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WOUND CARE

Essentials

The World Health Organization (WHO) lists what it considers to be the essentials for wound care worldwide (Table 25-1), varying with four levels of hospital capabilities (described in Table 5-1).

TABLE 25-1WHO Wound Treatment Essentials

Hemostasis

Wound Tourniquets

Optimal wound care requires an inspection for deep structure injury and foreign bodies. A dry field, without bleeding, is usually necessary. For wounds on a finger or toe, the best method is to apply a large venous tourniquet tightened around the base of the finger or toe and secured with a large clamp (Fig. 25-1). No one will forget that they have a hemostat attached to their hand. The old “rubber band” tourniquets are generally not a good idea, because they are easy to inadvertently leave on after the procedure is complete.

FIG. 25-1.

Safe method of applying tourniquet to finger.

Make another type of digital tourniquet by cutting the finger off a surgical glove and putting it on the finger to be sutured—or putting the entire glove on the patient’s hand. 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 (Fig. 25-2). It is safer if you leave the entire glove on the hand so that no one forgets the tourniquet is there. The cut-off glove finger alone works well on a toe, especially the hallux of an ingrown nail needs to be removed.

FIG. 25-2.

A finger tourniquet made by rolling a glove’s finger or finger cot down the digit.

Pyramid Dressing

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 you identify a briskly bleeding area—often from a relatively small wound—occlude it with finger pressure. Then replace the finger with a tightly folded “nugget” of gauze held firmly on the spot. If the positioning ...

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