dilute side, about 4 caps per litre.
    Landcruiser 76SW.

    “Great journeys are memorable not so much for what you saw, but for where you camped”.

    At least "Once a year go someplace you have never been before" Delai Lama.

    TransAfrica 2015/2016 blog www.slowdonkey.com

  4. #4
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    Quote Originally Posted by Stan Weakley View Post
    Tropical ulcers are fearsome and take ages to heal. One sees many of them on the locals but I do not have much experience in treating them. I am sure general principles apply.

    Dilution of antiseptics? There are not usually instructions on the label. Rather on the dilute side, about 4 caps per litre.
    Great stuff Stan - especially the issue of dillusion. I for one would have gone for neat Dettol etc for maximum effect on a wound.

    Just a question - as a professional should you not have a disclaimer on your advice.
    Cheers

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  5. #5
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    Keith, I do get your point about a disclaimer and have spent some time thinking about it. But it is indeed a sad world that leads well meaning people to even consider the need for a disclaimer. Fortunately I do have the credentials to back this guide and have posted this information in good faith. If anything adverse should ever come of my advice I would just have to face up to my responsibilities. This I have to do many times a day in the normal course of my work. I don't think a disclaimer would carry any weight legally?

    However, you have got me thinking about the type of frankly irresponsible medical advice some individuals feel compelled to post from time to time. I refer to boasts that prophylaxis for malaria is not needed and that they have managed to get away with XYZ. These are the people that should be covering themselves with disclaimers.

    You are correct though, the social climate is changing as evidenced by the fact that my medical liability insurance is now in excess of R150,000 per annum. Thanks be that as yet, the insurers are making a massive profit out of me.

    Thanks for your thought provoking comment. I shudder to imagine the day I would feel it necessary to issue a disclaimer for my professional advice. Perhaps that day would herald that the time has come for me to pack away my tools and head off on my long anticipated trans-Africa expedition.

    Further comments on management of wounds in the bush are welcome. I am quite happy with my ethical and moral obligations. At the end of the day I am just a happy camper like the rest of us.

    Stan.
    Landcruiser 76SW.

    “Great journeys are memorable not so much for what you saw, but for where you camped”.

    At least "Once a year go someplace you have never been before" Delai Lama.

    TransAfrica 2015/2016 blog www.slowdonkey.com

  6. #6
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    Thanks Stan.

    I was also advised this by my GP after an infection.

    He also advised me to check my First Aid kit at least once a year for and expired medication, and replace any that had been opened.

    Do you have further advice on this.
    Discovery 3 TDV6 S G4 No 29 - Mine
    Discovery 4 TDV6 SE - SWAMBO's

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