How do you manage an open, oozing wound in an adult with no known allergies or medical history in a resource-limited setting?

Managing an Open, Oozing Wound in the Street with Limited Supplies

Immediately irrigate the wound thoroughly with any available clean water—tap water is as effective as sterile saline—and cover it with any clean cloth or material to prevent contamination until proper medical care can be accessed. 1

Immediate Wound Irrigation

• Irrigate the wound thoroughly with large volumes of water until all visible debris and foreign matter are removed. 1
• Running tap water is equally effective as sterile saline solution for wound irrigation and should be used without hesitation in a street setting. 1
• Cold water works as well as warm water for cleaning, though it may be less comfortable for the patient. 1
• If running water is unavailable, use any source of clean water available. 1
• The goal is to remove bacterial contamination and debris—simple rinsing may not provide adequate pressure, so use forceful irrigation if possible. 1

Control Any Active Bleeding

• Apply direct pressure to the wound using any clean cloth, clothing, or material available. 1
• Direct pressure is the most effective method for controlling bleeding and should be maintained continuously. 1
• Elevation of the injured body part is NOT recommended as it may compromise the proven intervention of direct pressure. 1
• Do NOT use pressure points—they are ineffective and may interfere with direct pressure. 1
• Tourniquets should only be used if direct pressure fails or is impossible, and only with proper training, as they carry risks of nerve damage, muscle injury, and systemic complications. 1

Cover and Protect the Wound

• Cover the clean wound with any available clean, dry material to create an occlusive barrier against contamination. 1
• An occlusive covering prevents external contamination, reduces pain, and protects the wound until definitive care. 1
• If available, use clean cloth, gauze, or even clean plastic wrap—the priority is creating a barrier. 1
• Do NOT apply any ointments, creams, or antiseptics in the street setting, especially if the wound is deep or the patient's allergy status is unknown. 1

Critical Wound Assessment

• Examine for signs requiring immediate emergency care: deep wounds exposing bone/tendon, wounds with severe bleeding uncontrolled by direct pressure, wounds with visible contamination that cannot be adequately irrigated, or any wound showing signs of severe tissue damage. 1
• Animal or human bite wounds, or any wound contaminated with saliva, require urgent medical facility evaluation regardless of appearance. 1
• Hand wounds are particularly serious and warrant medical evaluation even if they appear minor. 1

Transport and Definitive Care Planning

• Keep the wound elevated during transport if swelling is present, but only after bleeding is controlled and the wound is covered. 1
• The patient should seek medical care within 24 hours for wound evaluation, potential closure, and assessment for antibiotic needs. 2
• Tetanus status must be addressed at a medical facility—if the patient's last tetanus booster was >5 years ago for a dirty wound or >10 years for a clean wound, tetanus toxoid is required. 1

Common Pitfalls to Avoid

• Do NOT use antiseptic solutions like povidone-iodine or hydrogen peroxide for irrigation—they offer no benefit over clean water and may delay healing. 1
• Do NOT attempt to close the wound in the street setting with tape or other materials—contaminated wounds should not be closed. 1
• Do NOT apply ice directly to wounds—it can cause tissue damage. 1
• Do NOT waste time searching for "sterile" supplies when clean tap water and clean cloth are immediately available. 1