Superglue instead of stitches

[plow_2]

Absolutely amazing. I wish I knew everything.:barf:

 

[Cliff Stamp]

The study has 16 patients. I suggest you ask someone at the NIH about the statistical significance of that or its applicability.

In regards to numbers, yes they are small, provide references to larger studies which support your viewpoint, from the specific point of view of emergency wilderness wound treatment.

Their mouths are “irrigated” and “debrieded” by a periodontist in an office. The study authors themselves state, “…subgingival irrigation with PVP-iodine without concomitant mechanical debridement might not improve microbiological and clinical variables in comparison with saline irrigation, at least not in sites with radiographic evidence of subgingival calculus.”

Yes because the basteria would keep breeding, this would be akin to using an iodine solution on a wound which you had not cleaned. However when it was cleaned it worked to reduce the bacteria which was the arguement, in regards to the wound type no, it isn't an example as this isn't usually something you would treat in a survival sitation, except for a *very* long term one of course. It was in regards to lowering bacterial load.

They did not irrigate these wounds, rather laid an impregnated dressing over them.

Yes so the amount of iodine is likely lower.

There are to numerous websites providing frightening misinformation.

These were medical journals, not website articles. There were also a number of review articles, all visible on pubmed, and none of them make the statements you make in the above, they similar argue that you need to consider factors such as level of infection.

The general idea after reading them would seem that using it when a wound has a low bacterial load isn't optimal as it does nothing helpful, however when there is cause to be concerned about infection it is different because it can reduce bacterial growth over saline.

It would be nice to see some actual studies comparing different severities of wound types and states of inflammation, but none turned up in a search which is why I asked you for the medical references, since you have such a strong opinion I assumed you have read them and are basing your opinions on actual data.

If you do not have the appropriate irrigant, you shouldn’t just irrigate with the wrong one ...

So you would actually argue it is better to not irrigate any wound in an emergency wilderness setting if all you have is a diluted iodine solution?

Of interest :

http://www.wemsi.org/specific.html

They say they exact same thing Skammar noted in the above, who didn't advocate "dumping chemicals" into the wound, but using a diluted providone iodine solution to irrigate the wound, which will both flush out the wound as well as act to reduce any bacterial contamination and to purify the water.

-Cliff

 

[Outdoors]

Wow,
I guess a few minutes research on the internet is superior to formal medical education and years of professional experience. I believe there is a term for that - Hubris.

I'm sure you can find the definition ... on the internet

Pat

 

[LSkylizard]

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

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

...Irrigate your wounds...

...the first and foremost thing for a wound is copious irrigation...It goes without saying that if you need an iodine tablet to sterilize your water supply then you do that. None the less, 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)...

...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....

...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...

....copiously irrigate (with normal Saline), you markedly decrease the bacteria load which has been demonstrated repeatedly in the dirtiest of wounds to include perforated intestines.

...Let's face it, some out their still believe wound cleaning is best achieved at the end of a dog's tongue! Others saw "The Outlaw Josee Wales" and believe packing wounds with mud "because of good bacteria" still works. Just because some survivalist have succeeded using interesting methods does NOT mean it actually applies to the entire world...

...I am not going to argue this point anymore...

Or in other terms, I don't even see the point in continued bickering. You can reference what you want (i.e. Version 1.2 May 19, 1994 ). Not all medical journals are equal. Not all publications have any validity. I will not change your mind and that is fine. I have posted a different perspective that in my professional opinion is valid....as of 2005.

PS: The last thing I want to do at this point is start posting journal citations and help you to misinterpret or try to inappropriately apply something else. You seem to be able to do that on your own. I definately will not be able to train you in how to critically review and interpret scientific publications for their methods, design, validity and/or applicability.

 

[Outdoors]

Well, you may not change some peoples minds, but I've learned a few things. Thanks, Doc!

Pat

 

[LSkylizard]

...Thanks, Doc!

Pat

your welcome

 

[Cliff Stamp]

I will not change your mind and that is fine.

Sure you can, just make a logical arguement, and support it with facts, you listed earlier it is very well known, which means there must be a large body of data to support it you would assume as otherwise what is it based on, so where are the papers?

On a related note (broad consideration) what are you supposed to do when there is no water available, but there are other liquids? Do you irritigate a wound with drinks (various kinds), do you irrigate with unpurified water even, which is the worst risk for health problems? Some survival manuals (the main army one for example) will advocate urine in such cases and cite it as a mild anti-bacterial.

