Direct pressure dressings should be first line care to obtain hemostasis
Vasoconstricting sprays (1 mL of 1 : 1000 aqueous epinephrine in 400 mL normal saline) or gels (1 mL of 1 : 1000 aqueous epinephrine mixed with a tube of K-Y Jelly) are useful for superficial wounds
Tourniquets should only be used in cases of severe extremity bleeding when direct pressure fails
If available, use standard infiltration (e.g. lidocaine or bupivacaine) or topical anesthetics (LET [4% lidocaine, 0.1% epinephrine, and 0.5% tetracaine])
When standard options are unavailable, alternatives can be considered:
Injections
antihistamines (e.g., 1 mL of 5% diphen-hydramine in 4 mL NS for injection)
Sterile Water
Bacteriostatic normal saline (alone or 0.2 mL epinephrine 1 : 1000 mixed into a 20 mL vial of NS containing benzyl alcohol 0.9%)
Opioids
Topicals
Ice can be effective to decrease pain before needle injection but can be detrimental to crushed tissue in a wound
Vapocoolant sprays (ethyl chloride) are ineffective
Injections
antihistamines (e.g., 1 mL of 5% diphen-hydramine in 4 mL NS for injection)
Sterile Water
Bacteriostatic normal saline (alone or 0.2 mL epinephrine 1 : 1000 mixed into a 20 mL vial of NS containing benzyl alcohol 0.9%)
Opioids
Topicals
Ice can be effective to decrease pain before needle injection but can be detrimental to crushed tissue in a wound
Vapocoolant sprays (ethyl chloride) are ineffective
antihistamines (e.g., 1 mL of 5% diphen-hydramine in 4 mL NS for injection)
Sterile Water
Bacteriostatic normal saline (alone or 0.2 mL epinephrine 1 : 1000 mixed into a 20 mL vial of NS containing benzyl alcohol 0.9%)
Opioids
Ice can be effective to decrease pain before needle injection but can be detrimental to crushed tissue in a wound
Vapocoolant sprays (ethyl chloride) are ineffective
Use sterile water or normal saline if available
Non-sterile water is still preferable to no irrigation at all
Glues
Ideal method in the wilderness as it precludes need for anesthesia and is less painful than suturing
Cyanoacrylate (“superglue”)
Most commonly used as it is readily accessible
Disadvantage is more frequent wound dehiscence due to lower tensile strength compared with sutures
Petroleum-based ointments and salves, including antiseptic ointments can weaken glue increasing risk of dehiscence
Using cyanoacrylate on wounds under tension, such as over joints, can also increase risk for dehiscence
Other glues such as wood glue, panel adhesive, hobby cement, and various native (e.g., plant) substances may be used but may cause irritation, increase dehiscence risk, or contain toxins
Ideal method in the wilderness as it precludes need for anesthesia and is less painful than suturing
Cyanoacrylate (“superglue”)
Most commonly used as it is readily accessible
Disadvantage is more frequent wound dehiscence due to lower tensile strength compared with sutures
Petroleum-based ointments and salves, including antiseptic ointments can weaken glue increasing risk of dehiscence
Using cyanoacrylate on wounds under tension, such as over joints, can also increase risk for dehiscence
Other glues such as wood glue, panel adhesive, hobby cement, and various native (e.g., plant) substances may be used but may cause irritation, increase dehiscence risk, or contain toxins
Most commonly used as it is readily accessible
Disadvantage is more frequent wound dehiscence due to lower tensile strength compared with sutures
Petroleum-based ointments and salves, including antiseptic ointments can weaken glue increasing risk of dehiscence
Using cyanoacrylate on wounds under tension, such as over joints, can also increase risk for dehiscence
Petroleum-based ointments and salves, including antiseptic ointments can weaken glue increasing risk of dehiscence
Using cyanoacrylate on wounds under tension, such as over joints, can also increase risk for dehiscence
Staples
use if available (cannot be<unk> 
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Binding and Taping
Useful for shallow, non-gaping wounds
Reduce need for anesthesia
Any tape may be used
Tapes do not stick well on areas that are hairy, wet, prone to perspiring, or that are under tension
Fortification of tape closure with glue, bandaging, or more tape can mitigate this effect
Useful for shallow, non-gaping wounds
Reduce need for anesthesia
Any tape may be used
Tapes do not stick well on areas that are hairy, wet, prone to perspiring, or that are under tension
Fortification of tape closure with glue, bandaging, or more tape can mitigate this effect
Fortification of tape closure with glue, bandaging, or more tape can mitigate this effect<unk>  Sutures
Needles
Swaging a Hypodermic Needle (may be done at bedside or in advance)
Thread suture from sharp end of needle to hub end
After suture appears on hub end, break the hub off
pull the suture through the needle so that only a small amount remains within the needle
Use pliers to crimp the needle at the hub end to hold suture in place
Alternatively, insert hypodermic needle through both wound edges and thread suture from sharp end to hub. Then retract needle leaving the suture in place and tie
Suture Material
Fishing Line
Horse hair
Silk or Linen Thread from clothing
Agave fibers or other plant material
Dental Floss
Needles
Swaging a Hypodermic Needle (may be done at bedside or in advance)
Thread suture from sharp end of needle to hub end
After suture appears on hub end, break the hub off
pull the suture through the needle so that only a small amount remains within the needle
Use pliers to crimp the needle at the hub end to hold suture in place
Alternatively, insert hypodermic needle through both wound edges and thread suture from sharp end to hub. Then retract needle leaving the suture in place and tie
Suture Material
Fishing Line
Horse hair
Silk or Linen Thread from clothing
Agave fibers or other plant material
Dental Floss
Swaging a Hypodermic Needle (may be done at bedside or in advance)
Thread suture from sharp end of needle to hub end
After suture appears on hub end, break the hub off
pull the suture through the needle so that only a small amount remains within the needle
Use pliers to crimp the needle at the hub end to hold suture in place
Alternatively, insert hypodermic needle through both wound edges and thread suture from sharp end to hub. Then retract needle leaving the suture in place and tie
Thread suture from sharp end of needle to hub end
After suture appears on hub end, break the hub off
pull the suture through the needle so that only a small amount remains within the needle
Use pliers to crimp the needle at the hub end to hold suture in place
Fishing Line
Horse hair
Silk or Linen Thread from clothing
Agave fibers or other plant material
Dental Floss
Improvised wound management
Negative pressure wound therapy
Laceration repair
Burn dressings
Wound care dressing basics
Skin and soft tissue antibiotics
Procedural sedation 
Procedural sedation