# Cleaning a wound in a non-sterile environment?



## Diamondback 2/2 (Jan 23, 2010)

Okay a “Dooms day” question here for the medically stupid. 

How would some of you medical professionals advise someone with limited medical training to clean a wound to avoid infection? My question comes from the idea that normal medical services are not available and wound care is necessary with limited household items.


*Scenario:*

Your city has suffered a catastrophic event causing emergency services to fail. You have been basically cut off from the normal amenities or abilities to get standard medical supplies. You have a member of your family who has sustained a leg wound (6-inch laceration on the upper thigh) the wound is not fatal and the bleeding has been controlled. 

Fill in the blank….

*Action: *

*Condition:* Laceration wound with bleeding controlled, only household products available to clean wound.

*Standard:* Clean the wound to avoid infection.


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## txpj007 (Jan 23, 2010)

its gonna burn like a mother...but just good old anti-bacterial soap.  also you would want to use gravity to flush it out.  so say if it was a vertical laceration you would want to flush or pour water on it from the top down. so all the bad shit flows out the bottom.  if it was a horizontal lac then the same principal would apply.  roll to one side and wash in one direction. 

you trying out for a game show or something?


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## Chopstick (Jan 23, 2010)

txpj007 said:


> you trying out for a game show or something?



LOL.."Ill take traumatic amputations for $500 Alex".


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## Polar Bear (Jan 23, 2010)

Pee on it works for ear infections too....So I have heard but I am not letting anyone pee on me


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## Nasty (Jan 23, 2010)

Very worst case..lots and lots of water, but as the PJ said, soap and water would be better.


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## x SF med (Jan 23, 2010)

Ok... Assuming this is not a clean knife wound, but rather a traumatic laceration without clean edges, and intrusion of particulate and possible other foreign matter. Basing on a 6" long x 1-2" deep thigh laceration with no arterial, venous, ligament or tendon involvement - based on the above- time is not critical, this is a semi-secured area .

a. Stuff:

1. What is the availability of potable water? What is the availability of any water? If potable water is plentiful boil it for 2 minutes, just for safety's sake, cool it to just about body temp. If the water is suspect - filter through cloth (multiple layers) to remove sediment, then boil vigorously for a minimum of 8 minutes, and cool to just above body temp. (unless you're like me and keep a couple of bottles of sterile water in your med kit) make sure you have at least 1.5 gallon of water.

2. Got a turkey baster? got a Garlic injector? Got a soft toothbrush? tweezers? long needles? got a good sized bowl or two? Boil them separately from the water to be used for the actual cleaning.

3.. How well stocked is your home? (I personally keep betadine around, but that's me) No accdess to betadine or one of the other surgical scrubs or iodiform antiseptics... Dishwashing detergent, antibacterial soap, any soap you have on hand...

4. Towels, washcloths, clean rags...

5. More bandages, and preparation to control bleeding again - a good cleaning WILL restart bleeding.

b. Procedure:
*****THOUROUGHLY WASH YOUR HANDS - TWICE - NO, MAKE THAT THREE TIMES - UNDER YOUR NAILS, UP TO YOUR ELBOWS -REALLY CLEAN - AND GLOVE UP IF YOU HAVE THEM.*****

1. gather clean materials, one towel underneath the area to be scrubbed - you need to create a clean (not sterile) field to work.
2. fill one bowl with clean water, fill one bowl with clean soapy water, keep remainder available. If you are using betadine in the water, 1 oz betadine to a quart of water should be sufficient - if you are worried about the cleanliness of the water go to 2 oz/qt. If all you have is soap - a good sudsy mixture is all you need - about 1-2 tbsp per qt of water
3. with a clean soapy washcloth(not too wet) wash surface area- at least 6" out from the wound edges - to keep from reintroducing junk into the wound. Do not put this back into your clean soapy water
4. with a clean damp washcloth, rinse/wipe any soapy water from your clean field.
5, Really Inspect the wound, look for debris, and matter, anything that looks like it's not just plain meat (because there's no other involvement at the moment does not mean you're not close) - that's the first stuff that needs to be removed.
5.a. Remember that turkey baster or garlic injector? fill it with either the plain clean water or the clean soapy water - irrigate, put some force into the water stream, to help dislodge junk using gravity to help flush the wound. 
5.b. repeat step 5.a.
6. there are a few large pieces of junk still in the wound, nothing shiny (tendons,ligaments, bones), pulsing or veiny looking - it's a deep meat cut.... using your tweezers or sharp needles pick those large pieces out - can't get them? dunk the soft toothbrush in the clean soapy water and gently scrub them loose.

note- the above and below will restart bleeding - this is good, helps flush the wound - we won't try to recontrol immediately, unless it becomes a major torrent.

