The World Health Organization (WHO) lists what it considers to be the essentials for wound care worldwide (Table 22-1), varying with four levels of hospital capabilities (described in Chapter 5, Basic Equipment).
Table 22-1 WHO Wound Treatment Essentials |Favorite Table|Download (.pdf)
Table 22-1 WHO Wound Treatment Essentials
|Assess wounds for potential death and disability||E||E||E||E|
|Nonoperative management: clean and dress||E||E||E||E|
|Tetanus prophylaxis (toxoid, antiserum)||D||E||E||E|
|Minor surgical—cleaning and suturing||PR||E||E||E|
|Major surgical—debridement and repair||I||PR||E||E|
The best wound inspections (for deep structure injury and foreign bodies) and wound closures occur when the area can be visualized. To visualize wounds, it helps to stop the bleeding; finger tourniquets are a good way to do this. However, "rubber band" tourniquets are generally not a good idea since it is easy to inadvertently leave them on after the procedure is complete. One alternative is to use a large venous tourniquet tightened around the base of the finger or toe with a large clamp (Fig. 22-1). No one will forget they have a hemostat attached to their hand.
Safe method of applying tourniquet to finger.
Another method is to cut the finger off a surgical glove and put it on the finger to be sutured. Or better yet, put the entire glove on the patient's hand. It is safer if you leave the entire glove on the hand so no one forgets the tourniquet is there. Then cut a small hole at the top and roll the rubber down to the finger or toe's base and, voilà, a dry field in which to explore and suture the laceration or remove part of the toenail. The cut-off glove finger alone works well on a toe, especially the hallux if an ingrown nail needs to be removed (Fig. 22-2).
A finger tourniquet made by rolling a glove's finger or finger cot down the digit.
While large pressure dressings, tourniquets, and vessel ligation can all stop bleeding from a wound, an elegant and easily improvised pyramid dressing can often stop significant bleeding using fewer resources. Once a briskly bleeding area is identified—often from a relatively small wound—occlude it with finger pressure. Then replace the finger with a tightly folded "nugget" of gauze held tightly ...