First aid for wounds

myright said:
Sweet - Thanks.

My wife works in critical care so she's learned all this stuff, but has never worked in trauma so she wouldn't have come across one as of yet.

I look forward to hearing if she's experienced one.
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She said the one she saw was a pinkish red frothy bubbling wound, with a somewhat low pitched sucking sound.:thumbup:
 
misanthropist said:
Okay, I hear you...so suturing up a wound tends to control bleeding? Or do you have to wait for bleeding to subside?

I am just trying to get this right in my head here...it seems like unless you were looking at an arterial bleed then pressure would be enough and sutures wouldn't be necessary, but if it was arterial bleeding, wouldn't you need to repair the arteries to make it slow down?

Again I am speaking as a total novice, just my own experience with times my inside bits surprised me by being on the outside - not that I ever had to fix it myself!
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Ok, With arterial bleedng, its from a severed or knicked artery, and spurts bright red blood. The treatment for those is usually tournequet to controll bleeding. Then they need surgical intervention to repair the vessel. If you suture it, it will just bleed out internally.

As far as sutureing, by closing up a deep wound that isnt arterial bleed, It closes up the wound, and keeps the risk of infection down, and keeps the wound closed to keep it from being opened back up. Reduces scarring too. I dont care though, scars are cool! The sutures Ive seen done are usually bleeding minimally, not gushing, so bleeding has ben somewhat controlled.:thumbup:

Again, just my opinion, and how I observe, and take in the info that is thrown at me, I am not an expert.:thumbup:
 
j williams said:
She said the one she saw was a pinkish red frothy bubbling wound, with a somewhat low pitched sucking sound.:thumbup:
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Nice - thanks! Nothing like having a resident source of info on sucking chest wounds :D

Tell her I said thanks for the info.
 
Thanks for the info Jake! I also have your cell number. I think we should talk about some of this info...it's leading down that path again! I might take the plunge!
 
I can be of help to ya man!:thumbup:

You and Tony have a pretty good first aid kit it sounds like!!;):D
 
Nice thread.

I agree with JW that the first step in wound management is to stop the bleeding. Pressure works, even for some arterial bleeding. I once cut into an artery in my foot with an axe. I don't normally recommend this.

I was able to control the bleeding with pressure and a pressure dressing. Pressure is key. If pressure doesn't work a tourniquet often will. Now you are on the clock and need to get definitive care soon. Loosening a tourniquet can be tricky and can cause other problems.

Quik-clot is effective; however, you need to be careful when using it not to get any in contact with any mucous membranes or your eyes. I would reserve that for serious bleeding.

Like JW said, after the bleeding is controlled, preventing infection is the next step. This begins with cleaning the wound. This is also referred to as 'debriding' a wound. Remove dirt and organic material (and any axes) manually and then wash thoroughly. Use saline if you have it or the cleanest water you can find. Clean the wound again. Now go back and really clean it. It might hurt some, but that's what you get for putting an axe in your foot.

The subject of antiseptics is somewhat controversial. I avoid hydrogen peroxide as it can damage viable tissue and break down clots. For similar reasons, don't put straight betadine in a wound. I like diluted Betadine (1:10) to clean out a wound.

For deep wounds that have been well cleaned, suturing may be useful. You can use proper suture material if you have it, but I don't normally carry sutures with me. I mean who plans on putting an axe in his foot?
Field expedient suture material can be dental floss or fine fishing monofilament. In both cases it should be unused.

If you don't suture a deep wound, the wound heals by 'secondary intention.' As JW pointed out, this can lead to more significant scarring, but it may be a safer way to let a dirty wound heal. Keep the wound packed with a good dressing, but remember to change the dressing every 24 hours or so. JW alluded to tampons being good field expedient dressings. True. But remember Toxic Shock Syndrome? That can also happen with a wound with a dressing left in place for too long. Change dressings and clean wound daily.

Did I mention I think it's important for you to clean the wound?
 
Damn Rotte! Ouch!!!!!

Hey good point on the peroxide. I think its way too abrasive to be of use. I think I said something about diluting iodine, or meant to anyways......

Good call on the Toxic Shock, I alluded to tampons, but didnt really touch on em too much.

I agree clean that wound!!!!!! You dont want the complications that can arise from an infection.
 
j williams said:
Ok, With arterial bleedng, its from a severed or knicked artery, and spurts bright red blood. The treatment for those is usually tournequet to controll bleeding. Then they need surgical intervention to repair the vessel. If you suture it, it will just bleed out internally.