7. still got your toothbrush? good, lightly scrub the entire wound. Grab your turkey baster and fill with clean water - irrigate
8. Irrigate some more
9. irrigate a little more
10. dry the area.
11. inspect the wound - what do the edges look like - clean, jagged, what? this is going to get you to the bandaging.

recontrol bleeding at this time - the wound should be clean.

wound closure/Bandaging - depends on your materials - based on the description of the wound - sutures would be optimum closure - but I think butterfly closures / steristrips would be easier/faster/less traumatic to both parties involved. (Assuming fairly clean edges to the wound) -starting at the top of the wound one sticky side of the butterfly 'wings' on one side of the wound and pull that to the other edge of the wound, keep the edges together, no puckering or overlap - hold together, place other sticky side on the other side of the wound - repeat every inch or closer if you can - make more butterflies from surgical tape if you can. When finished - spay with nu-skin if you have it. the bleeding should be controlled - so wrap loosely to protect the wound if the person doesn't have to move for a while - if you have to move out, bandage snugly but not tightly.

Check the wound on a regular basis - 2x a day minimum, to see if any signs of infection appear.

This was probably more than you wanted, but hey, you asked.


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## HOLLiS (Jan 23, 2010)

Mentioned in training on a viscerated person, to keep the intestines moist/wet that if no water was available, use urine.      Well memory can be faulty.


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## HoosierAnnie (Jan 23, 2010)

DaTroll hit the nail on the head. Just thought I'd throw in this lil bit of medical triviata.  If you are in need of setting up a "as close to sterile as possible" field outside a health care feacility, raid the nearest newspaper box.  Due to the heat use in the process of printing the papers, the inner pages, until touched, are damned near sterile.


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## Muppet (Jan 23, 2010)

Nice thread. Good info. I have nothing now to say. :)

F.M.


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## pardus (Jan 23, 2010)

HoosierAnnie said:


> raid the nearest newspaper box.  Due to the heat use in the process of printing the papers, the inner pages, until touched, are damned near sterile.


 
That is bloody interesting right there!

Great break down xSF!

I've learnt a lot tonight thanks to the Troll and now Annie.



I was going to say use half a can of beer to flush the wound, drink the other half, repeat until you don't give a shit if you live or die.


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## txpj007 (Jan 23, 2010)

xSF --- x100---i took the still eatin breakfast, got a lot of shit to do today approach to my answer.  good shit, you blew me out of the water.


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## Mac_NZ (Jan 23, 2010)

Learning has occured, thanks.


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## x SF med (Jan 23, 2010)

Common sense is your best guide in these situations... stuff that you don't think about can be used in many situations...  like Annie's newspaper... roll it nice and tight and you have a field expedient baton to beat the shit out of your enemy....  rolled newspaper can also be used as the stabilizer for a broken bone...  unroll it and tear it up.... toilet paper...   crumple it a little (before or after use as toilet paper) and you have a fire starter (waste not, want not)....

Hmmm... idea for a new thread... creative uses for houshold items in a SHTF situation...

Thanks for the kind words...  but, I'm still a bastige...


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## Diamondback 2/2 (Jan 24, 2010)

Thans X-SF! and everyone else! 

I had the thought in my mind that i have all this trama kit and know how to keep someone alive somewhat but know jackshit about long term care. Big issue being small wounds becoming big problems due to infection...


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## medic1 (Jan 24, 2010)

Should have bleach or iodine in the house, can use to make the water potable as well as cleaning the wound [dilute of course!!].....


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## Nasty (Jan 24, 2010)

To bad GMAN is not here to add his 2 $$ worth!


