Removing Foreign Objects
Many wounds contain foreign objects. Wood or glass splinters, bullets, metal fragments, bits of wire, fishhooks, nails, tacks, cinders, and small particles from grinding wheels are examples of the variety of objects or materials that are sometimes found in wounds. When such objects are near the surface and exposed, first aid treatment includes their removal. However, first aid treatment does not include the removal of deeply embedded objects, powdered glass, or any widely scattered material of this nature. You should never attempt to remove bullets, but you should try to find out whether the bullet remains in the victim. Look for both entrance and exit wounds. The general rule to remember is this: Remove foreign objects from a wound when you can do so easily and without causing further damage; but NEVERHUNTFOROR ATTEMPT TO REMOVE DEEPLY BURIED OR WIDELY SCATTERED OBJECTS OR MATERIALS, except in a definitive care environ- ment.

The following procedure may be used to remove a small object from the skin or tissues if the object is near the surface and clearly visible:

1. Cleanse the skin around the object with soap and water and paint with any available skin antiseptic solution.

2. If necessary, pierce the skin with a sharp instrument (a needle, razor, or sharp knife that has been sterilized by passing it through a flame several times).

3. Grasping the object at the end, remove it. Tweezers, small pincers, or forceps may be used for this purpose. (Whatever instrument you use should first be sterilized by boiling if at all possible.)

4. If the wound is superficial, apply gentle pressure to encourage bleeding.

5. Cover the wound with a dry, sterile dressing.

If the foreign object is under a fingernail or toenail, you may have to cut a V-shaped notch in the nail so that the object can be grasped by the forceps. Do not try to dig the object out from under the nail with a knife or similar instrument.

Acurved or barbed object (such as a fishhook) may present special problems. Figure 4-32 shows one method of removing a fishhook that has become embedded in the flesh. As you can see from figure 4-32A, the barb on the hook prevents its direct removal. However, if you push the hook forward through the skin, as shown in figure 4-32B, you can clip off the barb with a wire cutter or similar tool, as shown in figure 4-32. The remainder of the fishhook can then be withdrawn in the manner indicated in figure 4-32D.

Figure 4-32.-Removing a fishhook.

Animal Bites
A special kind of infection that must be guarded against in case of animal bites is rabies (sometimes called "hydrophobia"). This disease is caused by a virus that is present in the saliva of infected animals. The disease occurs most commonly in wild animals, but it has been found in domestic animals and household pets. In fact, it is probable that all mammals are susceptible to it. The virus that causes rabies is ordinarily transmitted by a bite, but it can be transmitted by the saliva of an infected animal coming in contact with a fresh wound or with the thin mucous membrane of the lips or nose. The virus does not penetrate normal unbroken skin. If the skin is broken, DO NOT attempt wound closure.

If rabies develops in man, it is usually fatal. A preventive treatment is available and it is very effective, but only if it is started shortly after the bite. This treatment is outlined in BUMEDINST 6220.6. Since the vaccine can be obtained only at a medical treatment facility or a major ship, any person bitten by an animal must be transferred quickly to the nearest treatment facility for evaluation, along with a complete report of the circumstances surrounding the incident. Remember, prevention is of utmost importance.

Immediate local treatment of the wound should be given. Wash the wound and the surrounding area carefully, using sterile gauze, soap, and sterile water. Use sterile gauze to dry the wound, and then cover the wound with a sterile dressing. DO NOT use any chemical disinfectant. Do not attempt to cauterize the wound in any way.

All of the animal's saliva must be removed from the victim's skin to prevent further contamination of the wound.

CAUTION: DO NOT allow the animal's saliva to come in contact with open sores or cuts on your hands.

When a person has been bitten by an animal, every effort must be made to catch the animal and to keep it confined for a minimum of 8 to 10 days. DONOT kill it if there is any possible chance of catching it alive. The symptoms of rabies are not always present in the animal at the time the bite occurs, but the saliva may nevertheless contain the rabies virus. It is essential, therefore, that the animal is kept under observation until a diagnosis can be made. The rabies treatment is given if the animal develops any definite symptoms, if it dies during the observation period, or if for any reason the animal cannot be kept under observation. Remember that any animal bite is dangerous and MUST be evaluated at a treatment facility.