Basic steps in wound care

Stop bleeding in time, clean thoroughly, disinfect as needed, close for protection, and observe dynamically. If the wound is so deep that fat can be seen, the bleeding cannot be stopped, or it is pierced by rusty/dirty things, don’t deal with it yourself. Go directly to the hospital for debridement and suturing. This is the prerequisite for all care.

An important point: if the wound is deeper than 1cm, yellow fatty tissue can be seen, is punctured by rusty iron or dirt, and is still bleeding after being pressed for 10 minutes, don’t mess around on your own, go directly to the hospital for debridement, and tetanus if necessary.

When it comes to stopping bleeding, many people’s first reaction is to raise their arms and sprinkle powder on the wound. In fact, there are many misunderstandings here. I have seen too many people cutting vegetables on their hands at community clinics. Their first reaction is to run to the clinic with their arms raised. In fact, for ordinary superficial wounds, just apply clean gauze or cotton balls to the wound, and it can basically stop in 2-3 minutes. At present, there is still a little controversy about the hemostasis posture in the emergency field: European and American guidelines believe that local compression is enough, and whether it is raised or not has little impact on the speed of hemostasis. ； Many experienced nurses in China still advise patients to lift the injured part higher than the heart, which can at least reduce the amount of bleeding. There is nothing wrong with either approach, whichever is more convenient. Oh, by the way, if you don’t have clean gauze at home, you can just use a freshly opened pure cotton towel to press it. Don’t use lint-free rags or dirty paper towels, which will easily stick debris to the wound.

The first step after stopping bleeding is cleaning, which is even more controversial. In the past, elders always said that "wounds should not be exposed to raw water, as they will become infected." Now the International Wound Care Association's guidelines clearly state: For fresh superficial wounds, rinse them with running room-temperature municipal tap water for 1-3 minutes to remove the sand and dust in the wound. The cost-effectiveness is much higher than that of normal saline, and the risk of infection is less than 0.1%. Last time, I picked up a child whose knee was scratched by sliding on the slide. The mother insisted on bringing saline solution to wipe it. The child kicked up in pain. In fact, I took a bottle of room-temperature mineral water and rinsed it for two minutes. All the sand was washed away, and the child almost didn’t feel any pain. Of course, this does not mean that the old experience is completely wrong. If you were injured in the wild, surrounded by only surface water from unknown sources, or your immunity is particularly weak, it is safer to clean with sterile saline. There is no absolute right or wrong, it depends on the situation.

After cleaning comes disinfection, which is the hardest hit area. I have seen too many people pour 75% alcohol directly onto the wound. They grimaced in pain and thought "it kills bacteria quickly". In fact, irritating disinfectants such as alcohol and iodine will directly kill the new granulation cells on the surface of the wound. The pain is secondary, and it will also slow down the healing speed. Nowadays, the routine first choice is iodophor, which has almost no stinging sensation when touching the wound, and the disinfection effect is sufficient. Of course, this does not mean that alcohol cannot be used at all. If the skin around the wound is particularly dirty, it is okay to wipe the intact skin around the wound with alcohol for peripheral disinfection. Many grassroots hospitals still use iodine + alcohol deiodination to treat heavily contaminated wounds. Just don't pour it directly on the wound. By the way, don't sprinkle toothpaste, incense ash, or unsterilized medicinal powder on the wound. Last month, I picked up a worker at a construction site. After breaking his arm, he sprinkled cigarette ash on it. When it came, the wound was stuck with cigarette ash. I suffered a lot during the debridement. Of course, if there are no sterilization conditions at all in the wild, it is possible to use clean Yunnan Baiyao powder to stop bleeding in an emergency. However, you must go to the hospital for re-debridement afterwards, and don’t just leave it sealed.

The two factions have been quarreling for several years over the next part of the protection process. The older generation believes that wounds should be left open to heal quickly after scabs form. ； The current school of wet healing advocates that as long as the wound does not exudate much, put a breathable hydrocolloid dressing or a thin band-aid on it to keep it moist and prevent water from entering. The healing speed is 30% faster than leaving it open, and it is less likely to leave scars. I personally tested it. The last time I cut vegetables, I cut my fingertips. I put a thin band-aid on it and it grew back in three days. If it was left to dry, it would take at least a week. It still hurts every time. Of course, it doesn’t mean that it’s wrong to let it dry. If the weather is particularly hot and the wound is exuding a lot, it’s okay to leave it open for an hour a day to let it breathe. If it needs to be exposed to water, put a waterproof band-aid on it. After washing, take it off and let it dry for a while. Don’t keep it stuffy all the time. It’s as comfortable as you want. There aren’t so many rigid rules.

Finally, don’t think that it’s done after applying disinfectant and band-aid. You have to keep an eye on it. If the pus is still oozing 2 days after the injury, the redness and swelling are getting larger and larger, the pain is worse than when the injury was first made, and you even have a slight fever, don't carry it and go to the hospital quickly. It is most likely infected. I once had a patient who had his finger pricked by a fishbone. He disinfected it himself and ignored it. As a result, his entire arm was swollen three days later. He already had cellulitis when he came here. He needed fluids for five days to recover. This was because he neglected observation.

In fact, to put it bluntly, there are really not so many rules on how to do wound care. The core is not to seal the dirt in the wound, do not repeatedly stimulate the wound, and create a comfortable environment for the body's self-healing ability. If you are really unsure, go to a community clinic and ask a nurse to take a look. It takes two minutes and is much more reliable than searching at home for a long time.