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## Brooklynben (Jan 24, 2010)

X SF Med nailed it.  Some other options might be;
Fill an unused 'baggie" or zip-loc bag with water, snip one corner and you have fairly sterile method to stream water to irrigate wounds.  Squeeze the bag for more powerful irrigation.

UV light has all sorts of antiseptic properties.  I've had some luck (after cleaning) letting fresh wounds get about 15 minutes of direct sunlight (obviously, when time and conditions permit).  The down side here is that too much sunlight can overly dry and damage the connective tissues at the edges of the wound.  I have a couple of gizmo's I keep in my kit which put out very specific UV frequencies in light - work great on all sorts of things.  People often use hydrogen peroxide or mercurochrome on wounds - I avoid these astringents as they're VERY tough on the connective tissues of wounds.  Ex SF Med's advice of using soap and water is the best I know of right now.

I know this may sound strange, but if the wound can't be closed tightly and has exposed dermal or subcutaneous tissue, you can pack it with white granulated sugar.  Sugar is completely antibiotic and you simply clean and re-apply when the packing/bandage turns to syrup.  This method has been used for years and I can supply the medical references if needed.  In the same way; honey dipped bandages are outstanding treatment for burns.

If you're interested in this stuff, there's a couple of good books; "Ditch Medicine" and "Where There's No Doctor" are very good starters.


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## LibraryLady (Jan 24, 2010)

Brooklynben said:


> ... I know this may sound strange, but if the wound can't be closed tightly and has exposed dermal or subcutaneous tissue, you can pack it with white granulated sugar.  Sugar is completely antibiotic and you simply clean and re-apply when the packing/bandage turns to syrup.  This method has been used for years and I can supply the medical references if needed.  In the same way; honey dipped bandages are outstanding treatment for burns...


 
Not strange at all, BB.  Sugar and honey are time-honored wound remedies in the veterinary world.  They do a real good job of minimizing the scarring also.

LL


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## Starbuck (Jan 28, 2010)

This is a great thread - I'm going to mention some of this stuff next time I teach a cadet survival class! :)

Also, I've never tried this, but one of my instructors told us that you could make a poultice with plantago (common lawn weed) to control bleeding, as long as the person didn't have a history of blood clots or anything. You could use horsetail plant (I think) to make it heal faster and bouncing bet/soapwort to make a substitute for soap.

Does anyone know if these things really work?


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## pardus (Jan 29, 2010)

I know of a certain type of moss, that I only know by sight that contains penicillium the pre thingy to penicillin and has been used for thousands of years by our ancestors.
I've also been taught by an SF medic that moss can be used quite effectively to stuff a wound to stop bleeding.

I have to ask you, why the hell would you care if someone has a history of blood clots when thinking about stopping them bleeding out?
They will die in 2 - 5 minutes if you dont use the thing that _might_ cause reversible clots. :uhh:  

Then again, I'm the most junior douche medic you can get lol



Starbuck said:


> This is a great thread - I'm going to mention some of this stuff next time I teach a cadet survival class! :)
> 
> Also, I've never tried this, but one of my instructors told us that you could make a poultice with plantago (common lawn weed) to control bleeding, as long as the person didn't have a history of blood clots or anything. You could use horsetail plant (I think) to make it heal faster and bouncing bet/soapwort to make a substitute for soap.
> 
> Does anyone know if these things really work?


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## Brooklynben (Jan 29, 2010)

I had heard of using moss (if nothing else was available) to treat water before drinking, but I hadn't heard about the wound treatment.  I looked the subject up and it seems wound treatment goes back a long time.  It's the Sphagnum moss that is discussed mostly.  Wikipedia has most of the information http://en.wikipedia.org/wiki/Sphagnum

Good info, thanks.


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## x SF med (Jan 29, 2010)

If you use H2O2 to clean a wound, dilute it with 50% clean or sterile water.  There are a lot of jungle medicine ways to stop bleeding...  If you are really worried about being able to survive after the coming apocalypse... get the FoxFire bOOks ( a series - and expensive - but excellent Appalachian 'do anything' advice).

Stump water is good for a drying agent - the tannic acid is astringent and antiseptic... 

