Where There Is No Doctor 2011 89
WOUNDS THAT ARE LIKELY TO BECOME
DANGEROUSLY INFECTED
These wounds are most likely to become
dangerously infected:
• dirty wounds, or wounds
made with dirty objects
• puncture wounds and
other deep wounds that
do not bleed much
• wounds made where
animals are kept: in
corrals, pig pens, etc.
• large wounds with
severe mashing
or bruising
• bites, especially from
pigs, dogs, or people
• bullet wounds
Special care for this type of ‘high risk’ wound:
1. Wash the wound well with boiled water and soap. Remove all pieces of
dirt, blood clots, and dead or badly damaged flesh. Squirt out the dirt
using a syringe or suction bulb.
2. If the wound is very deep, if it is a bite, or if there is a chance that it still has
dirt in it, give a cephalosporin antibiotic such as ceftriaxone, 1 g. a day
for 3 to 7 days (p. 358). If you do not have this type of medicine, give
erythromycin (p. 354), cotrimoxazole (p. 357), or a sulfa drug (p. 356).
3. Never close this type of wound with stitches or ‘butterfly’ bandages.
Leave the wound open. If it is very large, a skilled health worker or a
doctor may be able to close it later.
The danger of tetanus is very great in people who have not been vaccinated
against this deadly disease. To lower the risk, a person who has not been
vaccinated against tetanus should take penicillin or ampicillin immediately after
receiving a wound of this type, even if the injury is small.
If the wound of this type is very severe, a person who has not been vaccinated
against tetanus should take large doses of penicillin or ampicillin for a week or more.
An antitoxin for tetanus (p. 388) should also be considered but be sure to take the
precautions on p. 70 if using tetanus antitoxin made from horse serum.
If the wound is from an animal bite and there is a chance of rabies (see p. 181),
get an immunization right away.