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infected water first to soften the coagulum.) If an infection is present, pus usually pours
out when the wound is opened. If no infection is present, opening the wound usually does
little harm except for the discomfort, which is of little consequence when compared with
the damage that could result from an undiscovered infection.
Treating Wound Infections
Treatment of an infected wound consists of drainage and antibiotic therapy. The wound
should be opened by prying apart its edges with a pair of sterile forceps. Since pus in an
infected wound tends to collect in pockets, the deeper parts of the wound must be probed
to ensure all such pockets are drained. If one is found, others should be expected. After
drainage, gauze should be placed in the wound to keep it open. The gauze, preferably im-
pregnated with petroleum jelly, should be changed whenever the wound is dressed. The
edges of the wound should not be allowed to reseal as long as any evidence of infection is
present.
Infected wounds covered by a crust of coagulated serum and pus, particularly those on
the extremities, benefit from soaking in warm water. Moisture softens the crust and per-
mits more thorough drainage. Heat causes the blood vessels to dilate, increasing the flow
of blood to the tissues, which promotes healing and the eradication of infection. For infec-
ted small wounds on the extremities—or for large wounds if the person cannot be evac-
uated—the dressing should be removed and the wound immersed in warm, sterile water
for periods of twenty to thirty minutes three to four times a day. An antiseptic such as
povidone-iodineshouldbeaddedtothewater.Afterward,theskinshouldbecarefullydried
and a fresh dressing applied.
Antibiotics shouldnotbegivenroutinely toindividuals withsoft-tissue injuries because
the probability ofinfection islow,antibiotics have onlyalimited ability toprevent soft-tis-
sueinfections,andtheriskofallergicreactionsandotheradversesideeffectsissignificant.
However, for severe soft-tissue injuries or badly contaminated wounds, antibiotics should
beadministeredprophylacticallybeforesignsofinfectionappear.Inaremotesituation,an-
tibiotics should also be given to persons with major wound infections with the understand-
ing that the major benefit would be to inhibit spread of the infection and not to eradicate
the infection within the wound.
If antibiotics are administered as a preventive measure, they should be given in large
dosages for only two days; such a brief course of antibiotics does not allow the emergence
of resistant bacterial strains. If a significant, established soft-tissue infection is being
treated,however,highdosesofantibiotics shouldbegivenforatleastfivedays,oruntilall
signs of infection are gone.
BANDAGING
A bandage is usually composed of three layers, each with different functions.
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