And yes...  rubbing dirt in a wound can help (kaolin clay actually) control bleeding


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## pardus (Jan 29, 2010)

x SF med said:


> Hmmm... idea for a new thread... creative uses for houshold items in a SHTF situation...



Great idea, start it!



x SF med said:


> Thanks for the kind words...  but, I'm still a bastige...


 
Don't worry we know.... WANKER!


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## pardus (Jan 29, 2010)

Hydrogen Peroxide is a shitty cleaner when it comes to killing bacteria, I read a study from the AMA that stated the only beneficial thing the peroxide did was to dilute the bacteria, something tap water would have done just as effectively.

If I can find the article again, I'll post it.

In the meantime...

http://www.mercer.edu/camps/message/summer2001/summer2001-disinfectant.htm


OK, I didn't find the exact article but this is almost word for word what I remember:



> In conclusion, hydrogen peroxide appears not to negatively influence wound healing, but it is also ineffective in reducing the bacterial count. However, it may be useful as a chemical debriding agent. The American Medical Association concluded that the effervescence of hydrogen peroxide might provide some mechanical benefit in loosening debris and necrotic tissue of the wound.



The source for this is: Rodeheaver GT. Wound cleansing, wound irrigation, wound disinfection. In: Krasner D, Kane D. Chronic Wound Care: A Clinical Source Book for Healthcare Professionals, Second Edition. Wayne, PA: Health Management Publications, Inc., 1997:97-108.

Got this from this article: http://www.medscape.com/viewarticle/456300_3


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## Starbuck (Jan 29, 2010)

pardus said:


> I know of a certain type of moss, that I only know by sight that contains penicillium the pre thingy to penicillin and has been used for thousands of years by our ancestors.
> I've also been taught by an SF medic that moss can be used quite effectively to stuff a wound to stop bleeding.
> 
> I have to ask you, why the hell would you care if someone has a history of blood clots when thinking about stopping them bleeding out?
> ...



Don't know  - my medical knowledge is limited to very basic wilderness first aid training, and the instructor who told me about the plant may not have had much more first-hand experience than me.  I'm glad I had a chance to check the accuracy of the information before I passed it on to the kids, though, and the info about the moss is wonderful. Thanks, guys.


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## Brooklynben (Jan 29, 2010)

Question regarding bleeding;
 "In the old days" most (real) men carried styptic pencils in their shaving kit to stop minor bleeding from razor cuts.  It was common practice for old time butchers to immediately jam coarse salt in their wounds when they cut themselves.  They said it stopped the bleeding and the salt worked as an antiseptic. I've used sea water to wash out all sorts of wounds and all of them healed nicely with no infections.  But I've never run into any training that would suggest using salt on wounds.  Besides the obvious pain issue of 'rubbing salt into a wound', does anyone have any insights as to why the use of salt is absent from most wound treatment protocols today?


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## pardus (Jan 29, 2010)

I found this, can't verify the accuracy of it though...

http://www.thenakedscientists.com/forum/index.php?topic=6869.0;prev_next=next



> Provided by Walter Sipe, M.D., clinical fellow of pediatric gastroenterology, hepatology, and nutrition, University of California, San Francisco (former HHMI medical fellow)
> 
> Before we get to the science part of your question, let me start by saying: Do not put salt on your cut. The single most important aspect of wound care in the backcountry is vigorous and copious irrigation with clean water (filtered or chemically treated so it is drinkable). You can generate a high-pressure stream by filling a zip-top plastic bag with water, poking a tiny hole in a bottom corner of it with a needle, and then squeezing the bag so water comes out through the hole. For dirty wounds, vigorous scrubbing to remove foreign bodies is also important. Exposing wounds to iodine, alcohol, peroxide, and pure salt is no more effective than water irrigation at preventing infection and can potentially damage tissues. The safest way to slow bleeding is to hold direct pressure on the wound until the bleeding stops.
> 
> ...


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## x SF med (Jan 29, 2010)

@Pardus - good post on H2O2...  It is really only good for the mechanical cleansing of a wound...  the reason for diluting it is for cost effectiveness.


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## Brooklynben (Jan 30, 2010)

pardus said:


> I found this, can't verify the accuracy of it though...
> http://www.thenakedscientists.com/forum/index.php?topic=6869.0;prev_next=next


 Great stuff!-  Your article explains a number of things to me.  Many thanks for digging it up.


