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adam
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02/15/2020 01:52PM   (Thread Older Than 3 Years)

Everything you wanted to know about gauze from Nurse Amy. They have a great youtube channel.



Love their survival guide Ultimate Survival Medicine Guide: Emergency Preparedness for ANY Disaster

 
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GearGuy
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02/17/2020 12:49AM  
Cute video. ER Nurse here. As a Nurse that works in an Emergency Department that is the center of trauma, I started out with a HUGEEEE medical kit that I brought to the BWCA. It's been 4 years now and my medical kit is aprox 4x smaller than it was when I started.

In this video she talks about Telfa, regular gauze, and ACE wraps. Telfa is gauze that doesn't stick to you, and doesn't absorb any ointment that you might apply to whatever wound underneath, thus the wound will stay moist. Regular gauze is for a wound that you want to absorb fluids from, for example a bite wound, laceration, abrasion, something that you want to stay dry (if it's bleeding OUT the infection isn't going IN). I also carry 1 small roll of 3" ACE wrap, this is what I would use to keep whatever dressing, whether it's telfa or gauze, in place and covered. I bring 1 or 2 Telfa's (they're 3x3 packed individually), and 2-3 gauze, in 2 different sizes (2x2 and 4x4), with 1 ACE wrap. You don't need any more gauze than this in my opinion.

One thing that this nurse does not talk about very well in her video is the importance of irrigation. When it comes to wounds, if you can only do one single thing in terms of wound treatment, it would be irrigation. Infection is the worst complication of a wound, I've seen infected wounds result in PICC lines needing to be placed, and IV antibiotics self administered for weeks, because infections got out of control, lost limbs are not uncommon. Proper irrigation is the single most important step if you suffer a wound.

One final note. If you injure yourself bad enough that the use of gauze and irrigation is necessary, please do not attempt to trip any longer, seek medical care.
 
MidwestFirecraft
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02/17/2020 06:03AM  
GearGuy: "One thing that this nurse does not talk about very well in her video is the importance of irrigation. When it comes to wounds, if you can only do one single thing in terms of wound treatment, it would be irrigation. Infection is the worst complication of a wound, I've seen infected wounds result in PICC lines needing to be placed, and IV antibiotics self administered for weeks, because infections got out of control, lost limbs are not uncommon. Proper irrigation is the single most important step if you suffer a wound. "

How do you accomplish this? Boil water, cool and pour? I've always had and dealt with wounds that are bleeding pretty good, so I figured they were flushing out any bacteria etc. Use alcohol wipes for anything small. In the late 90's I took a week long combat medic course and they gave us a huge kit to haul around. It had an IV bag that we could use for hydration or cleaning wounds, but I wouldn't want to carry that around the BWCA. Taking a group of 6 kids in August so looking forward to your answer.
 
Minnesotian
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02/17/2020 01:35PM  
MidwestFirecraft: "
GearGuy: "One thing that this nurse does not talk about very well in her video is the importance of irrigation. When it comes to wounds, if you can only do one single thing in terms of wound treatment, it would be irrigation. Infection is the worst complication of a wound, I've seen infected wounds result in PICC lines needing to be placed, and IV antibiotics self administered for weeks, because infections got out of control, lost limbs are not uncommon. Proper irrigation is the single most important step if you suffer a wound. "

How do you accomplish this? Boil water, cool and pour? I've always had and dealt with wounds that are bleeding pretty good, so I figured they were flushing out any bacteria etc. Use alcohol wipes for anything small. In the late 90's I took a week long combat medic course and they gave us a huge kit to haul around. It had an IV bag that we could use for hydration or cleaning wounds, but I wouldn't want to carry that around the BWCA. Taking a group of 6 kids in August so looking forward to your answer. "


This is a great topic and GearGuy I think you should weigh in with more insights on first aid practices.

MidwestFire, in terms of irrigation, I suspect the filtered water you use for hydration would work just fine.
 
GearGuy
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02/18/2020 03:36AM  
I don't think it's necessary to boil water prior to using for irrigation. Per a guidance resource we use in Emergency care with regards to suturing wounds, even using tap water to irrigate a wound will cleanse aprox 97-98% of the wound. With this said I would feel completely confident irrigating a wound with gravity filtered water. Ideally we would irrigate with a 60mL syringe that sprays saline or water in a "beam", and we would use this "beam" to really get down into the wound, the more fluid pressure that can be tolerated the better. We would irrigate with a minimum of 180mL for a laceration up to 5 inches in length and up to an inch deep which isn't that much when you measure it out. In the field, without a 60mL syringe to shoot the water in a "beam" I would irrigate with >500mL of fluids. If you can irrigate with pressure then that's ideal, if you can't irrigate with pressure, I would try to manually open the wound to ensure irrigation reaches the extent of the wound and then I would wash out the wound with filtered water. The less pressure you have, the more volume of irrigation you should use, even if you can just drip it into the wound, this is infinitely better than doing nothing. Inspect, make sure there is no visible dirt or anything in there that shouldn't be there, if there is just keep irrigating. Once irrigation is completed (skin should be nice and puffy from absorbing the fluid), apply a small bit of triple antibiotic and cover with telfa or gauze and lightly tape down. Apply triple antibiotic no more than once or twice a day. Leave wounds Open to Air as much as you possibly can,

