Comments on: Bunker Med – Suturing Under Austere Conditions – PART I

By: USNERDOC

USNERDOC — Wed, 07 Apr 2010 06:48:29 +0000

Continued (PART II) . . . irrigation with water and not to put things in wounds such as hydrogen peroxide or betadyne (with the rare exception). The mantra was “nothing in a wound that you wouldn’t put in your eye!” So my comments along these lines are to help change that mindset to better wound management. Irrigation, antibiotic ointment, gauze / Bandaids are great.

I will include here my response as a PM to another viewer since I have received so many questions along this line . . .

By: USNERDOC

USNERDOC — Wed, 07 Apr 2010 06:09:59 +0000

(PART III) . . . Hydrogen peroxide (H2O2) is great for removing matted blood from hair and blood stained clothing (check color fastness first!). The deal with H2O2 is that it kills cells (i.e. cytotoxic) and while it kills harmful bacteria, it also kills “good cells” (i.e. fibroblasts, macrophages, white cells, red cells, etc) that your body uses to mediate the healing process. By killing these cells you end up delaying the healing process and more importantly increasing the risk of infection.

By: USNERDOC

USNERDOC — Wed, 07 Apr 2010 05:11:02 +0000

(PART IV) . . . I think everyone is all impressed with H2O2 because it does that foaming business. All that is is the result of protein released from dead cells. We were taught in residency to “not put anything in a wound that you wouldn’t put in your eye” . . . the message being nothing toxic to cells. The very best thing you can do for a wound is good aggressive irrigation with clean water.

By: USNERDOC

USNERDOC — Wed, 07 Apr 2010 04:55:29 +0000

(PART V) . . . Studies have shown that pressure irrigation with a narrow bore syringe tip is the most effective method for decreasing bacteria count in a wound. Betadyne is best for cleaning skin surrounding a wound. Only for a dirty wound would I consider using dilute betadyne in a wound which would then be followed by irrigation with clean water.

Hope this helps! I apologize if I got too complicated.

By: whiskeymedic

whiskeymedic — Wed, 07 Apr 2010 04:28:22 +0000

If I may make a request? What types of wounds makes me say, hmm that needs stitches. What is the time frame that tells me that if I need to do this versus trying to evacuate patient?

By: outward2006

outward2006 — Wed, 07 Apr 2010 04:09:21 +0000

USNERDOC,

perfectly clear. Thanks for taking the time to explain in detail.

again, thanks for posting and taking the time.

By: USNERDOC

USNERDOC — Wed, 07 Apr 2010 03:19:44 +0000

You are more than welcome!

By: dvospeed1

dvospeed1 — Wed, 07 Apr 2010 02:50:13 +0000

Pretty sure I’ll be watching this series every 6 months or so and before I go on extended back country excursions.

Great series!

By: yoyoimhome

yoyoimhome — Wed, 07 Apr 2010 02:03:30 +0000

But it cleans the wound and i have never had any problems with it. And it’s FDA approved.

By: USNERDOC

USNERDOC — Wed, 07 Apr 2010 01:46:53 +0000

yoyoimhome – just passing on my training and experience. i manage wounds on a daily basis in a busy emergency department. Ultimately you have to make you own decision.