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## medic1 (Jun 6, 2010)

Jeez I know that this is an old post, but just thought I would inject some life into it!!

Dirty & contaminated wound.......why not use Hydrogen Peroxide 3% or 6%: I know it has had some bad press in the recent past, and I think that if you leave it on the wound it does produce problems. However, I think good irrigation with HP to clean the crap out and then irrigate with potable water.....failing that use a weak bleach solution to replace the HP. Good soap is great for most wounds, makes it smell nice and Pruuuudy too!


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## pardus (Jun 8, 2010)

You talk about HP and failing that bleach to clean a wound. I just want to put out there *again* to people that they both use very different processes for cleaning.
HP has no anti septic properties, Its only anti septic benefit is through dilution. It's only real benefit is the mechanical cleaning of a wound (which you can probably achieve better with a good scrub out), it won't kill bacteria, whereas bleach will kill, well pretty much anything lol.





medic1 said:


> Jeez I know that this is an old post, but just thought I would inject some life into it!!
> 
> Dirty & contaminated wound.......why not use Hydrogen Peroxide 3% or 6%: I know it has had some bad press in the recent past, and I think that if you leave it on the wound it does produce problems. However, I think good irrigation with HP to clean the crap out and then irrigate with potable water.....failing that use a weak bleach solution to replace the HP. Good soap is great for most wounds, makes it smell nice and Pruuuudy too!


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## medic1 (Jun 9, 2010)

Yea Pardus, Hydrogen Peroxide does not necessarily disinfect the wound, it will however clear any aerobic micro organisms out from the would and thus help prevent infection. This is particularly important in a wilderness or non conventional setting where EMS is a while away or there may be a delay to conventional emergency treatment. These aerobic micro organisms are commonly seen in dirt, earth and vegetation. I should have stressed that following the irrigation with HP the wound should be irrigated with at least 500 ml of potable water. Soap will clean a wound, due to the ph factor but will do little to kill any nasty shit. HP is not suitable for any wounds, and if EMS is available within 12-24 hours I would not advise it's use other than an emergency, however if you are out in the boon-docks or in a civil emergency it is great to use.........if not stick to bleach!! Hydrogen Peroxide, if used neat can cause chemical burns, it is best used in a 20% solution with potable water to eliminate this risk.
Hydrogen peroxide appears not to negatively influence wound healing, but it is also ineffective in reducing the bacterial count. However, it may be useful as a chemical debriding agent. The American Medical Association concluded that the effervescence of hydrogen peroxide might provide some mechanical benefit in loosening debris and necrotic tissue of the wound.


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## pardus (Jun 9, 2010)

Excellent, Thanks for that medic1.


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## DoctorDoom (Jun 26, 2010)

Concentrated peroxide will kill living tissue without decreasing bacteria density, which then gives bacteria something to feed on retards wound healing, not a good idea.  Diluted bleach (1/4 to 1/8% solution, or Dakin's) is your best bet for treating infected wounds; I use Dakin's on wounds almost daily.  But nothing beats irrigation: "The solution to pollution is dilution" is an old surgical maxim.


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## Wills (Jul 15, 2010)

Do not use betadine or peroxide, they both kill healthy tissue and create an environment for bacterial growth. Vigorous irrigation with sterile saline is the best wound care , lacking that Darkins solution (google it) is the next best alternative.
I teach my students this maxim, start broad-spectrum antibiotics as soon as possible, if fact through scientific research we have discovered the ideal time to start them is one hour before you are wounded.


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## pardus (Jul 16, 2010)

Starting treatment one hour before being wounded.... AWESOME!

I advocate placing a tourniquet on limbs one hour before being wounded too, works great! :uhh: 



Wills said:


> Do not use betadine or peroxide, they both kill healthy tissue and create an environment for bacterial growth. Vigorous irrigation with sterile saline is the best wound care , lacking that Darkins solution (google it) is the next best alternative.
> I teach my students this maxim, start broad-spectrum antibiotics as soon as possible, if fact through scientific research we have discovered the ideal time to start them is one hour before you are wounded.





Wills said:


> Betadine. create an environment for bacterial growth..