Suturing should not be attempted in the field unless bleeding CANNOT be controlled with applied pressure to the wound. If you suture a wound that has not been irrigated, you're basically sealing all that potential infection, inside the wound, and guaranteeing the wound get's infected. If you must suture in the field, I recommend suturing with as few sutures as possible to approximate the wound, keep in mind these sutures will no doubt be removed when you get to the Emergency Room, so that proper irrigation can take place and then the wound will be re-sutured by a professional. An ACE wrap over some dry gauze, is more than enough means to keep a wound nice and covered until you get to a clinic or ER. Steri strips are my favorite if I have a wound big enough I need to close it up, their cheap, easy to apply by even a medical lay person and does not need to be performed aseptically like suturing ought to be. I have so little faith in suturing in the field that I think it should only be done to close off a bleeding artery.

Over the years my first aid kit has shrunk 3 or 4 sizes. I now only bring enough supplies to theoretically get me back to civilization.
 
MidwestFirecraft
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02/18/2020 03:09PM  
GearGuy: " Leave wounds Open to Air as much as you possibly can."

Thank you for the detailed response. I may consider carrying a syringe for this purpose. In the last few years the advise I have been given is to keep the wound covered and moist, as opposed to what I had been taught all my life. From my small personal experience, wounds do appear to heal quicker when kept covered and moist with something like argan oil and tea tree essential oil. Is this way off base?
 
cmanimal
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02/21/2020 03:29PM  
Thank you for the info
 
PatrickE
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02/22/2020 02:38PM  
Orthopedic surgeon here. Agree with most of what has been said. As far as suturing in the field, my opinion is that it has very little utility. Small peripheral bleeding vessels in the extremities with clot off with pressure and time. Major bleeding from your trunk or proximal extremities may be limb or life threatening, but it is not practical to suture anything like this in the field. Even a complete finger amputation does not need suture ligation and life threatening blood loss from a finger amputation would be exceedingly uncommon. Large peripheral vessels are not something you are going to be able to effectively suture in the field. You're better off with heavy pressure/compression bandage and resist the urge to "check the wound" as you'll break apart clot that has formed and restart the process. Wounds that will not stop bleeding need heavy pressure and an SOS call. Smaller wounds that are easier to manage are better treated with the SteriStrips as mentioned or medical grade skin glue/adhesive.

Acute care of most wounds would likely benefit from thorough irrigation. Personally, I wouldn't take the time to boil water, let it cool, then irrigate. Take multiple liters of the cleanest water you have and pour/squirt water into and around the wound and let it run off. Don't operate under the assumption that just because its bleeding, there isn't bacteria threatening a wound (it is not a one way street). One helpful lightweight item you may want to consider adding to your kit is a small bottle of betadine solution. Mixing several ounces of this with water (think ice tea color) and irrigating with this solution can be very effective in preventing infection. This is often times something we will do with open fractures in the emergency department.

As far as coverage of a wound, I disagree with the statement that a wound should be left open to air as much as possible. Wounds in which the skin edges are reapproximated with typically "seal" or complete epithelization often within 48 hours (dependent on multiple factors sometimes quicker/longer). Because you're in the wilderness, keeping the outside world (i.e. the bacteria on everything) from entering the wound should be a priority. Daily dry dressing changes for the first 2-3 days (or more frequently if you are saturating the dressing) would be recommended. For macerated wounds (think wet scab), continuous dressing coverage can prevent moisture from escaping over time and this is likely what GearGuy is referring to. Leaving it open to air can quicken the conversion to a dry scab can speed up the process but should not be utilized for all wounds. In my opinion, if you're in a campsite location and can't assure your going to keep an open wound clean from the surrounding environment, keep it covered.

You may have heard a wet dressing is better than dry. For a wound that the skin edges can't be brought together often benefit from application of a wet dressing that will eventually dry (often referred to as "wet to dry" dressing changes). This is more common for chronically open wounds and has less utility acutely in the wilderness. Let's be honest, if its this bad, get your a** out of the wilderness and don't continue to observe this without expert consultation.

Hope some of this helps. Every wound has a unique personality and a universal approach unfortunately will not always work. The smartest move you can make is to have the recognition of when you are over your head and you need to call the trip early or call in the calvary.

Not looking to create debate and some medical professionals may have different takes on the above issues.
 
MidwestFirecraft
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02/22/2020 03:15PM  
Thank you Patrick,
Very informative. Found betadine solution at Target.
 
02/22/2020 08:47PM  
Betodine has been added to my shopping list, and the flushing syringe is going back in my kit. This has been a very helpful discussion.
 
