knife Cut in Jungle

>>>I have a med kit that contains a bottle of boric acid. What/how do I use it?<<<

Boric acid can be poisonous to humans in sufficient doses. However, my *guess* is that the boric acid in your kit is a dilute solution intended for use to treat pink eye or conjunctivitis. Conjunctivitis is an inflammation of the conjunctiva, the mucous membrane that lines the eyelids. Conjunctivitis can be caused by a bacterial infection, injury, allergies, or irritants such as smoke or chemicals. The eyes may appear swollen and bloodshot and are often itchy and irritated. The conjunctiva may become filled with pus, so that the eyelids stick together after being closed for a while, as in sleeping. Putting a dilute solution of boric acid in the eye is a standard treatment for conjunctivitis; but I would urge you not to use this apparently poorly labeled bottle of stuff unless you are damn sure what it is.

This raises an issue that may be worth discussing. I dislike prepacked medical kits. They often contain mystery substances, like your boric acid. They often contain things you don’t need, packed as filler to make the kit look complete; and they often lack things you would want to have, if you thought about it. It is, in my view, much better to compile and pack your own medical kit, for several good reasons. It is often cheaper to buy individual items instead of a prepacked kit. You are able to select from among competing products. You know exactly what you have. You do not have things you do not know how to use. You will know where everything is, because you have packed it yourself, and everything will be packed so that the most important gear is most accessible. You will be able to make the appropriate size-weight-utility trade-offs for your trip and your team. You can make your kit modular in a way that makes sense to you. Most important, compiling and packing your own kit makes you *think*. It makes you think about where you are going to be using the kit, about the potential hazards in that area, about how you will deal with those hazards, and about the scope and limits of your training and experience. That can only be good. :-)

[This message has been edited by Walks Slowly (edited 30 December 1999).]
 
Walks Slowly,

You are very thorough on your medical posts (correct and informed also). You must either have a Merk Manual in front of you or you work in medicine (ER or Family Practice). Which is it
biggrin.gif
Am I wrong?

About medicine kits. I agree... make your own. We had a previous post where Walt (ER Doc) and I (Family Practice PA-C) posted what we carry in our made up kits... anyone remember where that was?

------------------
Greg Davenport
http://www.ssurvival.com
Are You Ready For The Challenge?
Are You Ready To Learn The Art Of Wilderness Survival?

 
Greg --

While it is always interesting to see what other people carry in their medical kits, and it is certainly a source of new ideas, I worry that it feeds the general stuff-orientation of a lot of wilderness discussion. I am concerned that, as with a prepacked kit, looking at someone else's list could distract a potential wilderness caregiver from what I think are more important questions. These questions include: What are my skills and knowledge? Where am I going? What are the potential hazards? How long will I be gone? Will I need modules for wound cleaning? wound closure? dental emergencies? oral antibiotics? What am I comfortable using?

Thus I think that a useful discussion is not so much *what* you carry as *why* you carry it. That also is why I think that, in teaching or learning wilderness care, it is important to teach or learn principles ahead of techniques. If you know *why* you lower the head of a shocky patient, you are more likely to remember it; if you know the principles of wound inflammation, you can remember how to recognize an infection, even in the midst of panic or despair.

As I noted earlier, I think there is some tendency for some wilderness and survival people to be stuff-oriented rather than skill- or knowledge-oriented. I remember that wonderful scene in the Backpacker TV series where Dr. Ron goes through the packs of these well-equipped backpackers and tosses everything out on the ground, saying, "You don't need this, you don't need this ..." :-)

And thanks for your kind words. I have the greatest respect for your training and skills, and so it means a lot coming from you.

[This message has been edited by Walks Slowly (edited 30 December 1999).]
 
Walks Slowly; you said:

It is debatable whether antibiotic creams or ointments should be used prophylactically on a simple laceration in a wilderness setting. Certainly, antibiotic use is no substitute for aggressive wound cleaning. Also, in the wilderness, you are likely to have only one such antibiotic available. If an infection develops despite the use of that antibiotic, you have practically guaranteed that the infection is caused by a strain resistant to the only antibiotic you have. A wilderness caregiver might want to consider waiting to see if an infection develops in spite of appropriate wound care, and then using the antibiotic cream or ointment, in the expectation that the infecting strain is less likely to be resistant.
Click to expand...

I disagree slightly. Use of the topical antibacterial is indended to prevent infection. To withold it until an infection is present is nonsensical, since it is ineffective once that is the case. Oral or parenteral antibiotics are then indicated, as topical antibacterials do not work. Your concern about bacterial resistance is unfounded as well, as most systemic antibiotics are different from topical antibacterials. Further, since the topical antibacterials are only effective (and needed) for the first 24 to 48 hours, as the wound is sealed up after that. This is too rapid for resistance to develop, so any infection that occurs despite application of the topical antibacterial is due to resistant organisms being left in the wound to begin with. In that case, you have taken your best shot at preventing an infection, but have failed. This doesn't mean you shouldn't try to prevent the infection.

A good thing to have is a tube of opthalmic antibacterial or antibiotic (The difference is that antibacterials are produced chemically; sulfas for example. Antibiotics are substances obtained from living organisms; penicillin for example.). The ophthalmic preparation can be used topically on wounds AND in the eye. The topical antibacterial ointments are not designed for ophthalmic use.

Respectfully submitted, Walt Welch MD
 
Walt --

Thank you for your comments and suggestion. What you say makes sense, and I will think carefully about it.