As far as sutureing, by closing up a deep wound that isnt arterial bleed, It closes up the wound, and keeps the risk of infection down, and keeps the wound closed to keep it from being opened back up. Reduces scarring too. I dont care though, scars are cool! The sutures Ive seen done are usually bleeding minimally, not gushing, so bleeding has ben somewhat controlled.:thumbup:

Again, just my opinion, and how I observe, and take in the info that is thrown at me, I am not an expert.:thumbup:
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Okay, now bear with me here as I try to connect the dots...my brain is not always running in high gear.

Suturing won't help with arterial bleeds unless you can clamp off the damaged artery, suture it back together, and safely remove the tourniquet, am I on so far? This is how I picture it.

The main advantage to suturing is to just physically close up the wound so it doesn't become more severely contaminated and to keep scarring down? Am I hitting this right?

And the risk of infection from subsequent contamination of the wound if it's left open is greater than the risk of infection by closing up a wound that might have been contaminated?

I am not trying to seem argumentative, I am just trying to get this 100% straight in my head. I know that sometimes I have a flat writing style that makes me come off like a prick so I am trying to alleviate that here. But it seems to my untrained mind that the risk of subsequent contamination of an open wound can be mitigated best by packing it with gauze and leaving it open to drain if it does become infected from initial contamination.

Maybe I am WAY off base here but I am just struggling with the idea that you can reduce risk of infection in the field by suturing closed a large wound. Just instinctively that somehow is setting off big alarm bells for me! But as I say I am not trained medical personnel at all so maybe I am just totally out to lunch.

Can some people confirm this for me? Are you really reducing risk of infection by zipping yourself back up, or should this only be done in really sterile conditions? I just want to have all the info I can here before I start sewing myself closed in the field!
 
I wish I had more experiance with quick-clot, but its still new to me.

Thanks for adding to this, its easy to leave out stuff when its all swimming around in your head when yu are tryin to put it in an easy to follow manner. I have always been a do type of person, not a teach type. I am still learning, always learning.

I just hope you guys are taking something away from these threads.
 
misanthropist said:
Okay, now bear with me here as I try to connect the dots...my brain is not always running in high gear.

Suturing won't help with arterial bleeds unless you can clamp off the damaged artery, suture it back together, and safely remove the tourniquet, am I on so far? This is how I picture it.

The main advantage to suturing is to just physically close up the wound so it doesn't become more severely contaminated and to keep scarring down? Am I hitting this right?

And the risk of infection from subsequent contamination of the wound if it's left open is greater than the risk of infection by closing up a wound that might have been contaminated?

I am not trying to seem argumentative, I am just trying to get this 100% straight in my head. I know that sometimes I have a flat writing style that makes me come off like a prick so I am trying to alleviate that here. But it seems to my untrained mind that the risk of subsequent contamination of an open wound can be mitigated best by packing it with gauze and leaving it open to drain if it does become infected from initial contamination.

Maybe I am WAY off base here but I am just struggling with the idea that you can reduce risk of infection in the field by suturing closed a large wound. Just instinctively that somehow is setting off big alarm bells for me! But as I say I am not trained medical personnel at all so maybe I am just totally out to lunch.

Can some people confirm this for me? Are you really reducing risk of infection by zipping yourself back up, or should this only be done in really sterile conditions? I just want to have all the info I can here before I start sewing myself closed in the field!
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Hey no worries bro! I am taking you the right way!!!:D:thumbup:

If you clean the wound really well, then clean it again, there is something to be said for using a sterile kit to stitch yourself up, just to reduce the risk of infection, however If it were my wound then I would use pressure, and keep it packed and super clean, changing bandages frequently. BUT....If you are far from help, or lost etc... Your FAK you carry will only go so far when changing bandages, and I would rather stitch it up, after cleaning it THOROUGHLY then to risk runnning out of supplies with no help in sight.

For everyday situations where help is a phone call away, or a short drive, I would clean it, pack it, dress it, and seek help.:thumbup:

When you are gettin into clippin arterys and cauterization of vessels to stop arterial bleeds, I would just use a tournequet, and pack the wound after thorough cleaning, and dress it, and change dressings and monitor my tourniquet and keep the wound clean.:thumbup:
 
misanthropist said:
The main advantage to suturing is to just physically close up the wound so it doesn't become more severely contaminated and to keep scarring down? Am I hitting this right?

And the risk of infection from subsequent contamination of the wound if it's left open is greater than the risk of infection by closing up a wound that might have been contaminated?
...
But it seems to my untrained mind that the risk of subsequent contamination of an open wound can be mitigated best by packing it with gauze and leaving it open to drain if it does become infected from initial contamination.

Maybe I am WAY off base here but I am just struggling with the idea that you can reduce risk of infection in the field by suturing closed a large wound. Just instinctively that somehow is setting off big alarm bells for me! But as I say I am not trained medical personnel at all so maybe I am just totally out to lunch.

