Page 72 - PJ MED OPS Handbook 8th Ed

Wound Debridement
Indications:
For removal of devitalized tissue and/or debris. In most cases, simple bandaging is all that is re-
quired for field management of wounds. Consider debridement with delayed primary closure if:
1. Evacuation to higher level of care is delayed >12–14 hours OR
2. The patient has a grossly contaminated wound with more than 8 hours until transport to higher
level care
NOTE: Provide adequate procedural sedation and local anesthesia with good exposure and
adequate lighting. Document total lidocaine administered; do not exceed 300mg.

CAUTION: Work gently, precisely, and methodically. DO NOT cut any structure not positively
identified as skin, muscle, or fat.

Procedure:
1. Extend wound if necessary to allow adequate exploration.
2. Irrigate and explore wound with gloved finger. Remove any remaining foreign matter and drain
entrapped accumulations of fluids or exudates.
3. Control bleeding by direct pressure or ligation.
4. Excise (cut) devitalized tissue preserving all vessels, skin, nerve and bone if possible.
5. Re-irrigate wound and control bleeding.
6. Apply bulky dressing and monitor patient for recurring hemorrhage or signs of infection.
NOTE: For larger wounds requiring packing, pack with gauze and change daily per wound
management protocol. This will aid in debridement of devitalized tissue.

Wound Suturing
Indications:
Suturing most of wounds sustained in combat is not indicated due to the high risk of infection. Be-
fore wound closure is contemplated, carefully consider the risk of infection and possibility of retained
foreign bodies within the wound. Suturing should only be considered when there will be a delay to
definitive care >12 hours and adequate irrigation and debridement can be accomplished in the field.
Procedure:
1. Irrigate and debride the wound as described above.
2. Ensure the use of sterile technique and use of PPE.
3. Anesthetize the wound with 1% lidocaine with or without epinephrine depending on suture
location (no epi in fingers, toes, penis, nose).

NOTE: Do not exceed 300mg or 4.5mg/kg lidocaine.

70 n Pararescue Medical Operations Handbook / 8th Edition