| Emergency
Wound Management for Healthcare Professionals in the treatment
of Necro-Mortosis victims
The
risk for injury to both citizens and Healthcare Professionals
during and after an undead outbreak is high. Apart from Necro-Mortosis
contamination from bites, other problems such as blunt force
trauma wounds mental trauma and tetanus have to be contended
with. Tetnus is a potential health threat for persons who
sustain wound injuries. Tetanus is a serious, often fatal,
toxic condition, but is virtually 100% preventable with vaccination.
Any wound has the potential for becoming infected with either
mortosis and/or tetnus, and should be assessed by a health-care
provider as soon as possible.
These
principles can assist with wound management and aid in the
prevention of amputations. In the wake of a 'Level three'
undead outbreak resources are limited. Following these basic
wound management steps can help prevent further medical problems.
Evaluation
Ensure that the scene is safe for you to approach the patient,
and that if necessary; it is secured by the proper authorities
(police, fire, civil defense) prior to patient evaluation.
Observe universal precautions, when possible, while participating
in all aspects of wound care.
Obtain a focused history from the patient, and perform an
appropriate examination to exclude additional injuries.
Treatment
Apply direct pressure to any bleeding wound, to control hemorrhage.
Tourniquets are rarely indicated since they may reduce tissue
viability.
Examine wounds for gross contamination, devitalized tissue,
and foreign bodies.
Remove constricting rings or other jewelry from injured body
part.
Cleanse the wound periphery with soap and sterile water or
available solutions, and provide anesthetics and analgesia
whenever possible.
Irrigate wounds with saline solution using a large bore needle
and syringe. If unavailable, bottled water is acceptable.
Leave contaminated wounds, bites, and punctures open. Wounds
that are sutured in an unsterile environment, or are not cleansed,
irrigated, and debrided appropriately, are at high risk for
infection due to contamination. Wounds that are not closed
primarily because of high risk of infection should be considered
for delayed primary closure by experienced medical staff using
sterile technique.
Remove devitalized tissue and foreign bodies prior to repair
as they may increase the incidence of infection.
Clip hair close to the wound, if necessary. Shaving of hair
is not necessary, and may increase the chance of wound infection.
Cover wounds with dry dressing; deeper wounds may require
packing with saline soaked gauze and subsequent coverage with
a dry bulky dressing.
If wound infections develop, and patient shows early to mid
signs of mortosis, such as a lowering of temperature, aggressive
behaviour, confusion, flu symptoms. migraine, hot flushes,
aching muscles or a slowing of the heart rate, patient must
be secured, tagged, and admitted to quarantine immediatly.
Other
Considerations
Be vigilant for the presence of other injuries in patients
with any wounds.
Ensure adequate referral, follow-ups, and reevaluations whenever
possible.
Dirty water and soil and sand can cause infection. Wounds
can become contaminated by even very tiny amounts of dirt.
Puncture wounds can carry bits of clothing and debris into
wound resulting in infection.
Crush injuries are more susceptible to infection than wounds
from shearing forces.
Guidance
for Management of Wound Infections
Most wound infections are due to staphylococci and
streptococci. This would likely hold true even in an undead
outbreak situation.
For initial antimicrobial treatment of infected wounds, beta-lactam
antibiotics with anti-staphylococcal activity (cephalexin,
dicloxacillin, ampicillin/sulbactam etc.) and clindamycin
are recommended options.
Of note, recently an increasing number of community associated
skin and soft tissue infections appear to be caused by methicillin-resistant
Staphylococcus aureus (MRSA). Infections caused by this organism
will not respond to treatment with beta-lactam antibiotics
and should be considered in patients who fail to respond to
this therapy. Treatment options for these community MRSA infections
include trimethoprim-sulfamethoxazole (oral) or vancomycin
(intravenous). Clindamycin is also a potential option, but
not all isolates are susceptible.
Incision and drainage of any subcutaneous collections of pus
(abscesses) is also an important component of treating wound
infections.
Partial
sources:
Zombie WorldNews.com
6th Edition
Emergency Medicine: A Comprehensive Study Guide, 2004
2nd Edition. Sanitation and the undead, 2007
34 th Edition.The Sanford Guide to Antimicrobial Therapy,
2004,
2nd Edition Treatment of the Undead. Necro-Mortosis 2006
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