1. Treat for shock.
2. Keep the victim warm and at rest.
3. Replace lost fluids with a suitable blood volume expander. DO NOT give the victim anything to drink until the extent of the injury is known for certain.

4. Give oxygen, if available.
5. Splint injured extremities.
6. Apply cold compresses to identifiable injured areas.

7. Transport the victim to a medical treatment facility as soon as possible.

SPECIAL CONSIDERATIONS IN WOUND TREATMENT

There are special considerations that should be observed when treating wounds. The first of these is immediate treatment to prevent shock. Next, infection should be a concern: Look for inflammation and signs of abscess. Hospital Corpsmen should be aware of these conditions and have the knowledge to treat them.

Shock
Shock is likely to be severe in a person who has lost a large amount of blood or suffered any serious wound. The causes and treatment of shock are explained earlier in this chapter.

Infection
Although infection may occur in any wound, it is a particular danger in wounds that do not bleed freely, in wounds in which torn tissue or skin falls back into place and prevents the entrance of air, and in wounds that involve the crushing of tissues. Incisions (in which there is a free flow of blood and relatively little crushing of tissues) are the least likely to become infected.

Battle wounds are especially likely to become infected. They present the problem of devitalized (dead or dying) tissue; extravasated blood (blood that has escaped its natural boundaries); foreign bodies such as missile fragments, bits of cloth, dirt, dust; and a variety of bacteria. The devitalized tissue proteins and extravasated blood provide a nutritional medium for the support of bacterial growth and thus are conducive to the development of serious wound infection. Puncture wounds are also likely to become infected by the germs causing tetanus.

COMMON INFECTION-CAUSING BACTERIA.- There are two types of bacteria that commonly cause infection in wounds: aerobic and anaerobic. Aerobic bacteria live and multiply in the presence of air or free oxygen, while anerobic bacteria live and multiply only in the absence of air.

Aerobic Bacteria.-The principal aerobic bacteria that cause infection, inflammation, and septicemia (blood poisoning) are streptococci and staphylococci, some varieties of which are hemolytic (destroy red blood cells). The staphylococci and streptococci may be introduced at the time of infliction, or they may be introduced to the wound later (at the time of first aid treatment or in the hospital if nonsterile instruments or dressings are employed).

Anaerobic Bacteria.-Anaerobic bacteria are widespread in soil (especially manured soil). While not invasive, anaerobic bacteria contribute to disease by producing toxins and destructive enzymes, often leading to necrosis and/or gangrene of the infected area.

MINOR WOUND CLEANING AND DRESSING.-Wash minor wounds immediately with soap and clean water; then dry and paint them with a mild, nonirritating antiseptic. Apply a dressing if necessary. In the first aid environment, do not attempt to wash or clean a large wound, and do not apply an antiseptic to it since it must be cleaned thoroughly at a medical treatment facility. Simply protect it with a large compress or dressing, and transport the victim to a medical treatment facility. After an initial soap and water cleanup, puncture wounds must also be directed to a medical treatment facility for evaluation.

Inflammation
Inflammation is a local reaction to irritation. It occurs in tissues that are injured, but not destroyed. Symptoms include redness, pain, heat, swelling, and sometimes loss of motion.

The body's physiologic response to the irritation is to dilate local blood vessels, which increases the blood supply to the area. The increased blood flow, in turn, causes the skin to appear red and warmer. As the blood vessels dilate, their injured walls leak blood serum into surrounding tissues, causing edema and pain from increased pressure on nerve endings. In addition, white blood cells increase in the area and act as scavengers (phagocytes) in destroying bacteria and ingesting small particles of dead tissue and foreign matter.

Inflammation may be caused by trauma or mechanical irritation; chemical reaction to venom, poison ivy, acids, or alkalies; heat or cold injuries; microorganism penetration; or other agents such as electricity or solar radiation.

Inflammation should be treated by the following methods:

Remove the irritating cause.

Keep the inflamed area at rest and elevated.
Apply cold for 24 to 48 hours to reduce swelling. Once swelling is reduced, apply heat to soft tissues, which hastens the removal of products of inflammation.

Apply wet dressings and ointments to soften tissues and to rid the area of the specific causal bacteria.

Abscesses
An abscess is a localized collection of pus that forms in cavities created by the disintegration of tissue. Abscesses may follow injury, illness, or irritation. Most abscesses are caused by staphylococcal infections and may occur in any area of the body, but they are usually on the skin surface.

A furuncle (boil) is an abscess in the true skin caused by the entry of microorganisms through a hair follicle or sweat gland. A carbuncle is a group of furuncular abscesses having multiple sloughs, often interconnected under the true skin. When localized, there are several "heads." Symptoms begin with localized itching and inflammation, followed by swelling, fever, and pain. Redness and swelling localize, and the furuncle or carbuncle becomes hard and painful. Pus forms into a cavity, causing the skin to become taut and discolored.

Treatment for furuncles and carbuncles includes the following:

DO NOT squeeze! Squeezing may damage surrounding healthy tissue and spread the infection.
Use aseptic techniques when handling.
Relieve pain with aspirin.
Apply moist hot soaks/dressings (110F) for 40 minutes, three to four times per day.

Rest and elevate the infected body part.
Antibiotic therapy may be ordered by a physician.

Abscesses should be incised after they have localized (except on the face) to establish drainage. Abscesses in the facial triangle (nose and upper lip) should be seen by a physician.