How should an open abdominal wound be managed in the field?

• A. Cover with sterile dressing, do not apply pressure to protruding organs, evacuate for surgical assessment
• B. Suture immediately on scene
• C. Apply tourniquet over wound
• D. Apply pressure to protruding organs

Answer: (A)

In this situation, the priority is to protect exposed tissues, prevent contamination and dehydration, and get the patient to definitive surgical care as quickly as possible. The correct approach is to cover the open abdominal wound with a sterile, moist dressing to create a barrier and keep the organs from drying out or becoming further contaminated. Do not push the organs back in or apply pressure to them, as this can damage tissue and worsen contamination. After covering, secure the dressing and prepare for rapid evacuation to a surgical facility for definitive repair.

Suturing on scene isn’t appropriate because abdominal closures require a sterile operative setting and definitive repair, not field suturing. A tourniquet isn’t applicable for an abdominal injury, since it targets limb bleeding. Pressing on protruding organs is harmful and contraindicated because it can crush tissue and drive contaminants deeper.