Wound care in the bush

Discussion in 'Bush Medicine' started by Jason, Oct 25, 2008.

  1. Jason

    Jason Founder Staff Member Administrator Vendor

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    The fact is that 9 times out of 10 it is not necessary to suture a wound. Most people think that you HAVE to get stitches to stop bleeding. This is simply not true in most cases. Bleeding can usually be controlled with direct pressure to the area for a length of time. Now we must consider also the depth and length of the wound. A 10 inch laceration extending deep into the muscle will most likely need some type of closure. But simple lacerations measuring only a few inches need not be closed. They should simply be irrigated with clean water and a sterile dressing applied. But each situation is different and must be treated as such. It might be helpful if people posed questions for specific scenarios they have in mind. I'd now like to address a few different points for taking care of wounds in the field.

    Irrigation:
    This is simply the most important thing you can do to prevent the catastrophic sequelae associated with infection, including gangrene or even death. Infection is your enemy and must be prevented. A wise man once said that the solution to pollution is dilution. Dilution can come in the form of any type of clean water available. You can get this through filtering or boiling, I really don't care as long as it's not straight from the river. Some will argue that plain water will cause tissue damage because it is not salt water like that found in your body. I disagree as I've seen plain old clean tap water used with no ill affects on wounds. If you want to get really fancy you can carry some salt to add to make a saline solution but don't ask me how much as I have no intention of doing it myself. Another irrigating solution can be made by adding liquid povidone-iodine to your water. I just like to make it look like iced tea, no need to measure. Again some critics will argue that this is toxic to tissues and should not be used. I have done this countless times with excellent results and tend to disagree as the benefit of its antiseptic ability far outweighs the microscopic damage to the cells. Yet a third possibility is to use something like peroxide as an irrigating solution. The drawback here is the weight of the solution itself as it's not something you can just whip up on the spot. The same warnings apply here concerning tissue damage but I will once again assure you that I've done it and it works, but I always irrigate with sterile water when finished to wash away excess peroxide. You should plan on irrigating with no less than 2 liters of water and preferably 3-5 for wounds and 9-12 for open fractures (a whole other topic). The more the better in my opinion, especially if the wound is grossly contaminated.

    Closure:
    If you absolutely positively must close the wound you need to consider a few things. First you must determine how deep the wound is. A wound extending down to muscle cannot be closed with staples alone, the deep layer of tissue needs to be closed first and in layers. I would not attempt this as it requires a high level of skill and specific sutures. More superficial wounds can be closed with staples, non-absorbable sutures, or steristrips. To be honest I'm a big fan of steri strips as long as you don't forget to use mastisol to glue them down. I say this because it's damn hard to do sutures in the first place if you are inexperienced and it's 10 times harder to do them on yourself especially if you only have one hand! If you do use suture I recommend a monofilament non-absorbable suture such as nylon. I say monofilament because if you use a braided suture the bacteria can set up shop deep in the braids and give you hell. 3-0 nylon should address most smaller wounds and 0 nylon should take care of most larger ones but there are always exceptions that might require as high a #2 nylon. Be careful to do this in a STERILE FASHION. If you do it while dirty then you are just adding to the problem. Another thing to consider is that closing a dirty wound will complicate matters. The infection becomes an abscess that gets walled off inside the body and your natural defenses or even antiobiotics become useless. So dirty wounds need to be left completely or partially open to drain. One more thing, stay away from skin glue in the field, there is absolutely no place for it whatsoever, trust me on this.

    Antibiotics:
    If going in the field for any length of time I recommend procuring a prescription of antibiotics prior to leaving. This way you can start treatment right away any hopefully bypass any infections. Most family docs should be reasonable and give you a script if you explain that you will be on a hiking trip or whatever. I recommend either Keflex or Augmentin but check with your doc to see if you have any allergies that would prevent you from taking these. I'm finding that many big stores with pharmacies are offering free generic antibiotics these days so call around to see if you can get them if finances are an issue. Just a draw to get you in the store so they can bleed you dry in other ways.

    That sure was alot of info but my take home point is that irrigation and proper sterile dressings (not a dirty bandana from your sweaty head) are infinitely more useful than any suture or staple. That said I would recommend steri strips and mastisol. Useful and add little weight to your pack. Please let me know if you have any questions or anything to add, I know I glanced over some things but I hope you find it helpful.
     
    Last edited: Mar 14, 2011
  2. GreyOne

    GreyOne Elder Lifetime Supporter

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    Koa, could we get this one made as a "sticky" ? I think it needs to be permanent.

    Thanks, GreyOne
     
    jasonb40 likes this.
  3. Jason

    Jason Founder Staff Member Administrator Vendor

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    No problem GreyOne.
     