 
I would like you to back this claim up please.

I would also like to know your medical training, thanks.


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## medic1 (Jul 16, 2010)

As I indicated, HP is to be used to chemically debride the wound and is to be used in wilderness environments when medical care is not immediately available, it is to be irrigated following use.


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## amlove21 (Jul 17, 2010)

yea, you had me until "antibiotics 1 hour before injury". while that may in fact be true, it is simply not practical. At least, not from my optic. i dont have that much antibiotics running around, and it just seems like bad luck....

"Hey, Williams, I am going to give you this Cipro before the mission.What? No, i dont think anything bad is going to happen! But seriously, take this with food...."


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## x SF med (Jul 18, 2010)

I was taught to start with an ABX of low spectrum that covers the endemic stuff in the area, and increase your spectrum of coverage if there is sign of infection after 24-48 hours. Easier on the patient, easier on your supplies of the big guns later, less chance of helping create super bugs... WTF is it with 4th gen Cephalasprins and Cipro as ABX of first resort? Most of the stuyff out there is not penicillinase resistant gram negative staph or strep... yet, but we're sure working hard at making it that way.

Prophylactic ABX is a bad idea. I agree with AMLove the rescue dog... "He dude, take this with food, we're getting ready to bust the wire... don't worry, you might start shitting all over yourself when we're in the beehive..."


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## Headshot (Jul 18, 2010)

X, what about the cutting away of proud flesh prior to treatment on certain wounds?  Everything seems to have generalized here.  Peroxide in extended use till healing, causes excessive scarring and delayed healing.  I would also as Pardus stated like to have you start a thread with your SF knowledge of more major wounds that require care beyond basic medical treatments pertaining to, but not limited to more life threatening field applications.  Have at it Bro!  You are more than qualified to teach here.  

I'm a bit hammered after showing my son vids of people getting their heads hacked off by cowards, so please excuse the lack of proper punchiation.


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## x SF med (Jul 18, 2010)

Wound debridement is not really something you can explain on a thread, it requires eyes-on to recognize what is good or bad flesh, where the bleeding is coming from, what kind of vessel it is, type of wound and depth of damage beyond wound edges...  depending on the round used, you may have to debride a lot more flesh that looks good, but has been traumatized by the shock of the round.  

I'm not a chicken about teaching it, hell that's what I trained for and did...  but sometimes a little knowledge is worse than no knowledge at all.


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## 8'Duece (Aug 2, 2010)

medic1 said:


> Jeez I know that this is an old post, but just thought I would inject some life into it!!
> 
> Dirty & contaminated wound.......why not use Hydrogen Peroxide 3% or 6%: I know it has had some bad press in the recent past, and I think that if you leave it on the wound it does produce problems. However, I think good irrigation with HP to clean the crap out and then irrigate with potable water.....failing that use a weak bleach solution to replace the HP. Good soap is great for most wounds, makes it smell nice and Pruuuudy too!



This is about jungle medicine and such.  You know, using honey on open wounds. Massive amounts of fructose into a patient that may have diabetes and such.  Good stuff.


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## Wills (Nov 14, 2010)

Remember that ALL combat injuries are dirty wounds to start with, so anything you do unless its pack it with camel dung is helpful. Actually dried dung wouldnt hurt either but stay away from the steamy stuff.
Laugh if you want but I have seen hajis brought in with dried camel dung wound packs.
Vigorous irrigation with fluid is best, preferably sterile saline but lacking that any reasonably clean fluid will wash out microbes. There is an old recipe to make a good irrigant fluid called "Dakins Solution" thats been used since WWI. Its basicly just baking soda, bleach and clean water. Its works better than Betadine in cleaning bacteria from wounds. Here is one link; http://www.shtfmilitia.com/pdf-downloads/how-to-make-dakins-solution-t4997.html.
After its cleaned cover it again with reasonably clean dressing.
If you can get some broad spectrum antibiotics in him great. You now have approximately 72 hours to get him to a FOB before infection sets in to the point of irreversable septic shock.

As for the subtopic of hemorrhage control, If you have hemostatic agents, use them mostly for deep arterial bleeds, lacking them a combination of tourniquets and at least 5 minutes of continuous direct pressure will work. Not an arterial bleed? No problem, just direct pressure and a pressure dressing will do fine.