Can some people confirm this for me? Are you really reducing risk of infection by zipping yourself back up, or should this only be done in really sterile conditions? I just want to have all the info I can here before I start sewing myself closed in the field!
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This is exactly what I've been wanting to know as well. Perhaps I'll ask my boss tomorrow for a second medical opinion.

edit: just saw your post Jake, thanks:thumbup: If I learn something from my boss tomorrow, I'll be sure to put it up here. And excellent post Rotte!
 
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If you don't suture a deep wound, the wound heals by 'secondary intention.' As JW pointed out, this can lead to more significant scarring, but it may be a safer way to let a dirty wound heal. Keep the wound packed with a good dressing, but remember to change the dressing every 24 hours or so.
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In my opinion, it IS the safer way to let a wound heal unless you happen to be a surgeon, ER doc, PA, or independent duty corpsman who has a good deal experience in closing wounds, who has the right equipment (significant irrigation fluids, betadine, drains and antibiotics). Even then, in sterile environments with staff, all the right equipment, and antiboitics, infections are a major problem after closing a wound. Surgeons OFTEN have to reopen wounds and allow the exudate (pus) to drain from a wound. You close that up inside your dermis (skin) and the only place it has to go is into your bloodstream for a systemic infection.

I can not hypothesize a scenario in which the risk of infection related to closing a wound in the field after a half ass debridement and without antibiotic therapy is more desireable than a scar.

If you don't know anything about microbiology and don't have any training, there is NO reason you should be considering this. There is a reason that suturing isn't taught in basic first aid courses.

Just because Rambo did it in First Blood doesn't mean you should.
 
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Also I think some of your concern is just a natural fear of doin something that extreme. That is totally understandable. I feel your concerns, and hope you are getting some kind of basic knowlage to arm you if you ever need it. That helps to make you more calm and level headed when dealin with this stuff.:thumbup:

Its better to voice concerns and hash this stuff out here then to get out there and have all these conflicts with yourself on what needs to be done!:thumbup:
 
nemoaz said:
In my opinion, it IS the safer way to let a wound heal unless you happen to be a surgeon, ER doc, PA, or independent duty corpsman who has a good deal experience in closing wounds, who has the right equipment (significant irrigation fluids, betadine, and antibiotics). Even then, in sterile environments with staff, all the right equipment, and antiboitics, infections are a major problem after closing a wound.

I can not hypothesize a scenario in which the risk of infection related to closing a wound in the field after a half ass debridement and without antibiotic therapy is more desireable than a scar.

Just because Rambo did it in First Blood doesn't mean you should.
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Nobody is quotin Rambo dude.:rolleyes:

Think about it from a long term survival view, not a Ooops I am on a dayhike 4 miles from my car with a cell phone view. Realisticly its not to out there to assume that your dressings will run out before your wound heals. Ideally we would all travel with a trauma surgeon and ER in our packs, but its not the case. If you have a FAK, I hope their is iodine, and dressings, and gloves etc to use, and if you can boil water you can sterilize.
 
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siguy said:
J, thanks very much for sharing. this is helpful.

one tip i read once was to practice stitching on a sliced orange...what do you think about that? obviously training is key with stitches, but do you think practice would help at all?

I remember watching an episode of ER where Noah Wylie 's character was practicing his suturing on pig's feet. In fact, fresh pig skin is supposed to be very similar to human skin. May be worthwhile. Any thoughts?
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I have heard that too. NO experiance with it though, I know that the respitory anatomy of a deer is very similar to a human though!

I can see how it would be similar though.......
 
Awesome post, a good refresher. Makes me want to break out a wilderness traction splint device (mainly designed for use with the femoral fractions) that my Dad gave me recently. I doubt I'll ever carry it, but it's pretty sweet all the same. I might try to sell it if someone might actually carry it.
 
nemoaz said:
There is a reason that suturing isn't taught in basic first aid courses.
True, but basic first aid course, at least the ones that I have taken, don't talk much about anything wilderness related. I took a Wilderness First Responder course, and everything was tailored to back country situations. We discussed suturing very little with no actually practice. The reason for this is that evacuation is the plan for any scenario with this type of an injury... but what happens when that's not an option for some reason?

If it personally came to that point, I'm sure I would have wished I would have practiced a little, and had the knowledge to go about attempting it. If it meant life or death (granted these are the most extreme cases, but much of what we discuss here is), I want to be prepared for that.

All that said, I've got a few suture kits, a pen cauterized, and lots of other odd medical things. But I've got no experience with most of it other than reading, and testing on fruit and paper.

I'd love to see more of us taking advanced first aid courses tailored to the wilderness.
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