the explorers journal the global adventure issue - The Explorers Club

E x t r e m e m e d i c i n eyour heatlh and safety in the fieldA n k l e B i t e r sand other expeditionary riskscaring for wounds in the fieldby Michael J. Manyak, M.D., FACSAn acute traumatic wound in a remote location is achallenge without medical personnel or resourcesreadily available. Decisions made in the first few minutesoften influence both the need for evacuation andthe eventual outcome. We caught up with Jim Marinucci,director of the wound management program at GeorgeWashington University, at the recent ExpeditionMedicine Conference to discuss these issues.MJM: Jim, What should one do after a traumaticwound occurs?JM: The first step is to evaluate and stabilizethe patient. Knowing the cause of the injury isimportant to determine the possibility of a neckor spine injury and prevent movement. Stoppingany significant hemorrhage and making sure theairway is stable are very key steps. You shouldremove all jewelry for an upper extremity injuryto prevent cutting off circulation from swelling.If the victim is stable, you need to determine ifthe wound is contaminated or relatively clean.54The most important thing is good cleansing ofthe wound to prevent an infection. Irrigation ofthe wound with sterile saline or even tap water isimportant and you need to remove any obviousforeign material if possible. Pain medication andantibiotics would be next but it is important tofind out what medications and allergies the victimhas. Antibiotics used for diarrhea, especiallyCiprofloxin or Levaquin, are good for wounds.MJM: What do you do for someone with a deeplaceration that crosses a joint?JM: After stopping the bleeding, check to see ifthe person can move the joint to show if thereis any obvious ligament or tendon damage. It isoften good to splint an injury where this is suspectedbut the damage or extent may not be soobvious. A good bandage often acts as a splint.Splinting deep wounds for the first 48 hourshelps reduce the chance of infection but thesplint should be removed to allow some returna Devastating ankle injury purportedly sustained during a polar bear attack on campers in the Yukon.