Yes various journals are of varying degrees of quality which is why I asked for references, specifically in terms of emergency field health care with restricted supplies considering various states of wound trauma and level of infection and possible bacteria loading.

How do you handle an infected wound, at what point must you start to consider severe action to prevent blood poison, how long do you have once the signs start to set in. Is using regular maggot applications (not sterile of course) likely to be of more benefit or harm? There is little information of this kind typically discussed.

-Cliff

 

[skammer]

.

PS: The last thing I want to do at this point is start posting journal citations and help you to misinterpret or try to inappropriately apply something else. You seem to be able to do that on your own. I definately will not be able to train you in how to critically review and interpret scientific publications for their methods, design, validity and/or applicability.

Doc,

http://www.wemsi.org

WEMSI is the main governing body of outdoor medicine in the Untited States.

It is their protocol not mine, this is not some hair brained idea I came up with but has been part of my training for some time.
There is no misinterpretation so I will say it again, austere conditions are not the same as operating room conditions and thus there are different protocols. I am not saying you are right or wrong Doc only relaying accepted, accredited, published protocols.
If WEMSI is wrong then they need to know about it. Medical protocols are in a constant state of change as we learn so step up and get involved as this is the wrong forum for debate on this issue.

SKam

 

[skammer]

Wow,
I guess a few minutes research on the internet is superior to formal medical education and years of professional experience. I believe there is a term for that - Hubris.

I'm sure you can find the definition ... on the internet

Pat

A word of advice.
If you are in a car accident and an neo natal surgeon pulls over and looks at you and decides to render first aid on your broken body. I suggest you wait if at all possible until properly trained EMT's arrive on scene as more often than not that Dr is out of their scope of practice and has little training in meatball first aid.

Its the word DR that has sheeple hanging on every word when in fact they are usually as narrowly trained as any other profession and need to be questioned. Formal training means zip when its out of scope. Its buyer beware as always Dr's are only human.

Skam

 

[Horse]

“you must be joking or smoking crack to apply those references to this topic or suggest they are evidence of anything!”

That may actually explain a lot of things.

This entire forum has been dragged down by this kind of crap for a long time.

LSkyLizard, thank you for trying. It is a shame....

 

[Cliff Stamp]

If you are in a car accident and an neo natal surgeon pulls over and looks at you and decides to render first aid on your broken body.

I would prefer to have someone working the ER than a surgeon there, but better any medical doctor than nothing, assuming they act within their limitations and the ones that I know are fairly quick to do so in general. Big problem with "survival" is getting doctors to think past optimal.

Last time I was seriously cut it was across the tips of the fingers of my left hand, I went in for stitches as I was concerned about losing feeling. The guys didn't use liters of water to irrigate the wound by the way and just did a few sprays with a plastic bottle, less than 1/4 cup.

Anyway after he was done I asked him a bunch of questions like what is the minimum time I could wait before going swimming, how long could I go swimming for right now before the stitches could actually come lose to to water logged skin, how bad would the wound get infection wise before I should cut the stitches loose, etc. .

I was asking out of curiously in case I had to do something on my own with no hospital nearby, he would not discuss any of those situations just say "Don't go in the water until the wound is healed, check back in one week.", "Come in if there is any sign of infection.", etc. .

I can understand why he would be so restrictive considering how people are so sue happy now. But honestly, it seemed to me like he had no idea at all, he just went blank on the water questions, it would be just like asking him which plants I could use to manage pain/infection or for sutures.

He also did a poor job on the stitching, they were too tight and it scarred heavily and the top of my middle finger is lopsided.

-Cliff

 

[Outdoors]

A word of advice.
If you are in a car accident and an neo natal surgeon pulls over and looks at you and decides to render first aid on your broken body. I suggest you wait if at all possible until properly trained EMT's arrive on scene as more often than not that Dr is out of their scope of practice and has little training in meatball first aid.

Its the word DR that has sheeple hanging on every word when in fact they are usually as narrowly trained as any other profession and need to be questioned. Formal training means zip when its out of scope. Its buyer beware as always Dr's are only human.

Skam

Thanks, Skam.
But when I want medical advise, I generally go to someone who is board certified. that's the whole point of certification, after all. Not to mention liability insurance.

P.

 

[skammer]

Thanks, Skam.
But when I want medical advise, I generally go to someone who is board certified. that's the whole point of certification, after all. Not to mention liability insurance.

P.

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

 

[LSkylizard]

I am NOT going to try to rehash or redress what I have already stated. I will however make a few comments within the realm of some of what you have said.

