Last week, in a comment on the article on removing sutures, Michael asked about how to determine whether a wound is infected. It’s definitely a topic that merits coverage.
Many years ago, during the period when the History Channel was evolving from a really great source of entertainment and information to the aliens, Vikings, and Hitler channel, they had a show on about what would happen in America following an EMP. (I think it was an EMP. Could have been an economic collapse or something else. It’s been a while.) Anyway, life’s rough, people are losing weight, and one of the main characters cuts himself while working outside, I believe. It gets infected. He has no antibiotics. He dies.
In the real world, when I was in college, I had beautiful hands and long, strong fingernails. And every once in a while I’d get a hangnail. I hate hangnails. They catch on things and drive me crazy. So I yank them out. Which is exactly what you are not supposed to do. I have taught my children not to do this, but I have yet to break myself of this habit. I tell myself I will behave when things truly fall apart.
Anyway, I pulled out one of those hangnails in college. Like most of the hangnails I yanked out, it hurt. But unlike the others, this one continued hurting. And then my finger started to swell and throb. Not only that, but the red streak I’d read about in my pre-med classes had started up my finger. There was no delaying the doctor visit now.
What was an annoyance then and only involved an antibiotic prescription will instill great fear in the future for many and death for some.
Risk factors
The risk factors for developing an infected wound include a compromised immune system which may be due to a medical condition or which may arise due to malnutrition and/or poor hygiene. These latter can be avoided by preparing well. (And while prices continue to escalate due to inflation, some prep items can still be found on sale. At the grocery store just yesterday, I found over a dozen bottles of rubbing alcohol more than 60% off. That was on the heels of deep discounted hydrogen peroxide, hand sanitizer, and surgical masks. However, I’m not holding my breath about canning lids being discounted anytime soon. They still aren’t even on the shelves here.)
Prevention
Beyond avoiding injury in the first place and mitigating the risk factors, there are measures to take to prevent wound infection. The first is to take the time to disinfect and clean wounds properly. There is a link below to an article on this topic. The second is to use the right suture pattern when closing a wound, assuming that you are the one providing care. Interrupted sutures (where each stitch is individually placed and not connected to the others) are preferable to a running (whip) stitch. Choose a good suture as well. If the wound was particularly dirty, a monofilament suture may be a safer choice. Braided sutures are more likely to harbor bacteria.
Proper stitch removal, as addressed last week, is also important. However, even in the best of circumstances, wounds will get infected. The current rate of infection of surgical wounds is 1%; the incidence of infection in wounds closed in the emergency room is 3-4%.[i] In a collapsed society and austere conditions, the rate will likely be higher.
Signs and symptoms
Redness at the edges of the wound
Sometimes pus or yellowish scabs on or exuding from the wound
Increased tenderness at the site
Skin is warm or hot
Swelling[ii]
Fever, chills
Headache
Nausea and/or vomiting
Red streak from the wound (if it’s on an arm or leg) towards the torso
Differentiation
At this point, it is important to differentiate between a simple wound infection and other conditions. While insect stings and bites can result in an infection, this is not normally the case. A reaction to a bite or sting will generally occur more quickly and doesn’t spread after the first 24 hours. (This is why infections on the skin are outlined with a Sharpie.) Unlike an insect bite or sting, an infection on the skin will continue to spread.
Treatment
If sutures are in place, they must be removed. Antibiotics do not kill bacteria on sutures. And wound edges will not grow together if infected. Any bandages or other dressings must also be removed. Clean the wound again and be sure to remove any dead tissue.[iii]
The above procedures are usually sufficient for clearing up a wound infection, assuming the infection is not cellulitis, which may be difficult to differentiate in an austere situation. Cellulitis will be covered in a future post.
The decision whether to use herbs or antibiotics or anything will be a judgment call. As noted, simple but thorough cleaning of the wound may be all that is required. However, the body of an immunocompromised or malnourished individual may not be able to fight off the infection without assistance from antibiotics or herbs. Then again, do you want to risk wasting precious antibiotic tablets when they aren’t needed?
You may wish to begin simply with an antibiotic ointment applied a few times each day.
Herbal options:
Calendula
Echinacea
Japanese barberry
Japanese honeysuckle
Juniper
Lavender
Mullein
Oak
Oregano
Plantain
Raspberry
Rosemary
Usnea
Yarrow
Conventional pharmaceuticals often prescribed:
Augmentin, 250-500 mg, 3x per day
Cephalexin, 250-500 mg, 3-4x per day
If neither of those work, switch to or add:
TMP-SMZ, 1 DS tablet, 2x per day
Doxycycline, 50-100 mg, 2x per day
If those are still ineffective, a doctor will try ciprofloxacin or Levaquin. [iv]
So how do you determine whether your chosen approach to treatment is working?
Day 1. Redness may not decrease, but it shouldn’t increase much either, no more than ¼” beyond outlined border.
Days 2-3. Reddened area should be much smaller. If not, add 2nd herb or antibiotic.
Links to related posts:
The Right Way to Clean Abrasions
Wound Closure Options
Calendula
Juniper
Usnea
Yarrow
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