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## Wills (Nov 14, 2010)

"depending on the round used, you may have to debride a lot more flesh that looks good, but has been traumatized by the shock of the round.  "
Then you should know we dont do surgical debriedments in the field under non-sterile conditions. And we dont even try to teach nonmedics to do it. Whats the point ? A penetrating injury isnt going to be debried and closed on the battlefield or even in the tactical area. Where is the austere deployment you can carry enough gear to do this with?


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## TLDR20 (Nov 14, 2010)

> Where is the austere deployment you can carry enough gear to do this with?



How about in the 18D's aid station, or the Junglas training camp, or even an indig's back room. Never done one myself but see the need to have the skillset.


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## pardus (Nov 15, 2010)

Yeah, I'd rather have the knowledge and never use it than be in the situation where it's needed and not know it.

You have to be a member to get the PDF on the link Wills provided so here is a recipie from Ohio State Uni, Uni Med Center...


http://doreen.mkbmemorial.com/NF/dakins.pdf



Wills, Just out of interest what is your MOS? 18D, 68w10 /w1 etc...

I'm a 68W10.


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## The91Bravo (Nov 15, 2010)

pardus said:


> .
> 
> I'm a 68W10.



One of the most honorable professions out there.  Now hurry up and get your EFMB!

As for cleaning the wound, boiling water would work great too!:cool:
At least once.


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## DoctorDoom (Nov 15, 2010)

Boiled water, not boiling.  A burn would not help your wound at all.  Especially penetrating wound.
Debridement of a wound should occur significant time after initial injury, and I agree it is not a skillset easily taught and definitely a situation where a little knowledge would lead to overdebridement.
You won't absorb much fructose through your wound.  Honey can work but not nearly as well as frequent irrigation. KISS.


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## The91Bravo (Nov 15, 2010)

DoctorDoom said:


> Boiled water, not boiling.  A burn would not help your wound at all.  Especially penetrating wound.
> Debridement of a wound should occur significant time after initial injury, and I agree it is not a skillset easily taught and definitely a situation where a little knowledge would lead to overdebridement.
> You won't absorb much fructose through your wound.  Honey can work but not nearly as well as frequent irrigation. KISS.


I was joking.. lol  Some of my patients I wish I could boiling water on..


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## DoctorDoom (Nov 16, 2010)

Sorry, humor detector was on the fritz, back up now. :)
Now let's turn around while we wait for the water to boil...


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## pardus (Nov 16, 2010)

DoctorDoom said:


> Debridement of a wound should occur significant time after initial injury, and I agree it is not a skillset easily taught and definitely a situation where a little knowledge would lead to overdebridement.



So you would wait until you see what tissue is damaged? i.e. after a few days you see tissue turning funky colours etc...? That kind of thing?

DD what's your take on the Dakin's solution?


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## DoctorDoom (Nov 16, 2010)

Simple answer regarding waiting for debridement is yes, but that's assuming there's no other signs of infection/gangrene.

I love Dakin's, but would reserve it for infected wounds as the fluid for dressings.  Initial cleaning or care for non-infected wounds, there is no need fo Dakin's, and as an irrigant it doesn't add anything; just go with irrigation with clean water, or sterile saline if you have it available.  But with infected wounds, Dakin's is great; we use it as our default.

By the way, Peroxide is good for breaking up biofilm and lysing old blood/clot, which can for a medium for bacterial growth, so again it's good for some wound cleaning prior to dressing application but not needed as an irrigant.


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## pardus (Nov 16, 2010)

Great info, thanks.

If I ever need to debride it will only be in a zombie apocalypse type situation I'm sure.


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## Manolito (Nov 16, 2010)

http://www.diggerhistory.info/pages-nurses/wounds.htm
This was what I remember when I was in and we applied battle dressings and hoped for transport. You can see from the photos not much was done in the field.
Go to the second page for a little humor relief.
Respectfully,
Bill


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## x SF med (Nov 16, 2010)

Wills said:


> "depending on the round used, you may have to debride a lot more flesh that looks good, but has been traumatized by the shock of the round. "
> Then you should know we dont do surgical debriedments in the field under non-sterile conditions. And we dont even try to teach nonmedics to do it. Whats the point ? A penetrating injury isnt going to be debried and closed on the battlefield or even in the tactical area. Where is the austere deployment you can carry enough gear to do this with?



