Bites, Bullets, & Branches

Penetrating wounds are deceiving! They create an “iceberg effect”, where the skin is relatively unharmed except for a few puncture wounds despite severe damage to underlying tissues and blood supply. The patient may appear fine for a few days and then be suddenly overwhelmed by necrosis and infection. Pro-active patient assessment and surgical debridement are important to prevent progression to systemic inflammatory response syndrome (SIRS) and sepsis. Cover penetrating wounds to the chest immediately and other wounds as time allows. Even if the patient does not have respiratory signs at that moment, movement of the patient may shift wounded tissues in such a way as to result in pneumothorax. The seal on the chest can be improved by placing sterile ointment on the wound before adding the dressing and keeping pressure on the site with a gloved hand or bandage. Further wound care is undertaken once airway, breathing, and circulatory issues are addressed ...