can then be withdrawn in the manner indicated in
figure 4-32D.
Animal Bites
A special kind of infection that must be guarded
against in case of animal bites is rabies (sometimes
called “hydrophobia”). This disease is caused by a
virus that is present in the saliva of infected animals.
The disease occurs most commonly in wild animals,
but it has been found in domestic animals and
household pets. In fact, it is probable that all mammals
are susceptible to it. The virus that causes rabies is
ordinarily transmitted by a bite, but it can be
transmitted by the saliva of an infected animal coming
in contact with a fresh wound or with the thin mucous
membrane of the lips or nose. The virus does not
penetrate normal unbroken skin. If the skin is broken,
DO NOT attempt wound closure.
If rabies develops in man, it is usually fatal. A
preventive treatment is available and it is very
effective, but only if it is started shortly after the bite.
This treatment is outlined in BUMEDINST 6220.6.
Since the vaccine can be obtained only at a medical
treatment facility or a major ship, any person bitten by
an animal must be transferred quickly to the nearest
treatment facility for evaluation, along with a complete
report of the circumstances surrounding the incident.
Remember, prevention is of utmost importance.
Immediate local treatment of the wound should be
given. Wash the wound and the surrounding area
carefully, using sterile gauze, soap, and sterile water.
Use sterile gauze to dry the wound, and then cover the
wound with a sterile dressing.
DO NOT use any
chemical disinfectant. Do not attempt to cauterize the
wound in any way.
All of the animal’s saliva must be removed from
the victim’s skin to prevent further contamination of
the wound.
CAUTION: DO NOT allow the animal’s
saliva to come in contact with open sores or
cuts on your hands.
When a person has been bitten by an animal, every
effort must be made to catch the animal and to keep it
confined for a minimum of 8 to 10 days. DO NOT kill
it if there is any possible chance of catching it alive.
The symptoms of rabies are not always present in the
animal at the time the bite occurs, but the saliva may
nevertheless contain the rabies virus. It is essential,
therefore, that the animal is kept under observation
until a diagnosis can be made. The rabies treatment is
given if the animal develops any definite symptoms, if
it dies during the observation period, or if for any
reason the animal cannot be kept under observation.
Remember that any animal bite is dangerous and
MUST be evaluated at a treatment facility.
WOUND CLOSURE
LEARNING OBJECTIVE: Recognize the
different types of suture material and their
uses; recall topical, local infiltration and
nerve-block anesthetic administration
procedures; and identify the steps in wound
suturing and suture removal.
The care of the wound is largely controlled by the
tactical situation, facilities available, and the length of
time before proper medical care may be available.
Normally, the advice to the Corpsman regarding the
suturing of wounds is DO NOT ATTEMPT IT.
However, if days are expected to elapse before the patient
can be seen by a surgeon, the Corpsman should know
how to use the various suture procedures and materials,
and how to select the most appropriate of both.
Before discussing the methods of coaptation
(bringing together), some of the contraindications to
wound closing should be described.
If there is reddening and edema of the wound
margins, infection manifested by the discharge
of pus, and persistent fever or toxemia, DO NOT
CLOSE THE WOUND. If these signs are
minimal, the wound should be allowed to “clean
up.” The process may be hastened by warm,
moist dressings, and irrigations with sterile
saline. These aid in the liquefaction of necrotic
wound materials and the removal of thick
exudates and dead tissues.
If the wound is a puncture wound, a large gaping
wound of the soft tissue, or an animal bite, leave
it unsutured. Even under the care of a surgeon, it
is the rule not to close wounds of this nature until
after the fourth day. This is called “delayed
primary closure” and is performed upon the
indication of a healthy appearance of the wound.
Healthy muscle tissue that is viable is evident by
its color, consistency, blood supply, and
contractibility. Muscle that is dead or dying is
comparatively dark and mushy; it does not
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