Puncture wounds, needles

II. Indications. All wound injuries require consideration of tetanus prevention and treatment. This includes animal and insect bites and stings, injections from contaminated hypodermic needles, deep puncture wounds (including high-pressure, injection-type chemical exposures, such as those from paint guns), bums, and crush wounds. 

Use puncture-resistant, leak-proof containers, color-coded red or labeled depending on the standard, to discard contaminated items such as needles, broken glass, scalpels, or other it s that could cause a cut or puncture wound. 

Infiltration anaesthesia is applied fan-shaped, with as few needle punctures as possible, in close proximity of the wound or the skin area to be treated. An aspiration should always take place to avoid intravascular injection. Suitable alternatives are lidocaine (lignocaine) or prilocaine for injection 5-10 mg/ml, with or without adrenaline. When making an incision of an abscess it is sometimes difficult to use a local anaesthetic if there is a pronounced inflammatory reaction, since the effect of the anaesthetic is reduced due to an increased acidity level. While adrenaline reduces bleeding and delays dispersion of the anaesthetic, local anaesthetic/adrenaline combinations are contraindicated for local anaesthesia of digits, on the face or where the skin survival is at risk. 

Meanwhile, opium had been joined by other narcotics. Back in 1805 a German pharmacist s assistant had discovered how to isolate its main ingredient, morphine. A preparation of morphine is about 10 times as potent as raw opium. In 1832, another morphine derivative called codeine was isolated. By the 1850s, a more effective way to administer these powerful narcotics was developed—the hypodermic needle. During the American Civil War, battlefield surgeons had one effective way to relieve the pain of a shattered limb or punctured lung—an injection of morphine. Soldiers who survived their wounds after this treatment often became addicted to the drug. Morphine addiction was thus sometimes referred to as the soldier s disease. ... 

Wound botulism, a relatively rare form of the disease, results from the production of toxin by organisms that multiply in a contaminated wound. Wounds associated with botulism may not appear obviously infected (38). Before 1980, wound botulism was most likely associated with complicated wounds, such as extensive crush injuries, compound fractures and other wounds associated with avascular areas. Since 1980, most cases have occurred in illicit drug users, including intravenous drug users with contaminated needle puncture sites or drug users with nasal and sinus wounds secondary to chronic cocaine sniffing (38). In 2001, there were 23 reported cases of wound botulism in the United States, with one death (39). 

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