Acute Wound Management & Infection Control

Hepatitis overview
- Instructor’s self-deprecating opener (“I’ve got Hep B… I’m dirty”) used to grab attention.
- Multiple hepatitis viruses exist; many (A & E) are fecal–oral, whereas B, C, D are blood-borne.
Hepatitis B specifics
- Standard for health-care workers to be vaccinated; employers are legally required to offer 3-dose series.
- Typical schedule: \text{Dose 1}=\text{Day 0},\;\text{Dose 2}=1\text{ or }3\text{ months},\;\text{Dose 3}=6\text{ months}.
- Vaccination is now started in neonates (1st dose in hospital), raising debate: “Are we vaccinating too young?”
- Efficacy caveat: series does not take in all people.
- Post-series blood test = Hep B antibody titer.
- If titer negative ➔ entire series repeated (“getting a titer” in instructor’s wording).
Tetanus reminders
- For any dirty or penetrating wound, check date of last booster; update if >10 years (or >5 yrs for high-risk wounds).
Comparison to Chickenpox / VZV
- Varicella-zoster virus is same herpes family.
- Historical “chicken-pox parties” vs modern vaccination.
- South Park episode used as humorous reference; illustrates ethical issues of intentional exposure.

Golden rule distilled from 45–60 min OSHA training: “If it’s wet & not yours, don’t touch it.”
Gloves
- Mandatory for any wound care; resist culture of “ATs are cavalier.”
- Wrestlers commonly wear at least one glove ➔ not only BBP (blood-borne pathogens) but skin infections: impetigo, herpes gladiatorum, ringworm.
Hand hygiene
- No sink? Use alcohol sanitizer.
- Cold, dry weather ➔ skin cracks; sanitizer burns = sign of micro-openings ➔ infection portal.
Additional PPE when large bleeds or body fluids present (goggles, masks, gowns).

Skin = largest organ; essential barrier, thermoregulation, prevents plasma leakage.
Layer review (superficial ➔ deep)
- Epidermis
- Dermis: capillary beds, nerve endings, hair follicles, sweat glands; contains arrector pili m.
- Sub-cutaneous fat (adipose): varies by location; thicker at buttocks, abdomen vs dorsum of hand.
- Fascia → Muscle
- Deep structures: bone, large nerves, vessels.
Mucosal membranes (eye, nose, mouth, GI) more delicate & infection-prone.

Abrasion
- “Road-rash,” turf burn.
- Superficial; high pain (many nerve endings); oozes capillary blood.
Laceration ("lax")
- Uncontrolled, jagged tear from cleat, nail, etc.
Incision
- Clean, surgical scalpel cut.
Avulsion
- Tissue flap partially/completely torn off (e.g., posterior heel + Achilles case shown).
- High infection & closure difficulty.
Penetration vs Puncture
- Penetration = object enters & often traverses; may remain or exit.
- Puncture = small entrance, object usually still lodged (e.g., nail, javelin).
Blister
- Shear separates epidermis from dermis; sac fills with serous fluid.
- Common in new shoes, high friction zones.

Contusion / Bruise: internal bleed contained by skin ➔ hematoma.
Crush injury & Compartment Syndrome
- Swelling increases intracompartmental pressure, tamponades vessels/nerves.
- If unchecked ➔ ischemia, necrosis, may trigger rhabdomyolysis (muscle breakdown → myoglobinuria).
Hypovolemic / Hemorrhagic Shock
- Average adult blood volume \approx5\text{–}6\,\text{L}; abdomen alone can hide 3\text{–}4\,\text{L}.
- Internal bleeding difficult to visualize; monitor vitals, mental status, skin color.

Direct even pressure with sterile dressing.
Elevation above heart when possible.
Compression bandage (ACE wrap).
Tourniquet for life-threatening limb hemorrhage.
Hemostatic agents (modern; none available in “Black Hawk Down” era anecdote).
NEVER remove embedded object—may be tamponading a vessel; instead,
- Stabilize with bulky dressings & gauze roll.

Let minor puncture bleed briefly ➔ natural flushing.
Irrigation hierarchy
1. Saline flush (preferred; isotonic, non-cytotoxic).
2. Betadine (povidone–iodine) or Hibiclens (chlorhexidine) for broader antimicrobial if contamination high.
3. Hydrogen peroxide discouraged—cytotoxic to healthy cells, stings.
Antibiotic ointments (Neosporin, Bacitracin) maintain moist environment & reduce bacterial load.
Dressing selection
- Telfa (non-adherent gauze) for abrasions & large superficial wounds to prevent scab sticking.
- Occlusive/transparent films when visualization & moisture retention desired.

Field closure decision-making
- Length \gtrsim1\,\text{in} or deep = consider closure.
- Face/scalp bleed profusely; cosmetic stakes high ➔ often refer (plastic surgeon).
- Eyebrow occasionally field-closed; nose/lips rarely.
Steri-Strip application pearls
- Clean, dry, hair-free skin; approximate edges precisely.
- Place parallel strips first to relieve tension, then perpendicular bridging strips.
- Avoid highly mobile/flexion creases; adhesives may fail.
Suturing
- Skill expected of many ATs/orthopedic assistants; lab practice scheduled for spring.
- Close ASAP (<6 h ideally; face ≤24 h) after irrigation & debridement.
- Discuss scarring risk with patient.

#1 lawsuit source in PT clinics = thermal burns from hot packs.
- Monitor hydrocollator temperature; ensure adequate towel layers.

Pleasant Gap motorcycle crash → traumatic leg amputation (illustrates spectrum of trauma).
“Black Hawk Down” groin arterial shot scene: inability to clamp vessel; patient exsanguinates.
South Park “Chicken Pox Party” episode: ethics of intentional disease exposure; herpes family link.

Protect yourself first: gloves, eye protection, gown as situation escalates.
Maintain clean technique: cleanse → close (if needed) → cover → check.
Reassess wounds at each visit; look for redness, heat, swelling, pus, odor, systemic fever.
Remember the one-liner: “Cleanliness is the name of the game.”
Monitor vaccination records (Hep B, Tetanus, Varicella) for self and patients.

Note

0.0(0)

Chat with Kai