View source for Improvised wound management

==Overview==
===Principles of Care<ref>Auerbach, Paul S., et al. Auerbach's Wilderness Medicine. Elsevier, 2017.</ref>===
*Hemostasis
*Anesthesia
*Irrigation
*Closure

==Indications==
*Improvisation of wound care may be necessary when in the wilderness or when there is a lack of access to traditional medical supplies

==Contraindications==


==Equipment Needed==


==Procedure<ref>Auerbach, Paul S., et al. Auerbach's Wilderness Medicine. Elsevier, 2017.</ref>==
===Hemostasis===
*Direct pressure dressings should be first line care to obtain hemostasis
*Vasoconstricting sprays (1 mL of 1 : 1000 aqueous epinephrine in 400 mL normal saline) or gels (1 mL of 1 : 1000 aqueous epinephrine mixed with a tube of K-Y Jelly) are useful for superficial wounds
*Tourniquets should only be used in cases of severe extremity bleeding when direct pressure fails

===Anesthesia===
*If available, use standard infiltration (e.g. lidocaine or bupivacaine) or topical anesthetics (LET [4% lidocaine, 0.1% epinephrine, and 0.5% tetracaine])
*When standard options are unavailable, alternatives can be considered:
**Injections
***antihistamines (e.g., 1 mL of 5% diphen-hydramine in 4 mL NS for injection)
***Sterile Water 
***Bacteriostatic normal saline (alone or 0.2 mL epinephrine 1 : 1000 mixed into a 20 mL vial of NS containing benzyl alcohol 0.9%)
***Opioids
**Topicals
***Ice can be effective to decrease pain before needle injection but can be detrimental to crushed tissue in a wound
***Vapocoolant sprays (ethyl chloride) are ineffective

===Irrigation===
*Use sterile water or normal saline if available
*Non-sterile water is still preferable to no irrigation at all

===Closure===
*Glues
**Ideal method in the wilderness as it precludes need for anesthesia and is less painful than suturing
**Cyanoacrylate (“superglue”)
***Most commonly used as it is readily accessible 
***Disadvantage is more frequent wound dehiscence due to lower tensile strength compared with sutures
****Petroleum-based ointments and salves, including antiseptic ointments can weaken glue increasing risk of dehiscence
****Using cyanoacrylate on wounds under tension, such as over joints, can also increase risk for dehiscence
**Other glues such as wood glue, panel adhesive, hobby cement, and various native (e.g., plant) substances may be used but may cause irritation, increase dehiscence risk, or contain toxins 

*Staples
**use if available (cannot be improvised)

*Binding and Taping
**Useful for shallow, non-gaping wounds
**Reduce need for anesthesia
**Any tape may be used
**Tapes do not stick well on areas that are hairy, wet, prone to perspiring, or that are under tension
***Fortification of tape closure with glue, bandaging, or more tape can mitigate this effect

*Improvised Sutures
**Needles
***Swaging a Hypodermic Needle (may be done at bedside or in advance)
****Thread suture from sharp end of needle to hub end
****After suture appears on hub end, break the hub off
****pull the suture through the needle so that only a small amount remains within the needle
****Use pliers to crimp the needle at the hub end to hold suture in place
***Alternatively, insert hypodermic needle through both wound edges and thread suture from sharp end to hub. Then retract needle leaving the suture in place and tie 
**Suture Material
***Fishing Line
***Horse hair
***Silk or Linen Thread from clothing
***Agave fibers or other plant material
***Dental Floss

==Complications==


==See Also==
*[[Wound care dressing basics]], [[laceration repair]]

==External Links==


==References==
<references/>

[[Category:Procedures]]
[[Category:Environmental]]