Series Post: Ask Dr. Dina

Before we get into the post, I need to announce the winner of our anniversary giveaway of a Tiffany Reisz book! Congratulations to commenter Kirsty! An email has been sent notifying you of your win!

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don’t intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you’re having an immediate medical problem and you’re reading this blog for help, get off the damned computer and call an ambulance!

Previously on Ask Dr. Dina, we talked about bleeding. Today we’re going to talk a little about wound care.

Now, we talked a little about things in the post on cuts and punctures, and a little bit more in the post on treating infection. Why then is there a special post dedicated to wound care?

Well, because, it’s a huge topic and there are entire classes and even a nursing specialty dedicated to the subject, so sit down, shut up, and educate yourself here. Also because I didn’t cover it nearly enough in the previous posts. Having said that, let’s get started.

I’ve said before that cleaning a wound too often or with the wrong thing can actually do more harm than good. There’s also different types of wounds that need different types of treatment. You may have heard, “if it’s wet, keep it dry, and if it’s dry, keep it wet.” (That’s a Dr. House quote, by the way.) That kind of works for dermatology stuff, but wound care is a little different.

Now, I’m not going to go into huge detail about the different types of wounds again. We’ve already covered those in previous posts, so I’ll just do a quick little summary of the ones I’m going to talk about here. For the purposes of this post, we’re only going to talk about caring for open wounds that might come up in your writing, such as:

Puncture wounds (like gunshots)
Cuts (lacerations – like from knife fights/machetes)
Surgical wounds (incisions)
Thermal wounds (burns/frostbite)
Chemical wounds (made by chemicals – duh)
Bites and Stings (from humans, dogs, bats, rodents, snakes, insects, spiders)

Each injury is different and each requires a level of care equivalent with its severity (how bad it is), whether or not there are complications (difficult location, infection, adhesions, and many more), and if anything else was damaged that makes it difficult to heal the wound (such as an underlying organ that needs to heal, too). I could go into so much horrifying detail about wound care it would bore you to tears and you’d still not know what the hell I’m talking about, so I’m going to simplify things as best I can.

Though each type of wound requires a different type of treatment, there are some basics that 99% of wounds get treated with:

1 – Cleaning. All wounds, from surgical to traumatic, need cleaning (see also – debridement). How depends on the factors mentioned above, but that wound still needs to be cleaned. Usually that’s with plain old water (flushing or irrigation). Note: I am not going to get into the different types of water that might be used. There are a bunch and they’re all fucking water, so cope with it. Sometimes that water is pressurized, sometimes it’s not. It just depends. But every wounds needs cleaning, no matter what. A wound won’t heal very well if it’s not clean/has stuff in it. However, this step can also do more harm than good if you’re overzealous about it or use the improper solution, so be careful here. It may look cool to pour vodka in a character’s gunshot wound and make them scream, but medical people will roll their eyes at you.

2 – Treatment. See above. Treatment for various wounds depends on a whole lot of factors, and I’m not going to write a textbook on the subject. Go buy one if you’re so curious. Remember we talked about overuse of antibiotics, though – not every wound needs to be slathered in triple-antibiotic ointment. Remember we also talked about sutures and when to go to the hospital for your owie. Treatment is big and important, and if you don’t know how to care for your character’s wound, go look it up or ask someone who should know (like Dr. Dina).

3 – Dressing. All wounds need some form of protection while they heal. Sometimes you’re good with just a band-aid to keep things out of the injury. Other times you need sterile gauze and paper tape. Still other times you’ll need a lot more than that. As I said above – the level of care depends on the level of severity. Some wounds need to be “left open” so they can heal from the inside out. These require a special type of dressing that keeps the wound moist enough to heal while still keeping things clean and a close eye is kept on its progress. No matter what, though – all wounds need a dressing of some sort.

“But Dina,” you say, looking at me with anxious eyes. “I’ve always heard you should let a wound air out, not put a bandage on! That’s what I grew up with!”

Yeah? Well, now you know better. It’s been proven repeatedly – COVER YOUR FUCKING WOUND. Whether it’s a cat scratch, paper cut, or surgical incision, KEEP THAT FUCKER COVERED.

Now, if you want more about wound care, I suggest studying up if you want realism in your writing. This post from the Royal Children’s Hospital in Melbourne is a fantastic place to start (warning – heavy on the Fancy Medical Speak; it’s really for nurses/health care professionals). Hint: Melbourne, Australia has some of the best freakin’ medical schools in the world, and their guidelines are top-notch, in my opinion. If you don’t want to study up/caring for your character’s wound isn’t important to your story, fair enough. But YOU should know how to deal with things. Most people are good with the basics – clean, treat, dress. You’ve got those three down, you’re fairly safe for realism.

Next time we’ll talk about drowning! I’ve been promising you guys that one for a long time. Might as well start off the Northern Hemisphere hot season with a post on being asphyxiated by water.

Questions about medical issues with your writing? Leave them in the comments below and I’ll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)