Wound Care in the Field: Irrigation, Dressing, Topical Antibiotics and Penicillin Allergies.

Wound treatment has been studied throughout history and often parallels experiences from military conflicts. The following is an excerpt from an article from 2002:

“The history of wound care and management closely parallels that of military surgery which has laid down the principles and dictated the practices of wound cleansing, debridement and coverage. From a treatment standpoint, there are essentially two types of wounds: those characterized by loss of tissue and those in which no tissue has been lost. In the event of tissue loss it is critical to determine whether vital structures such as bone, tendons, nerves and vessels have been exposed. It is also important to determine the amount of soft tissue contusion and contamination. In any case primary wound healing by early closure either primarily or with the help of grafts or flaps is preferred to secondary healing and wound contraction with subsequent contractures which interfere with range of motion and function. Whether the wound is acute or chronic, essential principles of wound care must be observed in order to avoid wound sepsis and achieve rapid and optimal wound healing. — Tissues must be handled gently. — Caustic solutions capable of sterilizing the skin should never be applied to the wound. It is desirable never to put anything in the wound that cannot be tolerated comfortably in the conjunctival sac. — All devitalized tissues must be debrided either hydrodynamically, chemically, mechanically or surgically. — All dead space must be obliterated. — Exposed vital structures must be covered by well vascularized tissues. An essential part of any wound management protocol is wound dressing. It cannot be too strongly emphasized that a wound dressing may have a profound influence on healing particularly of secondary type healing, a critical feature being the extent to which such dressing restricts the evaporation of water from the wound surface. A review of available dressing materials is reported with emphasis on the newly developed concept of moist environment for optimal healing. A practical guide for dressing selection is also proposed.”

— Atiyeh, et al

Again, current medical literature suggests over the counter triple antibiotic ointment is generally very safe and RARELY causes life threatening allergic reactions. That being said, the same literature supports the following:

• High pressure irrigation with clean water.
• Keeping the wound clean and moist but not wet.
• Speak to your own doctor prior to using any over the counter medication, including topical antibiotic ointments, and specifically discussing your penicillin allergy if one exists.

It is our experience that mupirocin may be used as a topical antibiotic, IF INDICATED, in patients with penicillin allergies or other contraindications to traditional topical antibiotic use. Mupirocin is available by prescription from your physician. It is applicable to minor lacerations and abrasions; while silver sulfadiazine 1% cream is for use with burns. If you are isolated from definitive care and concerned about developing an infection in a small, superficial laceration or abrasion, use over the counter triple antibiotic at your own risk. If you have a penicillin allergy avoid triple antibiotics unless you have previously discussed its use with your own physician.

Minor cuts and scrapes occur often in the field and are usually only inconveniences. Proper treatment with some type of pressurized irrigation with clean water is likely the best treatment.

There are plenty of resources to manage this in the field. In fact, CANA Provisions PDWK is a clever kit that allows its user to filter and purify water AND treat superficial cuts and scrapes! (triple antibiotic ointment included) LINK HERE.

Stay safe out there!