[Lapse of time while Walks Slowly actually thinks carefully]

On the one hand, here is a paragraph from Trott A, Wounds and Lacerations: Emergency Care and Closure (St. Louis, MO: Mosby-Year Book, Inc., 2d ed., 1997), ISBN 0-8151-8853-6, page 326:

"A point of controversy that has yet to be resolved is whether the application of antibacterial creams or ointments under dressings has any value. Claims against the use of these agents include excessive maceration of tissue and the emergence of resistant bacteria. Suppression of infection and improved wound-edge healing, particularly for flaps, are reasons given in support of the use of topicals. Currently, these agents are recommended for facial wounds ... or any other wound that is treated without dressing and bandaging. For dressed wounds, any antibacterial effect is lost unless dressings are changed at frequent intervals, at least 2 to 3 times a day. This makes application of these ointments impractical for wound protection against infection."

On the other hand, I just spoke with Daughter Number Two, who is the Infectious Disease Daughter and has actually worked with floroquinolone-resistant bacteria. She comes down solidly on the side of Dr. Walt. She says that the emergence of resistant strains from topical antibiotics is much less a risk than the risk of infection. She says that resistant strains are a problem primarily for long-term hospitalized patients with compromised immune systems, and are less a concern for healthy adults with fully operating immune systems who are running around in the wilderness. She gave several other reasons as well, but the bottom line is that I am facing two big guns here and I am inclined to capitulate. :-)

However, I will continue to insist that no wilderness caregiver should think that the use of topical antibiotics relieves any responsibility for thorough and aggressive wound cleaning.

Walt, your point about packing an ophthalmic antibacterial or antibiotic instead of a topical is very helpful; is there a particular broad-spectrum product you would recommend for wilderness use?


[This message has been edited by Walks Slowly (edited 30 December 1999).]

[This message has been edited by Walks Slowly (edited 30 December 1999).]
 
Here we go... I have the mystery bottle in front of me right now.

Boric Acid Solution
"A soothing, cleansing lotion for use as an inhibitory bacterial agent."

5% Boric Acid, the rest is pure water.

The directions say to prepare a sufficient quantity for one day's use and discard the unused portion. Now, with the situation a little clearer as I should have been from the get go, what do I use this stuff for and how is it used?

------------------
When the chips are down, the buffalo is empty.

 
Walks slowly; I am delighted that your ID daughter agreed with me. I would defer to her expertise should she differ.

I have two favorite ophthalmic ointments; Polysporin and Gentamycin. I would also use sodium sulfacetamide. All give good coverage against the usual flora. Neosporin is to be avoided in the eye, due to the large number of people who develop an allergic reaction to the Neomycin. The manner in which a drug is administered is important with respect to the probablility of an allergic reaction occuring. Ophthalmic use is one of the best ways to cause an allergic reaction. When penicillin was introduced, pcn ophth. oint was popular for a while, but its' proclivity to cause allergic reactions caused it to be removed from the market.

Regarding the 5% aqueous solution of boric acid, it is included in first aid kits, as it can be dispensed without prescription. Ophthalmic antibacterial or antibiotic solutions or ointments are by prescription only. Throw the boric acid away. It is useless.

Hope this helps, Walt
 
Little late on this post...Just found this part of the forum. 1984 while working as a broiler cook I had the pleasure of finding out they had brought in newly sharpened knives the hard way. Got distracted as I was slicing tomatoes and cut to the bone and half way around my left index finger, it was just below the nail. Ran it under cold water immediately, held it open and packed it with cayenne pepper, tied a clean towel around it and went back to work. The bleeding stopped almost immediatly. After about an hour, I took off the towel, brushed off the excess pepper and put a bandaid over it. Have had no problems with it and only I can find the scar. This is only my experiance, so I know what worked for me.
 
so many ideas ,

after this thread and another one I started on most valuable books. I got alot of good ideas. I recently purchased THE OUTWARD BOUND WILDERNESS FIRST-AID HANDBOOK. In this book they talk of wilderness first-aid as a newly emerging field of practice where all kinds of people gather.from peace core workers to wilderness guides to doctors who love the outdoors and people who got into some nasty situations. It seems I found a keeper. There is no mention of cayene though.

another reason for bringing cayene is food/insect spicing and it deffitely helps with colds and stomach problems.I'll experiment on myself on my next big cut and settle the cayene debate.
 
Walt and Walks Slowly -- could you guys disagree a little more often? Listening in on two people who know what they're talking about, yet still disagree (politely) is a great way to learn.

Two questions:
Gangrene is only caused by a infection of live tissue by a single organism? So that means that necrosis and gangrene are two completely different things, right? I'd thought that they were basically two different terms for the same thing.

Also, for stopping bleeding quickly, what is the prevailing opinion of using something like a styptic pencil? I know it would hurt like hell, but if someone has a deep, ragged scrape-like wound (like from falling/sliding on rock) would this be a good first step before bandaging?
 
My tired old mind seems to remember my Boy Scout first aid training saying the best treatment is pressure and elevation above the heart. With a tourniquet a last resort.
When I cut my finger badly a few months ago, I am not sure but I think creative swearing and introducing my wife to new and colorful combinations of tired old words seemed to help a bit. This should not however be practiced in the hearing distance of impressionable youngsters unless you desire to shock other people. Most of my training since then has not contradicted this, granted I am in no way a doctor or nurse, but it has always worked for me. I would have to wonder what a clotting agent like a styptic pencil would do to an open vein or artery should it be introduced. I have never heard of that, but would it cause a possible clotting agent into the blood and if so would the amount introduced be deterimental?

------------------
Lee

LIfe is too important to be taken seriously. Oscar Wilde
 
Direct pressure and elevation will stop almost any bleeding, even from serious wounds -- in fact, even from amputations. A tourniquet is virtually *never* necessary. The only exception is when a deliberate decision is made to sacrifice a limb in order to save a life -- a decision, needless to say, made whenever possible in consultation with the patient.
 
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