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Sorry man, I meant apparantly instead of actually.
Thanks man, and good luck with your career!!
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First aid for wounds
- Thread starter j williams
- Start date
Sorry man, I meant apparantly instead of actually.
Thanks man, and good luck with your career!!
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ANother contraindication to trenellenburg might be the suspicion of fluid in the lungs either by the result of trauma or respiratory illness...if someone is blleding into there lung after a bad fall, tilting the body that way might cause them to drown in thier own stew..the same might be true in somebody suffering from CHF or a pump failure of the heart which causes fluid to back up in the lungs. THis is a great thread...Props to J for putting it together..It's nice to see some really knowledgable dudes chiming in as well.
myright
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Hey fellas - Can anyone help out?
myright-in my admittedly limited experience with using glue to close a wound ( I've seen it done once) the wound was a small cut that maybe would have taken two stitches but in a place (finger) that the stitches would have been likely to tear out.
The wound was washed thoroughly and a small drop of glue was applied then held closed until the glue dried. It was then covered with a band aide. The Corpsman didn't seem worried about infection or poisoning.
I know this isn't exactly expert advise but maybe it'll help till someone more knowledgable comes along
David
The wound was washed thoroughly and a small drop of glue was applied then held closed until the glue dried. It was then covered with a band aide. The Corpsman didn't seem worried about infection or poisoning.
I know this isn't exactly expert advise but maybe it'll help till someone more knowledgable comes along
David
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my right, I'd really shy away from the crazy glue..for a small cut just use a band aid...Not as cool I know... but I've seen a few folks that tries to play doctor with crazy glue mess them selves up. Not to say it can't be done I did try in myself once but...it's a risk vs benefit thing
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How did they mess themselves up? I have seen cyanoacrylate used successfully on a lot of wounds (by doctors). I am just curious what can happen when it is not used properly.
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seen a guy accidentally glue his dirty finger to his open cut.. saw another guy that glued a dirty handkerchief to his hand...also the worst one I saw was a guy who went to use some, he was rushing an didnt notice that the cotainer had a small perforation in it.. he squeezed it hard and it went into his eyes...he was in a bad way,, he wasn't in the woods but imagine if he was..just bad news... allot of people use it, it can be done I've seen some instances where it was beneficial and instances where it wasnt..what I am advising against is people who heard from a "source" that crazy glue is good for wounds and than forego a proper wound dressing.. which in my mind is safer, more sterile and it can be removed and changed to prevent infection... a luxury you don't have with crazy glue..whatever is in there is in there...but that's just me YMMV and respect ot everyone who's opinion differs. I'm not trying to start a debat just speaking my mind is all. Thanks for listening
could'nt agree more! although i do use KG for little tiny finger nicks.
Used it on myself MANY times instead of emergency room stitches. The whole family has seen my wound glue skills including the dog. I studied how to do it and proper wound care however.
Good point on the 80% of the population who are half wits tho. Dont try it unless you know how on large wounds, practice on yourself first of course.
Skam
Good point on the 80% of the population who are half wits tho. Dont try it unless you know how on large wounds, practice on yourself first of course.
Skam
myright
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That makes perfect sense, I've never thought about accidentally glueing fingers together or an article of clothing to my finger. I've never tried it and probably won't since I always have bandaids and wound dressing on me or close to me at any given time.
I've had quite a bit of deep cuts that I probably should have had stitches for, but was able to have them heal up nicely with the ole tried and true pressure and dress method.
Maybe glue would allow you to have it heal perfectly? Maybe.
I guess it kind of makes me a half wit
Thanks again for the info John.
I've had quite a bit of deep cuts that I probably should have had stitches for, but was able to have them heal up nicely with the ole tried and true pressure and dress method.
Maybe glue would allow you to have it heal perfectly? Maybe.
I guess it kind of makes me a half wit
Thanks again for the info John.
We've been using glues in the ED & OR for many years - studies have shown that small wounds, in areas of low tension tend to heal w/ cosmesis pretty much equal to that of sutures, with similar rates of dehiscence & infection. Once you cross into larger wounds, or wounds in areas of tensions (across joints, hands/feet, etc...) that the glues do worse, and have a higher incidence of dehiscence.
A good portion of the data was from kids (who tend to heal pretty well regardless), and from the OR (wounds created in a "sterile" environment, and the glue was typically used on tension free skin edges - deep sutures had already been placed).
ER docs tend to like it because its quick, requires less equipment, and doesn't require the use of local anesthetic (which for most people is worse than getting the cut in the first place, and is especially difficult with children). Small scalp/face/etc... lacerations can be repaired in a matter of minutes.
How does this apply to the real world - the crossover is limited by the lack of training/experience of the operator (joe average), the lack of proper supplies in most people's FAKs, and the limited ability to properly assess a wound once it has been closed. If this doesn't apply to you, then you are not the "average" joe.
There is risk of thermal injury from the curing of the glues (they are all exothermic as the cure - they produce heat - sometimes this causes pain, sometimes it actually damages tissue & retards healing). The metabolites can also be toxic to tissue (as the glue breaks down), and we try to use as little as possible to prevent any issues.
Some Emergency medicine studies have suggested using Dermabond in tandem with porous tape - you apply strips of the tape like you would a steristrip, then paint the wound (which is now approximated with the tape strips) with the dermabond, covering the tape strips as well. The glue secures the tape, and adheres the exposed skin between the tape strips.