02/23/2020 11:23AM  
Question for GearGuy or Patrick -

I've never had or seen a wound irrigated first hand. I was wondering just how painful it tends to be for the victim to have wounds flushed with tepid water and Betadine? I'm sure it varies on location, size, etc, but for a moderately deep laceration in a muscular area of the arm or leg for instance, where does it fall on the spectrum from mildly uncomfortable to "bite on this stick and try not to scream"? Just wondering what to expect in case I have to do it on someone..... or myself!
 
MossBack
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02/23/2020 09:16PM  
Not sure if this fits into the discussion. I recently bought a couple of small clotting sponges for my first -aid kit. Good or bad idea?
 
Obe
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02/23/2020 09:29PM  
Some good info here, thank you everyone that has contributed so far!

How many of you take a tourniquet as part of your kit? The more research I do, the more it seems like it would be be a good item to have for wilderness trips, but it's a large item to add when space and weight matter. It might be more important on hunting trips when guns, arrows, and knives are being used, but the thought of a compound fracture lacerating an artery is still something to be prepared for in the boundary waters.
 
PatrickE
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02/24/2020 07:28PM  
Few answers....

As far as how painful irritating a wound is...the majority of patients we perform this on in the ED have usually had some form of pain medicine. GearGuy may have a similar take on this. That said, the most common response I get is an initial discomfort from the sting of the irrigant then not all that bad. When we are in the operating room, we often use something called the pulsed lavage ( Pulsed lavage ). Think of it as a pulsing hose that shoots/sucks at the same time. This would not be tolerated without a deeper anesthetic.

Clotting sponges are not a bad idea at all. They add a chemical accelerant to aid clotting. We don’t utilize them all too much in the ED, but in the field could be helpful.

For bleeding that won’t stop with compression alone, a tourniquet can be a useful tool. There has been debates for years on whether they cause more harm with use. By impairing blood flow to the end of an extremity, you are speeding up the chance of tissue necrosis (death) and loss of limb. An interesting study that came out a few years ago showed less mortality associated with tourniquet use but potentially a higher amputation rate. The tough thing with this is just the proximity to a hospital. Average tourniquet time with that study was between 70-80 minutes. That’s realistic if you’re in a city or urban area. Middle of the park, I would assume time from injury to the nearest ED is going to exceed that by several times. If the injury is that bad and the bleeding can not be stopped with all other measures, I would absolutely use one. If you don’t want to carry a dedicated piece of equipment for this purpose, a belt or piece of clothing tied onto itself could suffice. Just remember to record the time of application for the healthcare team and get help ASAP. This is not a “let’s apply a tourniquet and see how it feels in an hour”.
 
GickFirk22
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02/25/2020 01:49PM  
THANKS for all the info! I'm subscribing to this post to keep learning...and adding to my shopping list for my kit!
 
goaljohnbill
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02/25/2020 02:42PM  
GickFirk22: "THANKS for all the info! I'm subscribing to this post to keep learning...and adding to my shopping list for my kit!"


+1
 
singlebladecanoe
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02/25/2020 07:03PM  
Great discussion.

I've had irrigation done on a very deep cut (deep enough to cut tendons) on the palm of my hand without any kind of pain meds or local anesthetics. I have a high pain tolerance, lets just say it was not a pleasant feeling.

My current first aid kit is relatively small. Everything fits in a small 5.11 pouch. Some of the things in it are the following:
8 4x4 sterile gauze pads
3" ace bandage
small bottle of Iodine
Small tube of neosporin
waterproof tape or duct tape
tweezers
lighter
3 packages of quick clot
alcohol wipes
6-8 small band-aids
Small thing of Advil
CPR shield
C.A.T tourniquet

 
02/26/2020 05:19PM  
These posts are always interesting.
Another medical professional here - veterinarian - certainly wont claim to know crap about people but the basics apply.
I agree, for the layperson cleaning and stabilizing a wound should be the goal. Most cases it's common sense what an emergency is and that you need to get professional help.

I got in the habit of bringing equipment to mange wounds from trips with my dogs. Lidocaine and ethilon can sure be handy! Friends have asked me to build a trauma kit like my own but without knowledge and proficiency I'd consider most of the stuff useless.
Everything I need still fits in a Maxpedition Janus (8"x4")
 
Frenchy
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02/27/2020 05:35AM  
This is all Great Information but please remember, especially when in the wilderness, safety first. I’ve always asked myself before attempting something I’m not sure about in the wilderness, “What are the possible outcomes?”
But accidents do happen and it is always wise to be prepared.
 
oldmil
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02/27/2020 08:42PM  
I would add one more item; a scalpel or razor blade. I had to cut a hook out of a guy's head on one trip. He had 2 hooks of a treble buried in the back of his scalp. No way to push both through the skin and yanking them out would have likely torn a big hole in his noggin. We had one blade from a utility knife in our kit. I made tiny cuts along the hook shank and as the blade dulled, I snapped off the tip to get to a sharper section of the blade. Got one hook cut out and then was able to cut the second one off. He took a swig of whiskey and went in the wood to push the other hook through.

If you have never had a hook stuck in your scalp, its amazing how tough the tissue is. It's basically a big sheet tendon.

Just a thought based on experience.

Oldmil
 
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