My problems started with just a little cut near the first knuckle of my left ring finger. I’d been backpacking for 10 days in arctic Norway and seen nothing but fog and rain the entire trip. It’s true, even busy instructors like me must sometimes take a break from teaching classes at the Wilderness Medicine Institute of NOLS to go into the wilderness ourselves.
Because of the awful weather, my hands were soft and waterlogged most of the time, and they were, as is normal on an extended backpacking trip, somewhat dirty. The cut on my finger was so tiny I didn’t even bother to apply a Band-Aid.
A day later, I noticed that my finger felt a little sore and that the skin near the cut was pink and inflamed. Dang, I thought, the little bugger is going to get infected.
So I washed my hands very well with soap and water, and when they were dry I covered the wound with a small bandage. Then I went slogging through another wet and swampy day of tundra hiking. The last thing I did that night was to set the alarm on my watch for the next morning. As I did so, I noticed that my wrist felt sore and bruised, as if I had smacked the watch against a rock or something—only I didn’t remember doing that. Strange, I thought, but I was tired and soon fell asleep.
The next morning I awoke to the sound of my friends already outside the tent, chatting and cooking breakfast. Something was wrong with me, besides being too lazy to get out of bed. My arm ached, my wrist hurt, and my cut finger felt puffy and swollen tight. I looked at my arm and was shocked to see two very clear pink lines tracing their way from my wrist up my arm and into my armpit. The lymph ducts were full of infected fluids, and even the axillary lymph nodes in my armpit were swollen, like hard knots under my skin.
Of course, I had shown many of the classic signs of soft tissue infection. While all wounds tend to have some inflammation as they heal, wounds that become more painful over time, not less so, are concerning. Minor infections appear as wounds that turn pink or red at the edges, and puff up, and even leak small amounts of pus. These wounds should be treated for mild infection immediately. If no improvement is seen in, say, 24 hours, it is prudent to see a doctor and certainly head home from the outdoors. My case clearly shows how quickly an infection can progress.
Pain and swelling extending more than 1cm away from the injury site, as well as red streaks leading towards the heart, are signs that the infection is spreading dangerously. More and darker-colored pus is alarming, and a fever and other “systemic signs” like chills and body aches signal a true emergency. Patients with these symptoms should be brought to a doctor immediately.
Once a wound gets infected, wilderness treatments are limited. The first step is always to re-open and re-clean the wound. Hot soaks are very beneficial. Heat water to a boil and then let it cool to a tolerable, but still hot, temperature before having your patient immerse the wound. (Note: this hurts—a lot!) Soak the wound for 20 minutes or so in the hottest water your patient can stand, and do this frequently; 5x or more per day is optimal. The warm water encourages wound drainage, keeps the wound cleaner than otherwise and encourages blood supply to the wound, bringing much-needed white blood cells to the fight.
Lastly, if your doctor will prescribe them for you, oral antibiotics may be added to your first-aid kit. These should be used in accordance with your doctor’s instructions should you develop a soft-tissue infection.
In my case, all 3 treatments were required to quell the infection. I cleaned the wound on my finger, which later developed into a rather graphic abscess (see photo). I commenced frequent and unpleasant hot soaks of my finger and hand. (Soaking the whole arm would have been best, but this was impractical as I was on a backpacking trip and had only a small stove and pot.) Lastly, I began a 5-day course of prescription antibiotics I’d obtained pre-trip. At least I’d done something right when I packed that first-aid kit!
By the time I was able to leave the backcountry almost 2 days later, my red streaks were gone and the swelling had abated considerably. Three days later, all that remained was the slowly healing finger wound. Lucky me!