Cleaning a wound in a non-sterile environment?

Discussion in 'Combat Medicine' started by JAB, Jan 23, 2010.

  1. x SF med

    x SF med Special Forces Moderating Staff

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    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.
  2. 8'Duece

    8'Duece Guest

    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. :rolleyes:
  3. Wills

    Wills sheet head shooter Unverified

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    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.
  4. Wills

    Wills sheet head shooter Unverified

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    "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?
  5. TLDR20

    TLDR20 Special Forces Moderating Staff

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    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.
  6. pardus

    pardus Moderating Staff

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    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.
  7. The91Bravo

    The91Bravo BNDN - Been Nowhere Done Nothing Verified Military

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    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.
  8. DoctorDoom

    DoctorDoom Size: Extra Asian Verified Military

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    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.
  9. The91Bravo

    The91Bravo BNDN - Been Nowhere Done Nothing Verified Military

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    I was joking.. lol Some of my patients I wish I could boiling water on.. ;-)
  10. DoctorDoom

    DoctorDoom Size: Extra Asian Verified Military

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

    pardus Moderating Staff

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    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?
  12. DoctorDoom

    DoctorDoom Size: Extra Asian Verified Military

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    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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  13. pardus

    pardus Moderating Staff

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    Great info, thanks.

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

    Manolito Lewis B. Puller for todays problems! Verified Military

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    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
  15. x SF med

    x SF med Special Forces Moderating Staff

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    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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  16. Wills

    Wills sheet head shooter Unverified

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    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.
  17. pardus

    pardus Moderating Staff

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    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.
  18. TLDR20

    TLDR20 Special Forces Moderating Staff

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    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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  19. x SF med

    x SF med Special Forces Moderating Staff

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

    Freefalling Signal Administrator

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    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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