If You Dont Know What to Do,

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<ul><li><p>8/14/2019 If You Dont Know What to Do,</p><p> 1/2</p><p>IF YOU DONT KNOW WHAT TO DO, DON'T CLOSE A WOUND.</p><p>Closing a wound by just sewing the skin together is a very bad idea if you don't know whatyou're doing. The skills involved are not terribly complex - Physician Assistant / Nurse</p><p>Practitioner / Special Forces Medic level skills; but require knowledge of anatomy that most</p><p>people (including paramedic/EMT skilled people) lack.</p><p>There are several problems with closing a wound wrong. If the wound isn't clean and bleeding</p><p>controlled, all you do is create a pocket for infection. How do you treat an infection like that?With more surgery, fixing it the right way, PLUS a lot of antibiotics and pain meds. If the</p><p>patient is lucky, you might be successful the second time around but the odds are against it:</p><p>Gangrene is everywhere and can easily get started, with very bad outcomes.</p><p>Wounds will normally heal on their own, more slowly and with a bad scar, but it's better to leave</p><p>them open than to close them incorrectly or prematurely. And even with that bad scar, it can be</p><p>repaired by a plastic surgeon in 6 months or so.</p><p>Despite people thinking that it's like sewing on a button, the skill required to suture is much more</p><p>complex than just sewing. Do it wrong and the person stands a pretty good chance of killing thepatient. One person even told me that its easy as pie, that I was being unnecessarily cautious.</p><p>Easy as pie?</p><p>OK, great! Easy as pie! Lets see: You have a very simple puncture wound of the abdomen (not a</p><p>gunshot, say a little stabbing). You will have to do the following:</p><p>Secure the airway and maintain breathing</p><p>Control bleedingmaintain circulation and prevent shockinduce and maintain anesthesia</p><p>open the wound and explore - vessels, the gut, and other structures may well have been cut, and</p><p>need to be repaired.How do you repair them?</p><p>Tie a bleeder?</p><p>Repair a hole in the gut?</p><p>Clean out everything that doesn't belong there? If the gut is penetrated, then fecalmaterial is in the abdomen and it will cause a life-threatening infection.</p><p>Close the omentum - what size/shape needle and type/size of suture?</p><p>Which suture, technique, and knots?</p><p>close the deep fascia - ditto?</p><p>close the (possibly 3 or 4 different) muscle groups - ditto?close the superficial fasica - ditto?</p><p>close the skin - ditto?</p><p>Bring the patient out of anesthesia</p><p>Dress the wound, monitor for infection, control pain</p></li><li><p>8/14/2019 If You Dont Know What to Do,</p><p> 2/2</p><p>develop a plan for exercise, monitor the bowel for activity, specify a diet, follow up on patient</p><p>care.</p><p>Even a simple skin laceration may involve 3 layers of tissue, each of which has to be closed</p><p>separately, using different types of sutures and (frequently) different suturing techniques. Screw</p><p>up the anatomy and you can damage a nerve too - want to save a limb with an 'easy as pie' suturejob but leave it non-functional because you accidentally severed a major nerve? Or worse, leave</p><p>the person in incredible pain (without lots of pain meds) because you stuck a suture THROUGH</p><p>a nerve?</p><p>I used to be an EMT (basic, and paramedic), and have been the course director more recently for</p><p>pre-hospital care courses including EMT and paramedic. The training you get (especially these</p><p>days) as an EMT doesn't begin to cover the anatomical structures in a body, much less how to fixthem.</p><p>Please note: I am not saying that only physicians can suture. However, before you think that you</p><p>can, you better get the right training in real life, from a qualified instructor, not from yourinterpretations of the orange book and watching westerns on TV. Buying a knock-off M3 bag</p><p>filled with junk, a tube of crazy glue, or a skin stapler, doesnt make one qualified to closeanything.</p><p>Like many things in medicine, doing the wrong thing, even with good intent, is a very, very badthing to do. Being close usually doesnt count.</p></li></ul>


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