  4. Trekon86

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    I've heard that if you have a dog with you and you don't have a way to get out quickly, let your dog lick the wound from time to time.
    Is this true or a fallacy?
    PMZ
     
  5. Jason

    Jason Founder Staff Member Administrator Vendor

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    Dogs mouths are filled with bacteria, this is not something I recommend under any circumstance. I see dog bite infections all the time.
     
  6. Trekon86

    Trekon86 Guest

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    Thank you for clearing that up for me:)
    PMZ
     
  7. rik_uk3

    rik_uk3 Guest

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    A dog can help long term survival if stranded, just kill the dog, cook it and eat;)
     
  8. bmatt

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    Yeah, why send it to go get help? ;)
     
  9. msbushman

    msbushman Tracker

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    Well we ain't talkin about Lassie here most of us just have hot dogs..:D I mean dumb ol dogs..
    Scott
     
  10. Woodswanderer

    Woodswanderer Scout

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    I also like steri strip's, better than butterfly's, I also have used super glue on smaller cut's after cleaning. I also carry suture in case. I have a ER nuse friend that hooked me up, and have praticed suturing if the need is there.

    Steve
     
  11. Iz

    Iz MEMBER of a BANNED Bushclass I Bushclass Instructor

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    Awesome post , Koa. Really good info.
    Later,
    Iz
     
  12. MrGatoMan

    MrGatoMan Scout

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    Guys just remember when it comes to trauma first aid and bushcrafting. We might practice and do primitive things and learning primitive health and first aid is always a good thing to know. But always carry the modern stuff in your trauma and boo boo kit. Its being used these days for a reason. They work. If you want to know whats the best stuff to carry then look at what combat medics are using. They tend to be in the know of the most modern techniques and equipment for saving a life. Ohh and dont ever close a wound before thoroughly cleaning it up. You dont want to get an abscess.

    Just some stuff iv learned from the pros who have been there and done that both in the civilian world and in the military world.
     
    Last edited: Aug 12, 2009
  13. Sgt. Mac

    Sgt. Mac Elder Staff Member Administrator Supporter Bushclass I Bushclass II Bushclass Instructor

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    Good advice Gato
     
  14. Rubarb

    Rubarb Contributor

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    Albert the links you have posted in three threads do not go to anything slightly related to the threads you are posting in, i have therefore deleted the links as they point directly to commercial TV advertising.

    In fact after checking your IP on whois you are a spammer based in India - bye bye
     
    Last edited: Aug 6, 2009
  15. joecrow

    joecrow Guest

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    Very excellent post Koa, thank you. I copied that to study.

    I have always maintained that I would never debase myself on the internet, but here goes: A couple of years ago I had a severely infected narrow open wound that was reddened all around, filling with copious amounts of pus daily and slowly becoming worse. I began to let the dog lick the pus out..... far cleaner than I ever could have gotten it and less painfully and then douched it with iodine afterward. It got better, which was not happening before and the dog got a treat.

    Boy howdy, I'm on a roll today. Two posts! One about how to wipe your a-- with your fingers and one on having a dog lick pus from an open wound. I'm gonna get excommunicated, no doubt.
     
    Last edited by a moderator: Aug 7, 2009
  16. Mountain Ron

    Mountain Ron Guide

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    I'm wondering what you think of the new wonder coagulants such as quick-clot and celox? When I was trained in the army we didn't have such goodies and everything was pressure points, comp dressings, battle dressings, butterfly bandages, plastic wrappers for sucking chest wounds and other techniques. We use to carry a 12 ml syringe for irrigating and as far as sterile irrigation we used 5% saline from the bag. Old tech works. Great post and much appreciation for posting it.
     
  17. Jason

    Jason Founder Staff Member Administrator Vendor

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    The new anticoagulant concoctions work very well from what I have read. I do not use them at all and have no real world experience with them so I can't tell you any more.

    Gentleman, please do not let your pets lick your wounds...please! :p The mouths of animals are not sterile as the wives tales might suggest. They are filled with rancid bacteria and cause very real, very well documented infections. Joe consider yourself a lucky man. But a very good story indeed.
     
  18. Trekon86

    Trekon86 Guest

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    Koa, what kinds of field expedient solutions can be used for irrigating deep wounds?
    I'm thinking just plain ol' water boiled well would work...maybe with some iodine from one's FAK added?

    PMZ
     
  19. MrGatoMan

    MrGatoMan Scout

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    Guys if you ever have to use Quickclot or Celox remember that it is not a magic dust. All it does is greatly increase ones blood to clot. You DO NOT just pour the stuff into a wound and expect it to work miricles. You MUST still apply direct pressure to the wound AFTER pouring in the haemostatic agent. Only then after pouring in the haemostatic agent then applying pressure will it work properly to help stop bleeding.
     
