Ultimate RMC #5 - Wound Care

[RESQDOC]

Wound Care:

1. Water purification capability – the solution to pollution is dilution. More than any other intervention, this is critical in wound care. Could be whatever, iodine, chlorine, boiling, flocculation, etc.

2. Wound closure mechanism – tape, superglue, or fishing line. Fishing line best for ability to close a wider variety of wounds, multi-layer closure, etc., if you have the capability of suturing.

3. Reusable suture needles. Even if you have no suture there are many improvised materials that can be used.

[Reasonable Rascal]

4. Irrigation syringe - may be glass or plastic, traditonal barrel/plunger or bulb type. Minimum 10 cc capacity, bulb types are normally 60 cc and larger. For wound irrigation using water and pressure to flush contaminants

5. Syringe shield - plastic device used to minimize splatter when irrigating wounds. Fits over tip of standard syringe. Normally shapped like an eye cup or a half sphere. More pressure, less mess

6. Bulky gauze rollers - dressing, bandaging, padding wounds following care. Sterile is ideal for versatility of applications. Numerous other improvisations also possible with a quality stretch gauze of 4" width. Can be cut down for narrower width if required so go with wider widths.

[NurseMan]

7. Nu Gauze packing strips. sterile packing strips to be placed in an open wound to help allow drainage.

8. Sterile Q tips. To assist packing any open wounds.

9. 4x4's to cover the wound once dressed.

[walz]

[QUOTE]Originally posted by RESQDOC
[B]Wound Care:

"Fishing line best for ability to close a wider variety of wounds, multi-layer closure, etc., if you have the capability of suturing."

Educate me on a field-expedient way to sterilize fishing line?

[walz]

10. Surgical Scrub Soap Kit - to clean your hands, area around the wound, tools, etc.

11. Steril Gloves - A thousand uses other than just infection control, including a wound irrigation device. I would like to know how to re-sterilize gloves in case of no supply.

12. Coban Rolls - my favorit all-round wound wrapper and splint strapper.

[tangent]

Walz,

in the operating room, about 1/2 way down there is a thread titled "sutures" that discusses using various materials for improvised sutures and different ways to sterilize them in the field.

-t

[RESQDOC]

Here it is:

Over the years I have closed wounds with a variety of improvised techniques and materials, due to necessity and the foolishness of youthful testosterone overload. Despite the later I have had good results, as far as I know. At least all of my boo-boo’s are closed and reasonably cosmetic. I think that there is a need to identify reasonable alternative/improvised suture material and concurrent sterilization techniques, for use in the wilderness and austere care environments. A “standardized, improvised” technique may be self-contradictory, but considering how often this issue comes up out in the real world I think it’s worth looking into.

It should be noted that we are discussing material for dermal closure only. While some materials have breakdown and inflammatory properties that *might* be acceptable in the worst case scenario, the sort of study needed to investigate that is beyond our capability.

Here is a list of the materials I have used over the years to close wounds:
-Sutures, all types absorbable & non-absorbable
-Superglue, medical (Dermabond) and commercial
-Fishing line
-Dental floss
-Stainless steel wire
-Carpet thread (nylon type)
-Cotton thread
-Nylon fibers pulled from 550 cord
-Elmer’s wood glue
-Panel adhesive
-All types of tape
-Staples, medical and otherwise

Not too pretty, huh? Never the less they worked. Fishing line and carpet thread is very, very similar to some types of suture material, as is cotton thread. The dental floss was a bit thick but worked. I’d avoid plain staples and panel adhesive in the future…

Here is a list of techniques I have used to “sterilize” some of the above:
- Boiling water
- Rubbing alcohol
- Vodka
- Jack D
- Wine
- Beer
- Hydrogen Peroxide
- Soap & clean water
- Bleach
- Zephrin Chloride
- Lemon juice
-Wrapped in foil and placed in hot ash (seems to work well, only need to hit 160-170 degrees to kill most bugs, but not hot enough to break down most material)
-Flame sterilized (stainless wire, obviously)

Infection rates were minimal, probably due to careful attention to wound cleaning before closure, and delayed closure of dirty/infected wounds. They all sting pretty good if no anesthetic available. Biggest complaints from alcohol, bleach, lemon juice.

Outcomes were good with thread & thread-like material, good with adhesive, only fair with dental floss and wire - coarse scars. Whatever you use, make it as small a diameter as possible that will still hold the wound together, good attention to technique, removal of FB & dead tissue, edge eversion, tape to reinforce & take tension off wound edges, all the little things that are art rather than science.

The ability of the human body to overcome even the most stupid damage inflicted on it never fails to amaze me.

[tangent]

try:

http://www.jannsnetcraft.com

look at a gill net kit while you are there too - for your survival kit.

I think RESQDOC's comments on this area are the most through and accurate I've seen. Good Job! I have seen fragments on the topic, here and there, but never a survey - brief enough to be adequate for education and reference.

at the same time, take a look at the original thread too - a few tidbits were not pasted over. I thought the use of boiled horse tail hair (soaked in ETOH) durring the civil war for suture material was particularly interesting.

-t

[Reasonable Rascal]

13. Adaptic Dressings - non-adherent dressings for suppurating wounds. Your patient will thank you later andf you'll help avoid tearing off new flesh or scabs when it comes time for dressing changes.

14. ABD Pads - for when a 4x4 just won't cover it. Don't forget this is a remote hospital, so abdominal surgery is a given. No laparoscopes here, just large surgical wounds. 5x7, 5x9 and 8x10 sizes if you please. Also very absorbant.

15. Wound Drains - latex strips or tubes that are inserted into wounds to aid in drainage from the inside to the outside. Various sizes available from 3/8" wide to 1" wide, lengths commonly 12". Cut to length as needed.

[themadmedic]

Kerlex, lots of kerlex...can be used for a variety of bandages and dressings

Agree with suture materials/needles...

Iodoform or similar treated packing gauze would be nice as well...many wounds encountered could be left to heal by secondary intent.