Superglue instead of stitches

[LSkylizard]

...The military....nobody has more experience than they do with dirty wounds...

The military has extensive experience with wounds, agreed. They of course regard:

All war wounds are contaminated and should not be closed primarily.

...Antiseptics have a long and controversial history in military surgery. While using antiseptics as therapeutic agents in treating grossly infected wounds SEEMS to be reasonable, using an antiseptic prophylactically is NOT. Any chemical capable of killing bacteria will also kill mammalian cells.

I am not sure you want to treat all home injuries, hiking/camping injuries, etc... as "war wounds" (before we get into a pissing match about how you never said that, etc... I know you didn't say that. I am just making a point that once again it is about applicability). I would also say that the military, while slow to admit it, does make errors and does so for years. One example includes the change in turniquette policy and the intermittent release of the turniquette.

What most do not understand about the military is that a large component if not the majority of experienced trauma surgeons are those called to active duty from civilian LEVEL I Trauma Centers. In fact, it is not uncommon for certain military surgical training programs to rotate their residents to civilian hospitals for the trauma experience!

I strongly believe in the US Military. I believe in the Military Doctors. I also know their hands are often tied and their protocols and/or practices would not fly for the average civilian. Just because the military has a protocol for something does not necessarily mean it is the best way to do something. There are other considerations as to how and why things are done in the military. So, let me add number 2 to the list:

1. Just because it is published (science journal, Wall Street Journal, Reader's Digest or otherwise) does not mean it is true/right/accurate/ and or applicable
2. Just because the military does something a certain way does not mean it is necessarily applicable or the right way (as it depends on your objective...and most hikers have a different objective then the US Military)

This is dragging on and I continue to bicker. By all means, do what you want. You have presented your perspective and I mine. I am satisfied that a reasonable alternate perspective has been presented by me.

 

[LSkylizard]

...Dr's attending an accident scene ...are held to a higher standard of care because of their training...

I would hope so!

...The good samartian law...protects people up to their level of training so in theory the more training you have the more trouble you can get into...

This is true inside the hospital as well. Which is why dermatologists and radiologists are not likely to provide much at a scene nor should they be expected to do so.

...is not for well trained people who make critical mistakes as you will be held to a much higher standard...

If you are a surgeon stopping at trauma scene and you make critical mistakes you will be held accountable just as you will be in the hospital trauma room...which is as it should be.

...All this comes from legal counsel I had on this exact subject...

That is great. I get the legal counsel and advising on this and other issues at least every two years. None the less, a trauma victim (i.e. dud falls off his roof...no apparent risk to anyone else) is in front of a surgeon, he/she walks off, they can be sued.

 

[LSkylizard]

...betadine, peroxide, iodine are all toxic to tissue & retard wound healing…

The pinesap, etc... crowd is more a testament to the rejuvenation abilities of the body, and less to the efficacy of home remedies. And that's the point - the body (esp. in a young, healthy person) will heal just fine on it's own...

...Antiseptics have a long and controversial history in military surgery. While using antiseptics as therapeutic agents in treating grossly infected wounds SEEMS to be reasonable, using an antiseptic prophylactically is NOT. Any chemical capable of killing bacteria will also kill mammalian cells.

...The best proven substance to clean a wound is sterile normal saline. Iodine actually inhibits migration of the appropriate cells needed for healing and combating infection. Just irrigate the wound copiously with sterile saline!

...Crazy glue is always the wrong tool for the job…

...the first and foremost thing for a wound is copious irrigation... …water should be your first line NOT watered down iodine

...(there are special exceptions in which you do just the opposite and pack the wound with iodine)...

…Copius irrigation is NOT to sterilize the wound. It is to decrease the bacteria load to enable your bodies natural defenses to take over. There is no real way to completely sterilize a wound without inhibiting the bodies ability to heal after you have chemically burned it...

…calculate how much water you can spare and you use what you can spare. You accept the possibility that infection will set in from inadequate irrigation and leave the wound open (control the hemorrhage though) until you can obtain better care…do not injure the wound base with chemicals just because that is what is available. Spritzing betadine/providone solution into the wound does NOT adequately irrigate and leaves foreign material as well as injured tissue as prime nidus for infection.

...It goes without saying that if you need an iodine tablet to sterilize your water supply then you do that…

...when someone comes to the operating room septic because they have perforated their colon (stool and corn in the belly), we irrigate with normal saline....NOT iodine...

...Just because some survivalist have succeeded using interesting methods does NOT mean it actually applies to the entire world...

... What most do not understand about the military is that a large component if not the majority of experienced trauma surgeons are those called to active duty from civilian LEVEL I Trauma Centers. In fact, it is not uncommon for certain military surgical training programs to rotate their residents to civilian hospitals for the trauma experience!...

... I strongly believe in the US Military. I believe in the Military Doctors...

