Wound Management

Let's face it, bowhunters play with sharp stuff! In this column we will discuss wound management. We will specifically look at what to do if you cut yourself in the field. In most cases a cut or laceration is little more than a painful inconvenience requiring a trip to the local ER and a few stitches. In a more remote setting or with a more serious laceration a wound can be life threatening.

Lacerations can cause problems in a number of different ways. As bowhunters we all have been taught that arrows kill by causing hemorrhage. Uncontrolled blood loss leads to the death of our quarry. Arrows can also cause damage to organs and other structures which they contact. A heart shot deer is a perfect example. The arrow causes pump failure by creating a leak in the pump. This quickly leads to death. The final way that arrows cause mortality is not so immediate. Delayed infection can also become an issue. A gut shot deer is unfortunately an example of this. The initial wound is not fatal. There is no life threatening hemorrhage or organ damage. The wound creates a hole in the intestines which allows leakage of bacteria into the animal's system. This causes an overwhelming infection leading to death. These same deadly factors which we use to harvest our venison come into play when you inadvertently cut yourself. The location and size of the wound help determine the potential seriousness of the wound and your necessary response. Obviously a small cut to your finger while your dressing your deer has little potential to cause serious bleeding or organ damage. Infection is probably the most serious complication and this can be minimized as we will discuss. In contrast, an arrow wound through your thigh can cause severe bleeding and be quickly life threatening.

As with most of these columns the first topic to discuss is prevention. The best laceration is the one that is prevented! Broadheads need to be kept in a hooded quiver until you are ready to shoot. Stalking with an arrow on the string is extremely dangerous. A simple misstep can cause you to fall onto that very sharp broadhead with disastrous consequences. Many hunters every year accidentally drop an arrow out of their treestand. It has happened to most of us I am sure. The problem comes later when you climb down and have forgotten about that arrow. The broadhead can be pointing straight up causing a very severe injury. This happens to unfortunate bowhunters every year. If you drop an arrow, carefully climb down and retrieve it immediately while you are thinking about it and know exactly where it is. Field dressing your animal is also another time when many hunters cut themselves. My best advice here is to take your time and do not rush! Go slowly and think about what you are doing. If you have not found your arrow, the broadhead could still be in there. Watch out! When using your knife be especially careful cutting where visibility is limited. A relaxed slow pace will prevent lots of trouble. Also watch out for your helpful partners hands.

 

Once you have sustained a cut the first thing to do is use your head and carefully assess the situation. Where is the cut and how deep is it? Is it bleeding heavily? How far are you from help or a hunting partner? Is the object that cut you still embedded in the cut? The answer to these simple but life saving questions will guide your decision making. A careful look at the wound will usually allow you to gauge the seriousness of the situation. Grossly dirty wounds should be carefully washed with water if available. Otherwise wipe out whatever dirt you can gently remove. If the cut is bleeding, direct pressure at the site will almost always control the blood loss. A clean rag or your shirt or any piece of cloth should be applied directly to the wound and pressure applied. Your hand will work fine to apply the pressure. If you need both hands, use your arm guard or belt to apply pressure over the wound. Direct pressure to the bleeding site will stop the bleeding in almost every case. If it is possible, elevating the cut above your heart will also slow the bleeding. In the rare instance when direct pressure fails, pressure points are the next step. Pressure points are simply areas on your body where you can feel your pulse. At these sites your blood vessels come close to the skin. The most obvious examples are on the inside of your upper arm and at the top of the inside of your thigh. Taking a minute to find them now will make it a lot easier to use them if ever needed. If you can locate a pressure point between the cut and your heart you apply firm pressure at the place where you can feel the pulse. Pressure points DO NOT take the place of direct pressure and should be considered additive to local measures. Tourniquets should be considered a last resort. Applying a tourniquet is making the decision to sacrifice your limb to save your life. The tourniquet should be applied just above the cut tight enough to stop the bleeding. You can use a stick to twist the cloth tightly and stop the bleeding. Once a tourniquet is applied it should NOT be removed until you reach the hospital. As soon as the tourniquet is applied the tissue below the tourniquet receives little or no blood. The limb begins to build up toxic chemicals because it is being starved of oxygen. These toxic chemicals are trapped by the tourniquet. When the tourniquet is released these chemicals can flood your system and cause you to go into shock. If you are not at the hospital this can be quickly fatal. A tourniquet is usually extremely painful and can lead to permanent damage to the area it was applied to. Amputation is a likely outcome if the tourniquet has been on greater than 4-6 hours. I want to impress upon you that tourniquets can be life saving but carry very significant risks. The application of a tourniquet should never be taken lightly and should only be needed in the rarest of situations.

If the object that cut you is still embedded most experts recommend leaving it in place until you reach the hospital. The theory is that the object may be pressing against blood vessels and helping to control bleeding. Removal may increase bleeding or cause more tissue damage as the object is pulled out. You should stabilize the object as close to the skin as possible with rope, clothes etc. and then immobilize the involved extremity with a splint. The splint can be made from sticks, your longbow, arrows (with broadheads removed) or whatever you can come up with. You are trying to limit as much movement as possible in both the object and the injured area. This is to limit further tissue damage and hemorrhage. In most cases I believe this is good advice. There are situations where removal may be necessary. If the object does not allow you to apply direct pressure to a heavily bleeding wound I would remove it if possible. Also sometimes the object will be very large and not easily immobilized or make transport difficult. In these situations you will have to make a judgment call. Removal should be done as atraumatically as possible with the goal to minimize further injury.

If you are in a wilderness situation and transport is not immediately possible you should keep the wound as clean as possible and change the dressing daily. Antibiotic ointment can be applied daily and the wound covered with a clean dressing. Unless you are experienced suturing in the field should be avoided. Duct tape and a clean piece of clothing will make a simple but effective dressing.

So far we have focused mainly on cuts to the extremities. These are the types of wounds where direct pressure and immobilization can make a difference. Wounds to the chest or abdomen can be much more serious. Field management for these wounds focuses on keeping the patient comfortable and early rapid transport. With a deep wound the patient will typically not be able to walk and will need some form of transportation. The method of transport depends on where you are and what is the quickest way to get the patient to the hospital. While getting the patient to the hospital you should keep the wound covered and as clean as possible. Elevating the patients legs above the level of the heart can increase the patient's blood pressure and prevent shock for a short time. Drinking fluids is somewhat controversial. First off, if the patient is very sick they will not want or be able to drink. Secondly, patients should not be given anything to eat or drink before an operation. A deep wound to the torso will certainly require an operation. If transport is going to be very long and the patient can drink, I would probably give fluids to attempt to keep the patient hydrated. For short transports I would avoid it.

As bowhunters, cuts are clearly a risk that needs to be addressed. For short hunts around home the vast majority of cuts can be managed with items that you already have with you. In a wilderness setting your first aid kit should contain bandages, Band-Aids, antibiotic ointment, tape, and possibly oral antibiotics. It is important to remember that the most important item in your first aid kit is what sits above your shoulders. Clear rational thinking will maximize good outcomes and get you back hunting in the shortest time.