Wound dressing

“ If the wound is small, the old-fashioned clean white rag that has been boiled and washed is as good as anything that can be used for a dressing. Tear off a narrow strip from one to two inches wide and as many feet long, according to the position of the wound, roll it round the finger or limb three or four times, and then take a turn round the wrist or nearest joint, to keep the bandage from slipping off. If the wound be likely to keep on oozing blood, put on first a thickness of surgeon's cotton, or prepared cotton-batting, an ounce of which can be purchased for ten cents at any drugstore. ”

“ The edges of wounds and the muscles involved in the wound should be kept as quiet as possible during the process of healing. Every wound should be protected by a sterile or antiseptic dressing whenever it is possible to retain a dressing in place. Dressings should be changed when it is apparent that they have become drenched with wound secretions or pus, or have become disarranged or too loose, permitting dirt to enter between them and the skin. If swelling appears beyond the edges of a bandage, it is an indication that it is too tight and it should then be removed and again applied. ”

“ Moreover, wounds should not be touched by anything, especially the fingers, either washed or unwashed, nor should the scissors, fingers or other object be allowed to touch the surface of the dressing that is to be placed directly upon a wound. ”

“ If he is wounded, cut away the clothing covering the wound, but don't remove any more than is necessary. If he has been burned, pour lukewarm water, containing a little saleratus or bicarbonate of soda, over the clothing before you remove it. If he is bleeding severely, stop the bleeding before dressing the wound. After the wound is dressed there is nothing for the novice to do, except bring the patient to consciousness, if unconscious, and remove him to a place of safety and comfort. ”

“ Only this sort of thing justifies running risk of infection. [182] Otherwise just put on a sterile dressing and bandage. In reality washing wounds only satisfies the aesthetic sense of the operator without real benefit to the patient in many cases. If a wound has to be cleansed before the doctor comes use boiled water; if this cannot be had at once, use water and alcohol half and half.
1. Always wash your hands thoroughly with water, soap and a nail brush, unless there is necessity for immediate help to stop bleeding which admits of no time to clean one's hands. Be sure your nails are clean. ”

“ If the wound happens to have been made with a knife or tool that you are not absolutely sure was perfectly clean, or if the wound gets manure or road-dirt or other filth rubbed into it, then it is best to go at once to a doctor and let him give it a thorough antiseptic dressing, which consists of cleaning it out thoroughly with strong remedies, called an{318}tiseptics,—which kill the germs, but do not injure living tissues,—and then putting on a germ-proof dressing as before. ”

“ The modern soldier is now taught how to make a prompt occlusive and antiseptic dressing of the wound which he may receive upon the battle-field, which, from the moment of its attention, continues to be treated according to the same enlightened method after he reaches the field-hospital, or when sent to the rear; so that men now receive extensive injuries to joints and to viscera, which previously were either promptly fatal, or fatal within a few days from erysipelas and hospital gangrene, from which they recover with useful—often with nearly perfect—limb or function of part restored. ”

“ When a gangrenous wound needed washing, the limb was thrust out a little from the blanket, or board, or rags upon which the patient was lying, and water poured over it, and all the putrescent matter allowed to soak into the ground floor of the tent. The supply of rags for dressing wounds was said to be very scant, and I saw the most filthy rags which had been applied several times, and imperfectly washed, used in dressing wounds. ”

“ A piece of sponge, carefully washed, dried and placed in the wound, Gilbert tells us, absorbs the discharges satisfactorily and prevents their penetration internally. Over the wound is placed a bit of linen moistened with egg-albumen, then a dressing of lint, and the whole is maintained in place by a suitable bandage. Finally the patient is to be laid in bed and maintained in such a position that the wound will be dependent, so as to favor the ready escape of the discharges. This dressing is to be renewed three times a day in summer, and twice in winter. ”

“ If heat, swelling, redness, or pain develop in a wound after a day or two, a doctor should be consulted; and not a minute should be lost if the patient has a chill or if red streaks appear extending from the wound in the general direction of the heart. Until the doctor comes the wounded part should be elevated and covered with cold applications wet in alcohol 25%, or in a solution of common salt, a teaspoonful to a pint of water.
Several points should be remembered in dressing wounds. In the first place the mouth, which [274] is full of germs, is not a good place for cut fingers. ”

“ For this reason, a patient in poor health should not be operated upon, and any erosion of the skin about the seat of operation should be thoroughly healed before attempting plastic work. Aristol dusted on an abrasion will heal it quickly.
If hemorrhage follows the dressings of a wound, the dressing should be removed and the hemorrhage controlled by pressure, unless severe, and be redressed. Moist blood decomposes readily and is a source of early infection, unless careful drainage under antisepsis is established. ”

“ Attend to the patient on the spot, and fix the injured limb, at once, by splints and bandages. Use great gentleness.
If there is a wound, cleanse it and apply antiseptic dressing before putting limb in splints.
Disturb the limb as little as possible and make the patient comfortable until arrival of doctor.
SNAKE BITES.—Tie something tightly around the limb, between the wound and the heart. Give patient a good dose of brandy or some other spirit.
Encourage the bleeding by squeezing the bitten part and bathe with warm water. If breathing is bad, use artificial respiration. ”

“ The separation of the fragments and the overriding of the ends of the proximal and distal large fragments were due to bearing bodily weight or to muscular contraction.
The projectile causing the wound was moving with the velocity of mid range. The wound of exit was not lacerated.
The emergency treatment is antiseptic dressing and temporary splint immobilization. Permanent dressing, with extension and lateral compression, is the rule.
Infection in such cases is frequent owing to lack of facilities for proper dressing on the field.
Results in saving life and limb are generally good. ”