Final post to this thread/argument...well it has all been said already

 

[Gerald McDonald]

I've made up my mind, I can believe skylizard who sounds pretty darn sharp on this issue, or I can go with the Wit brothers, Dim and Nim. One whos main claim to fame is he can break anything, the other, well hell, he has no claim to fame as he likes his privacy.:yawn:

 

[Bob41081]

Personally the forums would be alot better of if dumber and dummest would quit arguing just see themselves in print. It's one thing to have an opinion and another to see that opinion shown to be wrong and keep arguing the point ad nauesm when they are not right. And numerous people try politely to get them to shut up and they won't. I'm not polically correct, if this gets me banned so be it. Skammer and Cliff SHUT UP and be like normal people!!!!! And people wonder why my post count is so low.

Robert Sears

Bob

 

[Ebbtide]

Thanx for trying LSkylizard.
Consider yourself welcome (and hazed).

 

[Moine]

Primo Non Nocere --> First of all, don't make it (f..king) worse.

I think this is worth mentioning

Thanks Doc (& others) for clearing that up a little. I learned a lot. That was a hot & great thread.

Cheers,

David

 

[Cliff Stamp]

I would tell you to seek medical attention first too. Infection can spread fast and I would NOT be advising you to pop/cut sutures… just come see a professional.

These are not usually available in a survival situation, pretty much by defination actually which usually means self-reliance and the ability to handle less than optimal situations with less than optimal materials and the ability to improvise.

Most if not all survival manuals won't deal with these kinds of situations, the army manual is one exception but it is vague with terms like "severe infections" which "don't heal" consider maggot treatment. However it doesn't define what severe means and how long healing should take, at what point should you decide that it isn't going to heal.

Flies obviously carry the chance of infection on their own so you have to weigh the ability of the maggots to debris the infected tissue with their ability to introduce new bacteria. So it is usually only considered when you have wrote off the usual methods, drain and clean the wound, use antibiotics on the dressings, etc. .

The army manual also cautions that maggots will eat healthy flesh, but lots of people promoting maggot treatment for severe wounds (diabetics for example) say the opposite and also promote that maggots are antibacterial beyond just consuming the damaged flesh due to the chemicals they release to digest the infected material.

Ideally of course the individual wishing to know the answers to these questions get the appropiate level of medical training, but realistically you can't expect everyone to spend the necessary years of training so it is more of a case of minimizing damage and raising the ability in general than optimal treatments.

In regards to closing a wound via strips, glue or sutures, the main reason I would do this in a survival situation is because it is necessary for function of the wounded part so the normal advice of not to stress the cut simply can't be held, you need to close it to regain use and rapidly enhance healing.

As an example I had a cut across the index finger of my hand, when I flexed the index finger it would crack the wound wide open, so I had two options, splint the finger and leave the wound open, or stitch/glue it. The latter caused the wound to heal in a fraction of the time and gave me function back almost immediately.

Many survival tasks are fairly difficult on their own, building a fire in high wind when the wood is wet/frozen for example, now try doing that without use of your primary hand. Without a fire you could die near immediately thus in general there is a lot more to consider for independent wound care often times it is a matter of picking the least harmful route.

Same thing with the water for example, take a direct route across the river which will expose a wound to saturation vs taking the possibly days or weeks to find a route across it or around it, or building a raft to get you across it without getting wet. So you have to consider how soaking a wound will effect it.

Interesting points made about the irrigation, note in regards to "notehesitate", most manuals will say "don't hesitate" to use a non sterile material to apply pressure to a wound, like your hand for example because you need to stop the bleeding and infection is a far less second consideration, this doesn't mean it is what you should choose if you have other options.

So LSkylizard, it would be your opinion that if you had to pick between filtered water not stearilized, and one what was with iodine, you would ideally drink the sterile one but use the other one for irrigation because the effect on slowing wound healing is of greater harm than any benefit of reducing bacterial load?

If the wound starts to get infected and you have to clean it, do you then still use the same water solution and just apply the antibiotics to the dressing and still not directly to the wound? Have you any experience with high sugar packing? I have seen several references to this being anti-bacterial directly, often argued with honey but as well with just pure sugar. Many commercial soft drinking have very high sugar contents which raises a question about them for that use as well.

-Cliff

 

[Outdoors]

The point in certification is 99% of Dr's are not first aid qualified and are not certified to treat roadside accident subjects. YOu want a skin DR manipulating your broken spine still strapped in the vehicle? Sorry I'lll wait for the firefighters who know what they are doing to arrive on scene thanks.
Most Dr's are not covered under any liability insurance outside their practice or work location thus you will see VERY! few Dr's aid in any situation, as it should be.

That said any ER doc should be the king at an accident scene but they are the minority and its a rare occurance.

Again this DR hero worship is misplaced and must be understood not all DR's are created equal and they all don't play heros like on TV.

Skam

Skammer,
I believe the topic is wound care, not vehicle extraction.

You'll never win an arguement by changing the subject - gotta stay focused, man.

Pat

 

[skammer]

Skammer,
I believe the topic is wound care, not vehicle extraction.

