Suturing Under Austere Conditions – PART I
PART I OF IV Download “Suturing Under Austere Conditions Guideline” by clicking on link below: www.box.net DISCLAIMER: TECHNIQUES AND INFORMATION EXPRESSED IN THIS VIDEO SERIES ARE INTENDED FOR INSTRUCTIONAL PURPOSES ONLY. APPLICATION CARRIES POTENTIAL FOR INJURY AND HARM. USE COMMON SENSE. SEEK APPROPRIATE TRAINING. THE VIDEO PRODUCER ASSUMES NO LIABILITY. No “hallway monitor” comments please. It is recognized that this will be used rarely in difficult situations and as such not optimal for sterility or technique. Sterility in an austere wilderness environment will be difficult, if not impossible, to achive. This information is meant to help those that may be required to provide this level of care in a difficult situation. This 4-part video series, Suturing Under Austere Conditions”, covers the basic tenants of suturing as aa wound management option under austere conditions such as a remote wilderness setting. There are a number of risks that need to be considered, so this should not be the first closure choice for wound closure. Exposure from cold, wet, windy, dark conditions will add significant difficulty. Appropriate training and practice are paramount before adding this to your wilderness medicine treatment arsenal. ALOKSAK® ELEMENT-PROOF BAGS www.loksak.com www.rei.com bepreparedtosurvive.com www.thewaterproofstore.com
“… opens a discussion of when it is appropriate to use each type of treatment? I realize there are liability issues …”
I’m happy to touch on this in the future. Honestly, I am having trouble keeping up with all the email, PM’s & requests. Not a bad thing & not complaining, its a good thing . . . just need more time/day!
“… suggestions for First Aid training?”
RC has some great courses & a great place to start.
“Thanks for the QUICK response!”
I’m trying & its my pleasure!
Hmmm, I guess that opens a discussion of when it is appropriate to use each type of treatment? I realize there are liability issues, but general rules of thumb, etc. might be helpful (a different vid?). Are there already posted guidelines somewhere?
Also, any suggestions for First Aid training? Would Red Cross, etc. have something like that?
Thanks for the QUICK response!
@GlueFactoryBJJ – QuickClot is a hemostatic agent while suturing is a wound closure technique, two different concepts.
Also, you have two different videos listed as Part III (3). One of them is actually Part II. CORRECTED & UPDATED . . . thanks!
BTW, do you have any suggestions for advanced First Aid training that is above Boy Scout, but not a full blown EMT course? Consider an advanced wilderness first responder course. If you have trouble, I could forward or post some links.
Thanks!
How about using something like QuikClot? It is supposed to stop even arterial bleeding.
Also, you have two different videos listed as Part III (3). One of them is actually Part II.
BTW, do you have any suggestions for advanced First Aid training that is above Boy Scout, but not a full blown EMT course?
Thanks for the great information!
First, this is an excellent demo. I wonder if staples would be quicker (likely given no anesthetic), easier to learn, and better if one has to close the wound and run. Removal could be tricky in case of wound infection, unless one also has the removal device.
Now I’m by no meens a nurse or even an EMT, but should you really recommend glue? Most people will just go and buy some crazy glue at Wal-mart, and AFAISK, that’s kind of toxic. I use Dermabond, a special glue for wounds.
Now, I might be wrong, you’re a doctor after all, and if so I appreciate any correction you might provide.
where do you get the sutures from without buying 100 of them at once?
For ease of use and to simplify carry concerns, I have switched to betadine pads. Just put a pad or two in the bottom of a camp cup and fill with water . . . the old KISS principle!
Unfortunately, I have no experience or literature regarding tea tree oil and wound management, so I will wave off on a specific recommendation. I will have to do some digging and research in this area!
“Two questions: 1. shoud I dilute the betadine to a strength of 10% or dilute it by 10%; 2. what are your thoughts on using Tea Tree Oil for wound treatment? I have read great things about Tea Tree Oil preventing infections.”
No need to be so specific with diluting betadine . . . when I use betadine (rarely), I aim for a dilute tea color.
Two questions: 1. shoud I dilute the betadine to a strength of 10% or dilute it by 10%; 2. what are your thoughts on using Tea Tree Oil for wound treatment? I have read great things about Tea Tree Oil preventing infections.
I love the tour of duty music, thanks for pasing on your expertise
You bring up interesting points, however, I will respectfully disagree. I appreciate your input. Thanks for watching!
Lab studies have shown povidone iodine toxic at the cellular level but clinical studies have failed to show statistically significant differences with control groups. Its always a mixed bag when you ask M.D.s about using H2O2 as well as iodine solutions for traumatic wound cleansing; just depends on which peer reviewed journal they read last. Great videos.
i understand
I have seen it spelled both ways. Thanks.
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.
But it cleans the wound and i have never had any problems with it. And it’s FDA approved.
Pretty sure I’ll be watching this series every 6 months or so and before I go on extended back country excursions.
Great series!
You are more than welcome!
USNERDOC,
perfectly clear. Thanks for taking the time to explain in detail.
again, thanks for posting and taking the time.
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?
(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.
(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.
(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.
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 . . .