… On a related note (broad consideration) what are you supposed to do when there is no water available, but there are other liquids? Do you irrigate a wound with drinks (various kinds), do you irrigate with unpurified water even, which is the worst risk for health problems? Some survival manuals (the main army one for example) will advocate urine in such cases and cite it as a mild anti-bacterial…

1. There is NO perfect all around answer
2. You need to take each situation independently…i.e. what kind of wound? Clean or dirty blade? Dirty stick stab wound? Etc…. All these things will determine what you do.
3. I am not advocating urine irrigation (in general), but in an otherwise healthy person, a ”clean catch urine” is sterile fluid.

… How do you handle an infected wound, at what point must you start to consider severe action to prevent blood poison, how long do you have once the signs start to set in.…

I do wound care. Every wound needs to be examined independently. Some wounds have rapid infection spread that leads to sepsis and death within hours (i.e. the “flesh eating bacteria”, etc&#8230. So, there is no way I can tell you in this forum the answer to that question. I have trained and continue to be trained in the care of all wounds. It is a broad field and you can’t just simply answer those questions.

…I would prefer to have someone working the ER than a surgeon there…

“We” are the ones the ED calls for help! “We” are the ones that teach advanced trauma. “We” are the ones that see the wounds in follow-up outpatient after an ED physician/PA/NP has sutured it. You can NOT be a "LEVEL I" trauma center without trauma surgeons... the buck stops with the surgeons. Sorry if that dissapoints you or dispells some illusions. (I could go into a long discussion about the changes in ED physician training, etc... but that would probably not answer a question and might mislead people who are NOT privy to the ins and outs of medical traing).

…Last time I was seriously cut it was across the tips of the fingers of my left hand… didn't use liters of water to irrigate the wound……

Treatment will have to depend on the type and cause of the injury.

… I asked him…what is the minimum time I could wait before going swimming, how long could I go swimming for right now before the stitches could actually come lose to to water logged skin, how bad would the wound get infection wise before I should cut the stitches loose, etc…

Generally, epitheliazation will occur within 24-48 hours (depending on the type of wound). Usually means you can SHOWER/wet the wound in 24-48 hours. However, it also depends on suture type. Generally, you can wet a clean sutured (prolene) wound in 48 hours and submerse (bath/swim/etc&#8230 in 7 days. The number of days can vary somewhat (i.e. 5-7 days etc&#8230 (this can depend on wound type/location/suture material). 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.

…He also did a poor job on the stitching, they were too tight and it scarred heavily and the top of my middle finger is lopsided. -Cliff

Unfortunately, a good number of things play into this. Suture type, suture tension, location, wound type, patient health…. Etc…. I can’t speak to what happened or was done by others.

 

[ColdCanuck]

I'm not entirely sure how to bring this forward, so I'll just post it straight out.

I'm not certain that WEMSI is THE authority on this, but as it has been sited as THE authority I thought it might be prudent to actually read what they had to say on the matter.

on wound irrigation WEMSI states this :

Irrigation

1. Use water as described under Water Disinfection.
2. Use a 30 cc syringe and 18 ga plastic intravenous catheter, or a zipper plastic bag with small hole to provide a small forceful stream.
3. Use about 100 cc of fluid per inch of wound.
4. Aim away from yourself and wear glasses or goggles and keep mouth closed to prevent splashing into your eyes or mouth.

http://www.wemsi.org/specific.html#open soft-tissue

under water disinfection they state this :

Water Disinfection

Medics who are asked to make recommendations for backcountry water purification for drinking by patients or team members should recommend iodine tablets or other acceptable iodine methods, using adequate contact time given the temperature and turbidity of the water, or iodine-resin filtration systems.

Medics should take care to point out the limitations of most filter systems: except for iodine-resin systems, they will permit diarrhea, Hepatitis, and other viruses through. And, Giardia filters will not filter out either bacteria or viruses.

For disaster situations, medics may use the following for drinking water:

* if dirty, flocculate (alum or white campfire ash)
* 8 drops Betadine®/L for 30 minutes; use more or leave longer if dirty or very cold water
* 4 cc of Clorox® 5% bleach for 40 L (10 gallons) overnight; double if have to use in an hour

For irrigating contaminated wounds, medics should not hesitate to use clean but not sterile water. The preference, however, is for water from a filter system system that removes bacteria (simple Giardia filters not useful for this purpose). There is no need to eliminate viruses from irrigation water, so most backcountry filters will be adequate for this.

http://www.wemsi.org/general.html#waterdisinfection

Now, I've read this a few times and I don't see where it says anything about using anything other that water for wound irrigation. It does mention that certain things can be used to produce drinking water, but for wound irrigation it says to use filtered water. Again I'm not advocating that WEMSI is THE authority on this issue, I just thought that, if they were being sited as THE authority on this issue, it would be prudent to state what they actually do say.

