Wound treatment: a little knowledge may be a dangerous thing

Aesop brings us a timely reminder that what may look like a simple medical problem might be a whole lot more complicated than we suspect.  He’s not talking about a minor cut or scrape, but wounds that may conceal something a lot more serious.

The problem with [a wound closure kit], like everything else, including the laceration, is multi-fold:

Do you know which lacerations to close, and which to leave open?
Do you know why?
Are you sure that’s a lac, and not the evidence of an open fracture?
How would you know that without an X-ray?
Did you clean and debride the wound first, with surgical thoroughness?
How did you do that without any local anesthesia?
What structures underneath the skin were affected/damaged?
Did you repair them correctly? With what?
Would antibiotics be appropriate?
What about tetanus prophylaxis?

The supplies necessary to close a lac, in every ER I’ve ever worked in, comprise enough material to fill a military-sized footlocker, and 95% of them are RX only.

It is not, ever, one alcohol wipe, one gauze pad, a zip-tie gadget, and a big band-aid.

. . .

More importantly, you need a Masters-program level Physician Assistant instruction to cover all the medical knowledge and precepted training by board-certified MDs you don’t get in that kit. (That’s 3-4 years after college, kids.)

There’s more at the link.  Recommended reading.

I was forcefully reminded, reading his article, about our first aid training at St. John Ambulance in South Africa during the 1970’s.  I was never a full member of the organization, just a school student who trained with them to assist at sports meetings.  Nevertheless, I ended up as a volunteer on some of their ambulances over one holiday season, using that training to get people to the hospital.  I’ve never forgotten the emphatic voice of a doctor, briefing us before we started duty, telling us very sternly that our first responsibility was not, repeat, NOT to do anything that might endanger the patient.  Only after that were we to do what we could to stabilize and transport them.  In particular, we were not there to treat their injuries.  That was the job of the emergency room.  Our job was to get them there, preferably still alive.  To that end, we were to control bleeding, immobilize them for transport and to prevent them injuring themselves again, and otherwise LEAVE WELL ALONE!

Of course, emergency medicine (particularly in the USA) is far more advanced today than it was then.  We didn’t have such classifications as EMT or paramedic.  We were, in hindsight, more glorified amateurs than anything else.  Still, that basic instruction prevented us making a lot of mistakes.  I remain grateful for it.

There was also the lighter side of emergency treatment . . . I trained in basic military first aid, like many troops, because in the operational area medical assistance might be a long way off.  One of the stranger treatments was for spitting cobra venom.  We had a snake called the rinkhals that would spit venom at the eyes of its enemies, with considerable accuracy.  If it hit them, the victim would go blind in fairly short order.  The treatment was to wash the eyes out right away with sterile fluid – but sterile fluid wasn’t always easy to come by in the bush.  The solution?  Urine from an undiseased bladder emerges as close to sterile as one can get from the human body;  therefore, we were advised to pee into the eyes of the afflicted person, so that the poison would be diluted to the point that it would no longer cause permanent blindness.

This worked, but it tended to produce strong reactions in the one being peed on.  I’m reminded of one occasion on which a large, strong soldier needed that treatment.  The field medic in charge kept on telling him that the poison wasn’t yet sufficiently diluted, and he needed more treatment.  Only after about a dozen soldiers had peed into his eyes, completely soaking his uniform in the process, did he begin to suspect that this was going a bit far . . . The sight of him, bleary-eyed, smelly, dripping wet and furious, chasing the medic around several nearby thorn bushes (and throwing him bodily into one when he caught him) was enough to reduce the rest of us to hysterics!  (The snake got away in the confusion.)

Ah, yes . . . medical memories . . .



  1. The overarching lesson was that years of training are not adequately replaced by $20 worth of gee-whiz Amazon gadgetry.

    Thanks for the link.

  2. And that long-ago training can still compete with what's taught nowadays as first aid. I well remember being taught what is now known as the Heimlich Manoeuvre about 60 year ago during British Army service. And 20 or so years later I remembered enough when my daughter's friend fainted and fell backwards off a high wall to know to do no more than check for heartbeat and unobstructed airway but not move her. The ambulance crew were quite complimentary. But don't knock Google et, I'd have died from prostate cancer years ago if I hadn't known the symptoms, and again more recently if I hadn't learnt the initial symptoms of a major heart attack – though technically I did die from it twice in the operating theatre.

  3. I remember being told about the use of urine as was described as an eye wash when I went through USAF Survival Training in 1975. Most of the class was 23 and 24 year old AF Pilots. We sort of took it strangely being the era that it was.

  4. Bush lessons. First is that urine is sterile. Second is that cobwebs are also sterile and great at staunching any bleeding other than arterial. Arterial bleeding? LOTS of hard pressure and get qualified help right now. As for snake bites older than a minute or so involved opening some of the larger veins next to the bite site. A single slice along the vein sufficed. Bleed for one minute (or less if the flow was fast) then bind tightly. Get professional help right now.

  5. Hot tip, selsey.steve

    1) Urine isn't "sterile"; people have UTIs all the time.
    The urinary tract is sterile, except when it isn't.
    But urine is less of a problem than, say, foetid swamp water full of parasites and bacterium.

    2) And cobwebs aren't sterile either, but most pathogens on them (like the resident dead and decaying bugs) are avoidable, and generally less of a problem than the open wound you've already got.

    3) Nobody (but witch doctors, AFAIK) with an IQ above room temp practices cutting open skin near snake bites anymore . It accomplishes nothing but mutilation, to no good purpose. Absolute 0% effectiveness, coupled with vastly increasing the wound problem.

    Update your treatment protocols from 1930, or say "Hi" to Dr. Mengele.
    Just saying, man.

    OTOH, we do use maggots and leeches grown under sterile laboratory conditions in current practice, and they bring a number of benefits.
    The wild variety, not always so much.

    Medicine moves pretty fast; try and keep up. 😉

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