You'll never win an arguement by changing the subject - gotta stay focused, man.

Pat

Not trying to win anything LMAO.

The subject was first aid at the point above and protecting the C-Spine last time I checked is first aid, has nothing to do with "vehicle extraction" . Either way there is enough info in this thread for people to see both sides.

FYI

Military medics do carry, use and are taught tourniquets.

This is a survival forum and nothing I have said is relevant to a quick 1 hr rescue but rather days from hospital. Most regular health care providers have a real problem thinking outside the box with this issue and believe golden hr protocols carry over into severe austere and distant environments. In some cases this is true but much of it is not.
It is this reason Dr's and medics must be highly trained in wilderness medicine before they can go on an expedition or even join a SAR team as a team DR as the protocols are very different.

Believe it or not but those are the facts.

Lets move on now huh.:thumbup:

Skam

 

[LSkylizard]

...the CHANGE in turniquette policy and the intermittent release of the turniquette...

..................................................................

 

[Outdoors]

Not trying to win anything LMAO.

The subject was first aid at the point above and protecting the C-Spine last time I checked is first aid, has nothing to do with "vehicle extraction" . Either way there is enough info in this thread for people to see both sides.
...

Lets move on now huh.:thumbup:

Skam

Skam,
Well, I'm not sure whay you were confused by my comment. I'll clarify. You said,
"YOu want a skin DR manipulating your broken spine still strapped in the vehicle? Sorry I'lll wait for the firefighters who know what they are doing to arrive on scene thanks. "

The thread topic was sutures vs superglue, and most of the comments have been on sutures and wound irrigation. That was what I was pointing out.

"Either way there is enough info in this thread for people to see both sides."
I agree. I'm happy to move on.:thumbup:

A new topic on say, general first aid and/or Wilderness first response would allow for a broader scope of discussion.

Pat

 

[LSkylizard]

...Most if not all survival manuals won't deal with these kinds of situations, the army manual is one exception but it is vague with terms like "severe infections" which "don't heal" consider maggot treatment. However it doesn't define what severe means and how long healing should take, at what point should you decide that it isn't going to heal.

Flies obviously carry the chance of infection on their own...

Start with the end first. Yes, flies do carry bacteria and thus risk infection. However, we have used maggots in our hospital. It is generally the medical teaching in wound care that maggots do preferentially eat/consume necrotic/dead tissue. They are more effective than us at removing dead tissue from living tissue without damaging the living tissue. Hospital maggots are actually "pharmaceutical garde"...come from a special clean bug farm.

..."I call them microsurgeons," said Edgar Maeyens, Jr., a doctor in Coos Bay, Oregon, who employs maggot treatment. "They can do what we can't do with scalpels and lasers."
Only a few species of fly larvae, primarily blowflies, are suitable for such duty...For the next 48 to 72 hours, the maggots dissolve dead tissue by secreting digestive juices and then ingesting the liquefied tissue and bacteria...
..."After two or three failures of conventional medical or surgical therapy, maggot therapy should be considered for non-healing wounds, especially those which are infected or contain dead tissue [gangrene]," said Ronald Sherman, a doctor at the department of pathology at the University of California at Irvine.
Wounds commonly treated include foot and leg ulcers, burns, and post-operative wounds that have become infected and re-opened...

...it would be your opinion that if you had to pick between filtered water not stearilized, and one what was with iodine, you would ideally drink the sterile one but use the other one for irrigation because the effect on slowing wound healing is of greater harm than any benefit of reducing bacterial load?

I think you might have gotten your question backwards. Nonetheless, I would save sterilized/iodine water for drinking and use clean/filtered/non-iodated water for wound irrigation...that is not to say an iodine impregnated filter is wrong for cleaning water for your wound. Such filtered water should be fine.

.If the wound starts to get infected and you have to clean it, do you then still use the same water solution and just apply the antibiotics to the dressing and still not directly to the wound? ...

This again is NOT a simple question. Generally antibiotic ointment/topicals are preventative and will not clear an established infection. If cellulitis is present, you really need a systemic antibiotic and the wound should be debrided of necrotic tissue..."cut the rotten meat back to healthy bleeding tissue" (what they used to say in the vascular surgery OR). If you have a foul/anaerobic bacterial smelling abscess, you cut it open and drain it. This is a circumstance in which numerous wound care surgeons might irrigate with betadine and/or do a first wet dressing pack with betadine packing. Again, cellulitis would really mandate the need for systemic antibiotics. Most of these conditions are not seen as acute injuries.

...I have seen several references to this being anti-bacterial directly, often argued with honey but as well with just pure sugar. Many commercial soft drinking have very high sugar contents which raises a question about them for that use as well...

I have seen honey used. Honey does have antimicrobial characteristics. However, honey in a hospital (or even at the grocer) has distinct cleaness you will potentially not obtain from a wild honey comb. No, the sugar content in and of itself is not the issue and I would not just dump sugar or high sugar drinks into a wound.