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Backpacker Magazine – May 2013

Treat Deep Wounds

Miles from the trailhead, your hiking partner springs a gusher after taking a fall on an iffy scramble. Here's what to do.

by: Ted Alvarez

PAGE 1 2

1. STOP THE BLEEDING
Use firm hand pressure and gauze (or your cleanest T-shirt) to stanch the flow. If possible, lift the wound above heart level and hold pressure steady for at least 10 minutes. If surface pressure won’t stop the bleed, you may have to insert your fingers into the wound to put direct pressure on the vein or artery.

Last resort Only consider a tourniquet if you’re prepared to trade the gushing limb to save the victim’s life. Learn more about tourniquets at backpacker.com/lifeorlimb.

Pro gear A couple of 2-inch and 4-inch ABD (army battle dressing) pads ($1 at pharmacies) are all you need, says Tod Schimelpfenig, Curriculum Director at NOLS Wilderness Medicine Institute. “If they’re not enough, use extra clothes.”


2. CLEAN THE CUT
A dirty wound is the perfect place for a bacteria-laden infection. Prevent it: Once bleeding stops, lift the dressing and direct potable water into the wound at a perpendicular angle from 1 to 2 inches away. Use at least 8 ounces of water, or as much as needed to flush dirt and debris from inside the wound.

Last resort Absolutely no treated water available? In a group: While one person stops the bleed, have another boil water to use for washing out the wound. Alone: Make a judgment call on cleanish sources of water like creeks or springs.

Pro gear Pack latex gloves on every trip (in a zip-top bag). Also add a plastic syringe—the wound-spraying tool of choice for EMTs—to your first-aid kit. (Improvise with your hydration-bladder hose.)


3. ASSESS RIPPED SKIN
Got a gaper? Leave suturing to the pros, but use ¼- to ½-inch-wide strips of medical or duct tape to close a cut (see below). Know when to leave wounds open: Animal bites, crushing injuries, and punctures are all at high risk for infection. Pack with moist gauze and dress as best you can, but don’t close them.

Last resort Superglue is FDA-approved for skin, but save it for very neat, clean cuts (like a knife slip), because you risk sealing bacteria inside. Better? Dermabond ($29; .5 ml vial; amazon.com) is easier to remove for follow-up care.

Pro gear Keep tape and even moleskin in place by first applying Mastisol Liquid Adhesive, a medical glue that makes skin super sticky ($3; .6 ml vial; metromedicalonline.com).


4. DRESS THE WOUND
Irrigate, then dress with a moistened pad (use antibiotic ointment if you have it), followed by a dry one. Far from help? Change a wound’s dressing every 12 hours, being careful not to restart bleeding when you remove padding. Monitor closely for infection. If the wound starts to swell, ooze, stink, or turn red, reopen the dressing, clean the wound, and leave it open. See signs of infection? Get to a hospital asap; deadly sepsis can set in within six hours.

Last resort Only have dirty clothes? Boil them. If you don’t have a multiday supply of gauze, you can boil, dry, then reuse it.

Pro gear Stuff a few antibiotics in your first-aid kit. (Ask your family doc about a prescription for ciprofloxacin or azithromycin.) They’ll slow the onset of most infections.

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READERS COMMENTS

Star Star
Katy L
May 26, 2014

Seriously!? Don't stick your fingers in a wound!!! First of all super unsanitary, secondly if you do you run the risk of opening the wound even more, thirdly if you do this and then remove your finger once the bleeding has stopped any clot that has formed beneath your finger will more than likely pull away with it. Also it isn't mentioned here but only attempt to close a wound that has been thoroughly cleaned (I'm talking an entire liter of drinkable water!) and doesn't have more than a 1/2 inch wide gape (width not lengthwise) anything wider should be packed with sterile moist gauze and evacuated to definitive medical care as quickly as possible. There is also a comment that says you shouldn't raise a persons legs because there isn't much benefit to it and there is a risk of additional injury, the benefit hasn't been proven but it also hasn't been disproven, as for the risk of additional injury there are two types of injury I could see potentially occurring with this practice. The first is the stress placed on the cardiac system by the increase in blood flow to the heart, however this is only going to cause an issue if the person is going into cardioginic shock but a person who is losing blood is going to be going into hypovolemic shock. The second type of injury would be the potential to exacerbate a spinal injury caused during the original trauma, to be honest though if this is your first aid training course? you've already made the spinal damage worse just getting them into a position where you are going to feel comfortable helping your patient and you should focus on keeping them alive until you can get definitive medical care.

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Amanda Sass
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Two corrections - Get rid of the latex gloves - to many latex allergies and you never know who you might need to help. Replace with Nitrile. Shock - no longer recommended to raise the legs - not much benefit and a greater risk of additional injury to the victim

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