You've never deployed or trained as an 18D... it's obvious.  My aid kit was as big as most conventional soldier's rucks, and I still had all my ruck gear to carry.  As to gear in an austere envirionment - if it's static - it's dropped in, and you're building a friggin hospital.

Don't spout out your pie hole if you have no idea what the capabilities of the individual you're trying to sharpshoot.  If youwant to know what an 18D can do, get selected and go through the course.


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## Wills (Dec 5, 2010)

x SF med said:


> You've never deployed or trained as an 18D... it's obvious. My aid kit was as big as most conventional soldier's rucks, and I still had all my ruck gear to carry. As to gear in an austere envirionment - if it's static - it's dropped in, and you're building a friggin hospital.
> 
> Don't spout out your pie hole if you have no idea what the capabilities of the individual you're trying to sharpshoot. If youwant to know what an 18D can do, get selected and go through the course.



Im very sorry I offended your sensibilities XSF and that you felt I was "sharpshooting" you. I do happen to know what the capabilities of 18Ds, SEALS , PJs, DOJ SWAT, SAS, and almost any special operator's training level in our allied nations are. Why. because after 30 years of operating
I now train them in OEMS and TCCC.
You are correct in one of your statements, its does take hands-on eyeballing and practical experience to teach someone this skill. This forum is
limited in the ability to do that and it should be stressed this is not something even the average trained combat medic should attempt in
the field. If you have done it successfully outside the hospital Im sure you were very concerned for the patient's delayed transport and it was either
take the risk or face his death from sepsis later.


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## pardus (Dec 5, 2010)

Wills said:


> Im very sorry I offended your sensibilities XSF and that you felt I was "sharpshooting" you. I do happen to know what the capabilities of 18Ds, SEALS , PJs, DOJ SWAT, SAS, and almost any special operator's training level in our allied nations are. Why. because after 30 years of operating
> I now train them in OEMS and TCCC.



Wills, Just out of interest what is/was your MOS /medical training?

That might help with people's responses here.
 We get a lot of people who join the site and think they know a lot more than they actually know but run their mouths like they know it all.
It's gets very old very fast as I'm sure you can well imagine.
We have a policy on the site that people need to back what they are saying, hense why some of us can be a little harsh with responses until we know that person isn't full of shit or has the background /knowledge on said subject.


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## TLDR20 (Dec 5, 2010)

I will say that as an 18D I was prepared for this very scenario very well in a horrible three week block of instruction. It involved very little sleep and lots of writing


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## x SF med (Dec 5, 2010)

Wills-
Here is the extent of the information I had to evaluate with whom I was conversing:


> Location: Jacksonville NC
> Occupation: medic
> none
> 
> sending sheet heads to allah


Which, along with an unverified status, led me to believe that I was conversing with a young medic fresh out of school.  You got Lowest Common Denominatored based on the available information and the number of posers, high school kids and freshly trained young soldiers who post...


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## AWP (Dec 5, 2010)

I don't wish to see this shyte get out of hand. Thin profiles are reduced to lowest common denominator status and while I well appreciate someone's desire to keep aspects of their life off the Net, this is a scenario where more information is better than less. Additonally, one could go to their Inbox and Start a Conversation with one or more of the key players to sort out any confusion or creds before a thread goes high order on us.

With that said, everyone take a moment to breathe before posting again. I am NOT trying to stop a very healthy discussion, I AM attempting to stop a group of Bighorn Sheep from duking it out on our digital ridgeline.


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## x SF med (Dec 6, 2010)

Point made and dropped.   Returning to my corner as instructed by the ref.


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## JOgershok (Mar 11, 2011)

JAB said:


> Okay a “Dooms day” question here for the medically stupid.
> 
> *Standard:* Clean the wound to avoid infection.



The solution to polution is dilution is a good rule.  Lots of irrigation with "clean" water if that is all that is available.  Cover and watch the wound for infection.  Evacuate ASAP.


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