BY
In long-term survival, the performance of tasks like chopping wood, cooking food over open fires, and other activities will likely lead to a number of soft tissue injuries. These are ones that do not involve bony structures.
From a simple cut to a severe burn, any damage to skin is akin to a hole in your body’s protective armor. Your skin is a considered an organ; indeed, the largest organ in the body. It serves as a barrier against infection and loss of fluids. When this barrier is weakened by an injury, your health is at risk. Rapid and effective treatment of these injuries will prevent them from becoming life-threatening.
Movie heroes can be shot in the arm and shrug off the injury. In real life, it’s not so easy. “Minor” injuries aren’t without consequences and have the potential to cause trouble down the road. As the healthcare provider in survival scenarios, you must monitor the healing process of every wound. Each is different in its nature and also in the process of evaluation, treatment, and recovery.
If you’re not present at the time the wound is incurred, begin by asking the simple question: “What happened”? A look around at the site of the accident will give you an idea of what type of debris you might find in the wound and the likelihood of infection. Always assume that a wound incurred outdoors is dirty. Other questions to ask are whether the victim has chronic medical problems, like diabetes, and whether they are allergic to any medications. This will give you an idea of how complicated the recovery might be and what tools you won’t be able to use during treatment.
TYPES OF MINOR INJURIES
When is a soft tissue injury considered minor? A torn knee ligament, for example, isn’t.
While there are many interpretations, a soft tissue injury is considered minor when it fails to penetrate the deep layer of the skin, called the “dermis.” This would include cuts, scrapes, blisters, and bruises:
Superficial cuts and scratches are tears in the skin that only penetrate the epidermis (superficial skin layer) and are rarely problematic in a healthy person.
Abrasions, also known as “scrapes”, occur when a portion of the epidermis has been scraped off due to trauma. You probably have experienced plenty of these as a child.
Bruises, also known as “contusions” result from blunt trauma and don’t penetrate the skin at all. However, there is bleeding into the skin from blood vessels disrupted by the impact. This small amount of blood under the skin gives a characteristic blue-black color.
Blisters occur where fluid fills a space between layers of skin. These bubble-like swellings form due to excessive friction, such as seen in long hikes with ill-fitting shoes.
The physical examination of a wound requires you to determine the following: Location on the body, length, depth, and the type of tissue involved. Local circulation and nerve involvement must also be evaluated. Whitish or blue coloration beyond the level of the injury may indicate impaired blood supply. Pins and needles and other strange sensations may suggest compromise of a nerve.
If an extremity is injured, you must determine if the wound has affected the patient’s range of motion. This is especially important if the injury involves a joint. Sensation and motor strength should also be assessed. In minor wounds, these are usually not greatly affected.
For contusions without an associated open wound, apply pressure and cold packs (if available). This action will help prevent it from getting bigger. Over time, bruises will change color from blackish-blue to brown to yellow. They may be gravity-dependent and may appear to descend slightly as time goes on. A black eye, for example, may show color changes in the cheek as it resolves.
Blisters are minor injuries than can cause major pain. Most people are eager to pop them right away. This shouldn’t be done with small blisters as it makes little difference and could lead to infection. The skin over a blister can serve as a kind of dressing; a sterile one, if it’s intact. Large blisters are different, as they pop easily anyway and it’s important to control how that happens. This is what you do:
• Clean the area with disinfectants like alcohol or povidone-iodine (Betadine).
• Take a needle and sterilize with alcohol or heat it until it’s red hot. Pierce the side of the blister, not the top. This allows the fluid to drain but keeps the protective skin covering. This will ease some discomfort and allow healing to begin.
• Cover the blister to offer protection and apply antibiotic cream if .you have it.
• Take some moleskin or Spenco Second Skin; cut a hole in the middle a little bigger than the blister.
• Place the moleskin on so that the blister is in the middle of the opening in the moleskin.
• Cover with a gauze pad or other bandage.
• Rest if at all possible. If you can’t, make sure that your bandage has stopped the friction to the area. Remember, bandages frequently come off, so check it from time to time to make sure it’s still on. Change the bandage frequently to keep it clean.
For many minor wounds, an alternative to ointment and an adhesive bandage is the “liquid skin” bandage. It’s a good way to cover a minor injury where the skin edges come together naturally. Apply it once to the cut or scrape. It dries within a minute or so and seals the wound. It also stops minor bleeding and won’t fall off during baths. There are various brands available (Band-Aid, New Skin, Curad, 3M); many come as a convenient spray.
Ibuprofen and Acetaminophen are useful over-the-counter drugs to treat minor pain. These injuries will heal over the next 7-10 days, dependent on the amount of skin area affected.
NATURAL REMEDIES
You don’t always have to travel the traditional road to treat many medical problems. If you have a minor injury, you can choose any of a number of natural remedies. If you think about it, if a survival scenario lasts long enough, natural remedies may be all you have once the medicines run out. It’s important for the survival medic to know what plants growing in their own backyard might have medicinal benefits.
Here’s an alternative process:
Stop minor bleeding with herbal blood clotting agents such as Cayenne Pepper powder and simple compression with gauze. Substances that clot blood are called “hemostatic agents.” These include:
• Essential oils, like Yarrow, geranium, helichrysum, lavender, cypress, myrrh, or hyssop. Apply any of these to the wound with a gauze compress and apply firm pressure until bleeding stops.
• Medicinal Herbs- Apply cayenne pepper or cinnamon powder with direct pressure; alternatively, use yarrow tincture soaked in a gauze compress.
After minor bleeding is stopped, the wound can be cleaned with an herbal antiseptic comprised of a few drops of certain essential oils with sterile water. Those who have this property include:
• Lavender oil
• Tea tree
• Rosemary
• Eucalyptus
• and Peppermint
As an alternative, use peppermint oil in a 50/50 mix with carrier oils such as olive or coconut oil. Other natural antiseptics include garlic, raw unprocessed honey, echinacea, witch hazel, and St. John’s wort.
At this point, the wound can be covered using adhesive bandages or clean gauze. Don’t wrap too tightly. Change the dressing, reapply antiseptic, and observe for infection twice daily until healed. Infected minor wounds will show worsening redness, warmth, swelling, and pain over time. Using a sharpie to mark the borders of the redness will give you an idea if things are getting worse or better. If the red area shrinks over time, it’s healingl. If it’s spreading, well, not so much. Here’s where oral antibiotics come in handy, something we’ve talked about in many videos, articles, and podcasts, and in our book Alton’s antibiotics and infectious disease.
Joe Alton MD
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