Originally Posted by
Fidel MD
Excellent thread!
Hi, Everybody! I'm new here, and so far loving it. Great topic, and great questions/answers.
As far as long term outcomes, keep in mind that as recently as the late 1800's a belly wound like that was a slow, painful death. A few things happened that changed that, and allowed medical science to figure out how to fix wounds like that.
Those things were the discovery of anesthesia, the understanding of the germ theory of disease, and the discovery of antibiotics.
Field treatment would be cover the protruding viscera with a damp dressing, cover that with an occlusive dressing, don't try and replace anything (it'll just have to come out later, anyway), nothing by mouth except perhaps a combat pill pack with antibiotics, maintain hydration with an IV if possible, and get to higher levels of medical care.
What higher levels would do is anesthetize the patient, administer pretty large doses of IV antibiotics and a tetanus booster, open the belly up (xiphoid to pubis), pick out all the foreign matter, tie off bleeders, check the bowel and other organs for leaks and make certain blood flow isn't compromised, flush the abdominal cavity out with sterile saline, and close up the many layers of stuff that make up the anterior abdominal wall, using different suture materials, needles, stitches and techniques for the different layers. Then bandage and wait, checking for bowel sounds and signs of infection.
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Pigs feet, with the skin on, work. So do bananas, and if you're really good, oranges. But sewing is easy, knowing when to suture and more importantly NOT to suture is key. Closing up a dirty, or bleeding wound is a really, really bad idea. I won't do primary closure on wounds (clean or dirty) that are more than 8 hours old: The risk of infection is too high. The patient can wait a couple of days and then have the wound closed.
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