Basic pre-hospital algorithm
Upon injury, it is important to immediately minimize the risk of suppuration. Initial tactics begin with copious irrigation of the damaged area with ordinary soap and water. For subsequent antisepsis, alcohol or iodine preparations are used, treating only the undamaged skin around the wound. The bleeding surface itself is covered with a dressing.
There is a strict surgical rule: in the first three days from the moment of injury, the wound is not sutured. This is necessary to avoid sealing potential infection inside the tissues and developing severe complications.
Specific tactics are applied for superficial damage. Abrasions need only be treated with an antiseptic, and film-forming agents can be applied as a primary dressing—they create a reliable protective barrier. Further healing of the abrasion proceeds under a crust. If the injury is accompanied by bone damage, antiseptic treatment must be supplemented with transport immobilization.
Specifics in severe spinal injuries
Open injuries of the spine and spinal cord require strict adherence to the basic DrABC resuscitation principles. However, from an antisepsis perspective, it is critically important to prevent secondary infection of the deep wound.
To achieve this, the edges of the defect are thoroughly treated with an antiseptic, and an aseptic dressing is applied. If moderate bleeding is observed, the wound tract is tamponaded with a gentamicin-impregnated hemostatic sponge before applying the dressing. Transporting such injured patients requires mandatory cervical immobilization (where possible), or on a wooden spine board if rigid stretchers are unavailable.
Outpatient stage and primary surgical debridement (PSD)
Small wounds (incised, stab, lacerated, contused, or animal bite wounds) are treated in an outpatient setting. The main method is performing primary surgical debridement (PSD). This is a set of measures that must be performed radically, in a single stage, and definitively to ensure rapid healing.
PSD begins with the toilet of the wound and the surgical field:
- The skin is treated with warm soap and water, hydrogen peroxide solutions, alcohol, or benzine.
- Hair around the damage zone is shaved off without fail.
- Local or general anesthesia is performed.
- A small excision of non-viable edges is carried out, followed by single-stage closure (if the time elapsed since the injury permits).
For ordinary closed contusions, the tactics are different: cold is applied for the first two days to stop hemorrhage, and then heat to accelerate hematoma resorption.
Antisepsis in drainage of purulent foci
If an infection has already developed (a phlegmon or abscess has formed), surgical opening is required. After evacuating the exudate, the cavity is thoroughly washed with antiseptics. Proper drainage is crucial for complete cleansing:
- First 5–6 hours: gauze drains densely soaked in 10% hypertonic sodium chloride solution are used, which actively draws out pus.
- First dressing (the next day): the purulent wound is washed with broad-spectrum antiseptics. Hypertonic drains are removed and replaced with gauze containing antibacterial ointment and rubber drains (strips cut from a surgical glove).
- Active drainage: for deep phlegmons, perforated polyethylene or polyvinyl chloride tubes are installed and connected to a suction device.
The operation usually concludes with the application of a gauze dressing soaked in Vishnevsky ointment.
The "EIC" rule for the pre-hospital stage: Edges treated (with iodine), Irrigated (with soap and water), Compress/dressing applied (but not sutured for the first 3 days).
Class and exam questions
Is it permissible to pour iodine or alcohol directly into a wound during first aid?
No, at the pre-hospital stage, aggressive solutions (iodine) are applied exclusively to the skin strictly around the wound. Pouring antiseptic inside the wound is prohibited.
Why do surgeons not place sutures in the first days after trauma?
During the first three days after injury, the wound is not sutured. This ironclad rule of surgery avoids sealing infection inside tissues and the development of inflammation.
How to properly stop moderate bleeding in an open spinal injury?
In addition to treating the edges with an antiseptic, in case of moderate bleeding, the wound is tamponaded with a gentamicin-impregnated hemostatic sponge, and only then is an aseptic dressing applied.
What to treat a regular abrasion with if there is no bandage?
It is sufficient to wash and treat an abrasion with an antiseptic. Film-forming agents are excellent as a primary dressing, creating a protective barrier on the skin.
What else to study on this topic
- Differential diagnosis of wound types: differences between bite, incised, and stab injuries.
- Dangers and high risks of general anesthesia during the opening of superficial abscesses.
- Choice of surgical access on the face taking into account the topography of facial nerve branches and aesthetic consequences.
- Technique of layered tissue dissection and blunt muscle separation with a clamp when opening phlegmons.
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Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.