The scars from glued wounds are typically not better than sutures, but they are (when used on appropriate wounds) usually comparable. We still use sutures for any delicate work as they are more precise in aligning tissues.
The biggest concern w/ glues is trapping infection, because you make a watertight seal with them - while this sounds like a good idea (keeps stuff out of the wound), the risk is trapping foreign matter in the wound, which can lead to infection. Infections in areas such as the hands & face can lead to real problems - loss of function, and possibly limb. Infections can be mild, like a simple cellulitis, or life-threatening, as in a case of necrotizing fasciitis. I've seen & treated both - if the necrotizing fasciitis had occured away from civilization, the patient would have died (he almost did anyway, even w/ multiple surgeries, an ICU, and more antibiotics than most people will ever see in a lifetime.
Most people will never have a problem using glue on their cuts - most of which probably wouldn't need sutures or glues if brought into the ED. But, there is always the potential for a real bad outcome. You always have to have a low threshold for opening the wound - which is a lot easier if you don't use a glue. Out in the woods, If I were going to try to close a wound, I'd use steri-strips w/ a little benzoin - after washing the wound copiously. I'd even consider staples. I wouldn't glue anything that would actually need stitches. A little paper cut or slice that doesn't penetrate the dermis - maybe.
A good portion of the data was from kids (who tend to heal pretty well regardless), and from the OR (wounds created in a "sterile" environment, and the glue was typically used on tension free skin edges - deep sutures had already been placed).
ER docs tend to like it because its quick, requires less equipment, and doesn't require the use of local anesthetic (which for most people is worse than getting the cut in the first place, and is especially difficult with children). Small scalp/face/etc... lacerations can be repaired in a matter of minutes.
How does this apply to the real world - the crossover is limited by the lack of training/experience of the operator (joe average), the lack of proper supplies in most people's FAKs, and the limited ability to properly assess a wound once it has been closed. If this doesn't apply to you, then you are not the "average" joe.
There is risk of thermal injury from the curing of the glues (they are all exothermic as the cure - they produce heat - sometimes this causes pain, sometimes it actually damages tissue & retards healing). The metabolites can also be toxic to tissue (as the glue breaks down), and we try to use as little as possible to prevent any issues.
Some Emergency medicine studies have suggested using Dermabond in tandem with porous tape - you apply strips of the tape like you would a steristrip, then paint the wound (which is now approximated with the tape strips) with the dermabond, covering the tape strips as well. The glue secures the tape, and adheres the exposed skin between the tape strips.
The scars from glued wounds are typically not better than sutures, but they are (when used on appropriate wounds) usually comparable. We still use sutures for any delicate work as they are more precise in aligning tissues.
The biggest concern w/ glues is trapping infection, because you make a watertight seal with them - while this sounds like a good idea (keeps stuff out of the wound), the risk is trapping foreign matter in the wound, which can lead to infection. Infections in areas such as the hands & face can lead to real problems - loss of function, and possibly limb. Infections can be mild, like a simple cellulitis, or life-threatening, as in a case of necrotizing fasciitis. I've seen & treated both - if the necrotizing fasciitis had occured away from civilization, the patient would have died (he almost did anyway, even w/ multiple surgeries, an ICU, and more antibiotics than most people will ever see in a lifetime.
Most people will never have a problem using glue on their cuts - most of which probably wouldn't need sutures or glues if brought into the ED. But, there is always the potential for a real bad outcome. You always have to have a low threshold for opening the wound - which is a lot easier if you don't use a glue. Out in the woods, If I were going to try to close a wound, I'd use steri-strips w/ a little benzoin - after washing the wound copiously. I'd even consider staples. I wouldn't glue anything that would actually need stitches. A little paper cut or slice that doesn't penetrate the dermis - maybe.
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Thanks for sharing you first aid tips, these will come in very handy in almost everyone's day to day at some point.
It could also be mentioned that when tying an interrupted stitch, the knots created should be on either left or right side of the wound, this helps them to be removed easier. It makes for a lateral pull of the of string instead having to curve it's way through the wound. This of course isn't crucial, but if you aren't to nervous or if time isn't absolutely critical when suturing a wound it wouldn't hurt to try it out.
It could also be mentioned that when tying an interrupted stitch, the knots created should be on either left or right side of the wound, this helps them to be removed easier. It makes for a lateral pull of the of string instead having to curve it's way through the wound. This of course isn't crucial, but if you aren't to nervous or if time isn't absolutely critical when suturing a wound it wouldn't hurt to try it out.
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I've used knots over a a rolled up chunk of gauze placed over a dressing to create a "pressure dressing" i heavy bleeders. but those are special circumstances.
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Sorry for any misunderstanding Flotsam..as a field provider I don't do sutures I was reffering more to dressings..I could definitely see the rationale for avoiding that in a suture situation.
No misunderstanding - I was taught the same dressing techniques when I was a medic - it does work (sometimes) for wounds that still bleed after a standard dressing has been applied. We were taught to make a wad of cravat/gauze/pt's clothes & then place that directly over the wound & tie it down w/ whatever was available.
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I place dressings directly over wound, then an roll of kerlex(still rolled up) on top of that, then I wrap with an additional roll of kerlex or Coban. Tie off kerlex into a knot. Works great, for a pressure dressing on those stubborn wounds.
I've used kerlix & an ace wrap (coban isn't normally on the floors or in the ED these days -but I've used it it & it works well) in a similar fashion. 4" kerlix is one of the items that should be in every FAK - it's very versatile - from wrap, to sling, to wound dressing or packing, it can cover a lot of tasks.