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If You Dont Know What to Do,

If You Dont Know What to Do,

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Published by Flighterdoc

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Published by: Flighterdoc on Feb 04, 2010
Copyright:Attribution Non-commercial


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IF YOU DONT KNOW WHAT TO DO, DON'T CLOSE A WOUND.Closing a wound by just sewing the skin together is a very bad idea if you don't know whatyou're doing. The skills involved are not terribly complex - Physician Assistant / NursePractitioner / Special Forces Medic level skills; but require knowledge of anatomy that most people (including paramedic/EMT skilled people) lack.There are several problems with closing a wound wrong. If the wound isn't clean and bleedingcontrolled, all you do is create a pocket for infection. How do you treat an infection like that?With more surgery, fixing it the right way, PLUS a lot of antibiotics and pain meds. If the patient is lucky, you might be successful the second time around but the odds are against it:Gangrene is everywhere and can easily get started, with very bad outcomes.Wounds will normally heal on their own, more slowly and with a bad scar, but it's better to leavethem open than to close them incorrectly or prematurely. And even with that bad scar, it can berepaired by a plastic surgeon in 6 months or so.Despite people thinking that it's like sewing on a button, the skill required to suture is much morecomplex than just sewing. Do it wrong and the person stands a pretty good chance of killing the patient. One person even told me that it’s ‘easy as pie’, that I was being unnecessarily cautious.Easy as pie?OK, great! Easy as pie! Let’s see: You have a very simple puncture wound of the abdomen (not agunshot, say a little stabbing). You will have to do the following:Secure the airway and maintain breathingControl bleedingmaintain circulation and prevent shock induce and maintain anesthesiaopen the wound and explore - vessels, the gut, and other structures may well have been cut, andneed to be repaired.How do you repair them?Tie a bleeder?Repair a hole in the gut?Clean out everything that doesn't belong there? If the gut is penetrated, then fecalmaterial is in the abdomen and it will cause a life-threatening infection.Close the omentum - what size/shape needle and type/size of suture?Which suture, technique, and knots?close the deep fascia - ditto?close the (possibly 3 or 4 different) muscle groups - ditto?close the superficial fasica - ditto?close the skin - ditto?Bring the patient out of anesthesiaDress the wound, monitor for infection, control pain

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