Wound Cleaning Essentials

Courtesy of a reader.

NB that stitches will enclose any crud that you miss.

Think that through.

3 responses to “Wound Cleaning Essentials

  1. Understated, but pretty good.
    1) Clean, unopened bottled water is great for wound cleaning.
    (Water that you’ve backwashed into already, not so much. Just makes an open wound an infected bite wound, functionally.)
    2) You can get screw-on adapters that can turn bottled water into a squeeze-rinse deal, great for washing out wounds. Also great (again, with unopened water bottles) for washing debris out of eyes.
    One example of such:
    https://www.amazon.com/green-sprouts-Spout-Adapter-Bottle/dp/B004K6LMW0
    There are others.
    3) IF you can still find it, sterile non-preserved saline for contact lenses, usually generic WallyWorld/Target/chain drug store brands, are the freaking bomb for wound cleansing. Usually 4-6 oz., cheap (much cheaper than sterile saline for irrigation from pharma companies), sealed until you pierce the tip, and ready made for a single-use wound-cleansing squeeze bottle.
    And FTR, screw expiration dates, if they stay sealed and are clear. You know what’s in a sealed bottle of sterile saline years after the expiration date?
    Sterile saline.
    4) A home-built splash guard is a good thing. Kudos.
    5) {Caveat: Provided the patient is not allergic to iodine!} Betadine, or any generic that’s the same thing, is your friend. While a “weak tea” mix w/water is okay, here’s a dose of ER/OR reality: that isn’t what you want. You want to blast a 50/50 mix of betadine and water or betadine and saline into the wound. Followed by a blast of straight water/saline. Followed by the mix, again. Followed by the rinse again. And again. And again. And again.
    That’s how we roll in every ER, and surgery, even when antibiotics are going to be ordered/already running. Don’t scrimp unless you don’t GAF about your or a friend’s body parts. Or life.
    Betadine and rinse is cheap, sepsis is deadly. And bacteria in wounds multiply exponentially over time. Kill the f**k out of them early, often, and repeatedly, starting with the first time.
    6) Scrubbing and removing foreign bodies (FBs) is good.
    It also hurts like a m*****f*****. Or worse. Your patient will fight you. And scream. Also bitch, whine, and moan. This is what medical assistants are for; to keep them from trying to pull away and/or sock the hell out you while you’re trying to keep them from getting a life- or limb-ending infection. Killing them with kindness leaves them just as dead. Blast it clean, then pick and scrub it clean. And if it’s too bloody to see, you aren’t done cleaning yet.
    7) Quickclot, CombatGauze, etc., are useful only if and when you reasonably expect someone with mad medical skillz will be digging that crap out of a wound again. Putting it in after TSHTF, if no one is likely to go in and dig it out, is condemning your patient to death by sepsis. It stops bleeding, it doesn’t undo the laws of wound care. It’s intended to be removed, usually in/during surgical repair. Bear that in mind.
    8) Plain old Bactine(tm) not only contains BZK ( helluva wound cleaner, that -unlike hydrogen peroxide and isopropyl alcohol – doesn’t sting like hell, and actually kills germs, rather than vital tissue), and it also contains a very mild dose of lidocaine (which really does numb the pain somewhat – and it’s exactly what they inject around a wound to clean it, debride it -i.e. pick the chunks out – and then repair it, via sutures/staples).
    9) Absent the licensed knowledge and skills, actual lidocaine, the hardware to inject it locally, a footlocker full of all varieties of sutures, and antibiotics in good supply, kudos to author doc rader for recommending that nobody whip out their field surgical kit, and start suturing/stapling wounds up. Which, unless you’re a trained and licensed P.A., N.P., or M.D., is probably a monumentally bad idea. I don’t care if you’ve done it before, successfully, semi-successfully, on your spouse/kid/cow/whatever, you’re still an untutored idjit in 99% or more of any cases, and what you don’t know is going to cripple or kill someone, eventually.
    10) Neosporin or just bacitracin are okay to put on a wound after you clean it, and before you dress and bandage it.
    It’s also okay not to. Use it if you’ve got it, but don’t obsess over it either way.
    11a) Dressings – which are always sterile – are changed every 24 hours, or when soaked/wet/dirty. This is non-negotiable. (Otherwise, it’s kinder to just shoot your victim in the head, and spare them the septic death later.) (No, don’t REALLY shoot them in the head, just Change The Effing Dressings DAILY.)
    11b) Healthy healing means clean and dry skin.
    You change the dressings daily or more often, so you can also re-examine the wound. Remember SHARPS:
    Swelling
    Heat
    Ache
    Redness
    Pus
    Streaks
    These are the signs that the infection is getting worse, not better.
    Which means you effed up, and for your punishment, you may need to go back in and clean the wound some more. With more betadine and irrigation solution. While your patient screams, bitches, whines, and moans.
    And with some wounds, you can’t help but eff up. You still have to try.
    Welcome to my world.
    12) Bandages don’t need to be sterile. Gauze, Ace wraps, bedsheets, or whatever can be washed out for cleanliness, and re-used, if necessary, provided you do a good job of cleaning them. The cleaner the better.
    Rule of Thumb: If you wouldn’t use it on you, don’t use it on them.
    Florence Nightengale/Clara Barton Rule Of Thumb: Boil the hell out of them, and they’re sterile anyways. Rotate as necessary.
    13) UV kills germs. Which is why doing dressing changes at noon, outside, in sunlight, and leaving them uncovered to get some high quality UV for 15-30 minutes is a good care plan. Especially at altitude, where the UV is higher.
    Obviously, in rainforests during monsoon season, or during a blizzard, this will not be an option, But if possible, do it.
    14) Tape rolls and foil-pack wipes go bad in kits. Check them annually, at least, and replace as necessary. Gauze dressings and bandages should be packed in Ziploc bags for ad hoc water tightness, and will last near indefinitely that way, if you make sure the baggies don’t get holes rubbed in them, and let your supplies get soaked if the kit gets wet.
    15) Getting a decent nursing textbook, and learning certain bandaging techniques, can show you ways to minimize tape application and removal, which prevents skin breakdown, and other problems. When you’ve got 1-14 locked on, make that extra effort.

    Carry on.

  2. SemperFi, 0321

    Already signed up for CPR again next month, then a Wilderness First Aid class in late May since I’m headed for the mtn’s all summer.
    Just can’t get folks to understand why they need a basic trauma kit, band aids and aspirin won’t cut it when you’re 20 miles from the trailhead, and weather is closing in……..most people seem to be under the assumption that someone else is carrying all the medical gear, and will magically rescue them when they get hurt. Dumb is dead does not occur to them.

  3. Very informative – thanks for your comment.

    I’ve got a well-stocked medical kit and feminine hygiene supplies for emergencies but I neglected the saline solution and Bactine. Thanks for reminding me!

    Any ideas where to get a simplistic Medical Field Manual? Something with pictures or anatomical overlays would be great.