“ At any period, it is unsafe and unwarrantable to dive, pretty much 396at random, with a sharp needle, amongst tendons, nerves, arteries, and veins, with the hope of so including the wounded branch. In some cases of secondary bleeding—if no great inflammatory action has taken place, and no abscesses have formed—the wound may be dilated freely, and compression made on the bleeding point by dossils of lint filling the wound completely, and supported by a bandage. This dressing, retained for some days, often succeeds perfectly ”

“ When cuts bleed very much, tie a handkerchief tight above the wound, or place a finger on it until you can get a physician: in the country, persons should be supplied with a surgical needle and adhesive plaster, and have lint scraped and linen rags in a convenient place. Balsam apple put in a bottle when fresh, and whiskey poured on it, is an excellent application for fresh cute or bruises. For the stick of a needle or pin, try to make it bleed, and hold the finger in strong vinegar and salt, as hot as you can bear it, this will prevent a gathering. ”

“ The bleeding from a slight cut is never very severe and will generally stop of itself in a short time. It is best to let a slight cut bleed a little, as the bleeding carries away the germs which may have been on the edge of the knife or whatever caused the wound. ”

“ If, on the third day after the wound was first dressed, the temperature is normal, and subsequently remains so, the wound is probably healing well; but if the patient’s temperature is up to or beyond 100° F., and the part is painful, there is probably some inflammatory change going on in the wound. The dressings should be taken off, and the wound examined. If the surrounding skin is red and shiny, and the limb swollen and tender, some of the stitches should be taken out, and the wound well syringed with an antiseptic lotion. ”

“ Swathe thickly in cotton wool and put on a clean bandage.
There is no need to again dress the wound, unless it becomes hot and painful. If you have got the wound absolutely clean, when the dressings have been on for a few days, it will have completely healed without discharging more than a few drops of fluid. If, however, the wound smarts, it must be dressed again, and possibly every other day. It should be dressed in the same way as it was in the first instance.
When the wound is very jagged, or impossible to get thoroughly clean, it is best to put on fomentations for the first day or two. ”

“ It is one which might be of much use in Base hospitals if the patients were brought directly into them, but in the Field hospitals, in face of the rush with which the first dressings have to be done, I think it is seldom applicable, and consider the interference with the wound as rather likely to increase the danger of infection than to decrease it.
Dressings should not be too frequent; two should suffice for simple wounds with type forms of entry and exit; there is little discharge and usually no bleeding: hence the more the dry scab form of healing can be simulated the better. ”

“ The loss of a few teaspoonfuls, tablespoonfuls, or, for the matter of that, cupfuls, of blood won't do you any harm, and its free flow will wash out the cut from the bottom, and carry out most of the germs that may happen to be present on the knife or nail. If water and dressings are not accessible, let the blood cake and dry over the wound without disturbing it, even though it does look rather gory. ”

“ The wound should now be cleansed as previously instructed and an effort made to stop the bleeding. The best method is to first apply pads of gauze wrung out of very hot water. When success is evident a pad made of boiled cotton should be placed on the wound and held tightly in place for some time. If the wound is of such a character as to demand stitches a physician should of course put them in.
Run-Around: Felon: Whitlow.—When pus germs enter around a finger nail and lodge in the soft tissue a "run-around" is the result. It is accompanied with pain, swelling, redness and inflammation. ”

“ Pressure will soon stop this form of bleeding.
That will do for the first and most important of all emergencies. What have we to put in our box for this purpose? Nothing at all. All we require is a hand and presence of mind.
Now about the treatment of wounds. First stop the bleeding, if this is severe. Then wash your own hands. Wash them well. Plenty of soap and hot water. Good hard work with the nail brush. Your hands should be absolutely clean before you meddle with a wound.
Now you will want some antiseptic. The best of all is carbolic acid. ”

“ Unless the blood is spurting in jerks from a cut artery, or bleeding very freely indeed, it is better to let the wound bleed, as this helps to wash out any dirt or germs that have got into it. When the bleeding has stopped, do not put on sticking plaster, because this keeps out the air and keeps in the sweat of the skin surrounding the wound, which is not healthful for the wound, and may also contain some weak pus germs. ”

“ Sutures.—Twisted silk sutures are to be preferred, as they do not invite sepsis, as softening catgut does, and retain the parts during the entire time required for healing, while the latter is liable to become separated by uneven absorption, allowing the wound to gape at that point and causing more or less of a cicatrix, so intolerant to patients of this class.
Dressings.—Bulky bandages are not required; they heat the parts, and look unsightly. The author employs antiseptic adhesive silk plaster for covering all external wounds, except where the hair prevents its use. ”

“ If, on the contrary, the hemorrhage is slight in amount or almost fails altogether; if it is venous in character; if the edges of the wound are only stained by imbibition of the blood, which is not infiltrated between the tissues, and the stain may be washed off; if the blood is not at all or only slightly clotted and the clots are soft; if the skin is not everted and the sides of the wound are smooth and lie nearly in contact ”

“ But sometimes the discharge of blood is so great, that if it be not stopt, the patient may die even before a surgeon, though at no great distance, can arrive. In this case, something must be done by those who are present. If the wound be in any of the limbs, the bleeding may generally be stopt by applying a tight ligature or bandage round the member a little above the wound. ”

“ If blood is dark, and comes in slow flow (venous) —
Tie a cloth around between end of limb and wound. Or use a tourniquet, loosening it in one hour.
Using a Tourniquet
In either case, bandage a clean gauze compress against wound. If unable to use these methods because of too rapid bleeding, press fingers into wound, but have another person tie as described. Do not use finger pressure if possible to avoid, for the wound should be kept clean.
Any of the following tend to stop bleeding:
Ice or ice water. Very hot water. Vinegar, 1 tbsp. to 4 tbsp. water. Salt, 1 tsp. to 4 tbsp. water. ”