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Cleaning a wound in a non-sterile environment?

x SF med

the Troll
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#41
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.
 
8

8'Duece

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#42
Jeez I know that this is an old post, but just thought I would inject some life into it!!

Dirty & contaminated wound.......why not use Hydrogen Peroxide 3% or 6%: I know it has had some bad press in the recent past, and I think that if you leave it on the wound it does produce problems. However, I think good irrigation with HP to clean the crap out and then irrigate with potable water.....failing that use a weak bleach solution to replace the HP. Good soap is great for most wounds, makes it smell nice and Pruuuudy too!
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:
 

Wills

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#43
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.
 

Wills

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#44
"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?
 

TLDR20

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#45
Where is the austere deployment you can carry enough gear to do this with?
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.
 

pardus

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#46
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.
 

DoctorDoom

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#48
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.
 

The91Bravo

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#49
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.
I was joking.. lol Some of my patients I wish I could boiling water on.. ;-)
 

DoctorDoom

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#50
Sorry, humor detector was on the fritz, back up now. :)
Now let's turn around while we wait for the water to boil...
 

pardus

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#51
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.
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?
 

DoctorDoom

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#52
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.
 

pardus

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#53
Great info, thanks.

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

x SF med

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#55
"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?
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.
 

Wills

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#56
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.
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.
 

pardus

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#57
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.
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.
 

TLDR20

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#58
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
 

x SF med

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#59
Wills-
Here is the extent of the information I had to evaluate with whom I was conversing:
Location: Jacksonville NC
Occupation: medic
none

sending sheet heads to allah
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...
 

AWP

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#60
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.