Ok Patient 1, thank you.
This could be serious if not treated correctly.
Firstly I would inspect the wound to see what stage it was at A-G by using this guide.
(
Fig. 31-1 TROPICAL ULCERS. A, the earliest stage of a tropical ulcer is a pustule, containing Vincent's organisms and fusiform bacilli. Alternatively, and some would say more commonly, the early stage is a small cut. B, the pustule ruptures to form an acute ulcer. C, a chronic ulcer showing the exposed tendons. D, the characteristic site of tropical ulcers anteriorly on the lower leg, becoming more lateral lower down. E, an acute tropical ulcer, with an everted oedematous edge, and a dirty slough covering much of its base. F, a chronic ulcer, with an edge which is not raised, and a uniform avascular base. G, a squamous cell carcinoma, with an everted edge, and an irregular base. MOST GRAFTING SHOULD BE DONE AT THE ACUTE OR SUBACUTE STAGE. )
It seems like we have a biotic infection in the hand so we must clean the wound/ulcer, I would firstly use a 5% Potassium permanganate and hot water solution to clean the wound. Leave to soak in the solution without agitating it and causing a bleed. Then we will clean with saline or permanganate solution using a squeezy bottle to flush the wound.
Then we will have a look for dead skin around the purple edges wound and into the grey base of the ulcer wound. It should be surgically removed by a professional, although maggots have been used by soldiers in Japanese prisoner of war camps in the second world war. But let's leave that for now, our current job is to clean the ulcer, by application of non-adheshive swabs of a disinfectant of Potasium permagernate solution, 3% hydrogen peroxide or salted saline solution.
We then dress with a healant gel or powder, (I have been recommended johnston & johnston first aid healing gel, but failing that we could add natural raw honey ( not pasturised store bought honey. ) to treat and cover the wound, the natural hydrogen peroxide should do a nice job of cleaning and protecting the wound. ) and sterile gauze and bandage, every day we will soak the dressing with a saline solution ( salt and water. ) to ease the removal of the dressing and redress with clean sterile non adhesive gauze, healing gel and bandage every day. You can be given a saline solution to apply to the dressing to keep the wound moist every 2-3 hours.
We will continue this for seven days and you should take a Tetracycline or Metronidazole antibiotic or penacilin to aid anti-infection.
We will check on this daily as you may have to travel to an area where they can perform a skin graft upon the wound.
In the time it takes to be seen by a profession health centre/hospital this would be the way I would treat the wound.
Wow, my first patient. I now realise that it's kinda pressured hard work but important procedures involved. I still feel like a first aider with added responsibility, the pressure, but this is my first day.
My great grandfather and grandfather were both Doctors, I hope this healing thing is in the blood. I spent many years working on building sites before getting my boat master licence.
Some of the information was taken from this link.
http://www.meb.uni-bonn.de/dtc/primsurg/docbook/html/x11011.html
Doctoring seems harder than being a skipper.
Thank you Patient 1, that was a good learning practise.
Ok, how did I do? Please be critical.
If I done ok, then next patient please.