Cheers,
ColdCanuck

Edited to add:

Thanks for all the well thought out intelligent replies LSkylizard.

 

[LSkylizard]

...Most Dr's are not covered under any liability insurance outside their practice or work location...

There is actually something called the "good Samaritan" rules/laws/guidelines that protect you from liability...you don't need malpractice insurance for that kind of thing. In fact, if I saw an accident and drove passed I could be sued for not applying my training ...being certified in advanced trauma life support, Advanced cardiac life support, Basic life support, trained in first aid, etc....(exception being that if doing so would place me or others with me in danger).

 

[skammer]

There is actually something called the "good Samaritan" rules/laws/guidelines that protect you from liability...you don't need malpractice insurance for that kind of thing. In fact, if I saw an accident and drove passed I could be sued for not applying my training ...being certified in advanced trauma life support, Advanced cardiac life support, Basic life support, trained in first aid, etc....(exception being that if doing so would place me or others with me in danger).

Agreed Lizard. The problem however with Dr's attending an accident scene is they are held to a higher standard of care because of their training and are more likely to be sued for many reasons.
For this reason most Dr's do not generally help accident subjects. The good samartian law was developed for regular civilians legal protection not Dr's. It protects people up to their level of training so in theory the more training you have the more trouble you can get into. I with a EMT-B, WFR and ALS am held more accountable for my actions as someone with no or little training. The good DR even more so and so on....

The samaritan law is not for well trained people who make critical mistakes as you will be held to a much higher standard. A Dr who has civilian first aid certification is better covered but not much. All this comes from legal counsel I had on this exact subject.

There is more to austere protocol than WEMSI as there are other bodies. The military has a excellent references on the subjest as well and nobody has more experience than they do with dirty wounds.

Skam

 

[skammer]

Now, I've read this a few times and I don't see where it says anything about using anything other that water for wound irrigation. It does mention that certain things can be used to produce drinking water, but for wound irrigation it says to use filtered water. Again I'm not advocating that WEMSI is THE authority on this issue, I just thought that, if they were being sited as THE authority on this issue, it would be prudent to state what they actually do say.

Cheers,
ColdCanuck

QUOTE]

WEMSI is one of the leading authorities on outdoor medicine. If you go to Everest you will have a WEMSI DR. Most major expeditions to the far reaches have WEMSI personal as their lifeline.

Wound and iodine use, if one should pack the wound in this fashion its not a leap you can irrigate it with iodine as well especially when the very water you are using is treated with it.

A simple google of "betadine wound irrigation diluted wilderness" should keep you busy.

Consider it sited.

High-Risk Wounds
Control bleeding.
Irrigate the wound (see below).
Leave the wound open, and pack and cover it with gauze soaked in povadone-iodine (e.g., Betadine®) diluted with 10 parts water.
Change the dressing every six hours; wash your hands or wear gloves before changing dressings, and keep your mouth shut when dealing with open wounds.
Evacuate the patient.

Skam

 

[ColdCanuck]

I'm confused, how does:

High-Risk Wounds ... Leave the wound open, and pack and cover it with gauze soaked in povadone-iodine (e.g., Betadine®) diluted with 10 parts water.

High-Risk defined as "open fracture, bone or tendons exposed, human or other bites, deep punctures, grossly contaminated wound, or severe crushing."

Translate to :

in the field it is impossible thus diluted iodine irrigation is the norm.
Skam

I'd say that is quite a leap. From "High-Risk" to "the norm".

Thanks for your opinion though.

 

[ColdCanuck]

If you read the entire thing it actually says :

Povadone-iodine may be used around but not in wounds; the only exception is diluted povadone-iodine for high-risk wounds as described below.

Look, I don't have a problem with people formulating their own opinions. In fact, that is great, but they are just that opinions. You can treat yourself or anyone else you can convince of your methodologies however you choose ... and live with the consequences. When a lay opinion is stated as fact, especially in the medical field, that can lead to dangerous mis-information.

I know this, every reliable source(even WEMSI) suggests that in serious cases evacuate the person to a medical facility. I'm pretty certain there are more reasons for doing this other than the equipment available at the medical facility. I'd be willing to bet the reason for doing this is that the medical staff at that facility are better equipped AND better trained to deal with the trauma, than a lay person in the field. Stabilize and evacuate ....

Edited to: correct some spelling errors