  20. Priam1

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    Greetings Kaol...great post but I have a few questions: 1) Is Urine considered "sterile"
    under your definition for this specific application? 2) Are there any positive advantages in utilizing a saline solution as opposed to sterile water--both long and short term? 3)would there be any advantage pertaining to irrigation by the utilization of a wide syringe (to had hydraulic pressure and thereby aid in flushing)?
    Based on my experience with equines, we are concerned that both providine and peroxide have necrotizing effects on skin tissue. I'm assuming that this same situation occurs with humans. You've already stated your personal opinion but is this why you recomend a more diluted mix (pertaining to both providine and peroxide)?
    4) In utilizing Iodine to purify water,from what I remember, there is a waiting period in order to kill pathogens. This is usually based on the temperature of the water. The colder the water the great the "dwell time." Is there a similar requirement in terms of water sterility for wound irrigation?

    One last comment: Any bottle that you put in any of your kits--including backpacks should have the caps taped. This is because of the constant vibration of both walking and bouncing in your vehicle can and will loosen your caps to the point of major leakage.
    (Don't ask how I found this out.) I suggest you do what commercial distributors do when
    sending out containers to customers--they tape them (the caps) with strapping tape--they tape the cap to the bottle itself to eliminate this possibility.
     
  21. Jason

    Jason Founder Staff Member Administrator Vendor

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    1) Technically urine is fairly clean regarding bacteria in most cases but contains other waste products from the body, not sure I can advocate this one so much.

    2) Saline solution is similar to the fluid contained in your body and is less likely to cause a fluid shift within the tissues themselves and cause swelling/dehydration. the closer the saline solution to the body fluid the better. That being said irrigation with plain water is fine for this scenario and is most likely the only thing you will have on hand.

    3a) The bigger the syringe the better for just that reason. I think a slight force from the pressure from the stream of fluid would be beneficial but gravity flow irrigation would be fine.

    3b) Both have effects on human tissue yes, but I consider this to be negligible of rinsed with clean water afterward. Some would disagree so do this at your own risk. I have years of experience with dirty wounds on myself and others that prove this is not as dangerous as some would have you believe. Yes the solutions should be diluted and should not be SOAKED for extended periods, we are talking about irrigation here only.

    4) I would let the iodine sit for a while to purify dirty water but the exact time is not known to me. That's a really good question and perhaps someone else knows this. I would say wait at least 30 minutes but that sort of takes away some of the advantage or cleaning the would if you let it sit there huh?
     
  22. SpookyPistolero

    SpookyPistolero Scout

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    This is a good thread! Very good information, and I agree with it.

    I'm a nearly-graduated pharmacy student, and have compiled a bit of information here:
    http://woodsmonkey.com/index.php?op...st-aid-kit&catid=41:how-to-articles&Itemid=63

    Two notions I might add about wound cleaning:

    - Most pharmacies can order more than you'd think. Try and see if they have prefilled syringes of normal saline for irrigation, great for kits. My wife is a nurse and they have prefilled line flushes of NS as well, so I get her to steal a few for me.

    -Saline sprays are available at most pharmacies (usually already in stock out front). They can be large/heavy, however.


    I have one small suggestion for your kit however, Koa: while Augmentin is usually a pretty fair antibiotic for soft tissue infections, it is also notorious for severe diarrhea that is unresponsive to several treatments (until the course of therapy is finished). Obviously in the woods, especially if you're limited in your mobility, dehydration from diarrhea can be a bigger problem than the infection. Plain amoxicillin or a cephalosporin may be a better choice for that. Just a thought!
     
  23. Nightside_Eclipse

    Nightside_Eclipse Scout

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    I highly recommend everyone carry an Israeli Battle Dressing (IBD) or 3 with them at all times, or at least keep some nearby.

    http://www.redflarekits.com/mm5/mer...Code=rfes&Product_Code=4331-C2&Category_Code=

    They've recently came out with a "civilian" version that's white instead of OD that's about a dollar cheaper, these things can be a life saver.

    Put some Nitrile gloves in a small ziploc bag and tape it to the IBD wrapper and you have a good gunshot wound/laceration dressing. They can even be used as a sling and a tournequit
     
  24. Jason

    Jason Founder Staff Member Administrator Vendor

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    I have recently seen a video in which the presenter sutures his own finger on youtube. Not only is this a bad idea in general but it was done in a blatantly non-sterile fashion most likely with the wrong type of suture. Adding to the stupidity the presenter was dangerously close to suturing his own extensor tendon to the skin. :rolleyes: I know it's cool to be a "real man" and everything but let's get serious people. If you had any idea of the potential complications that can occur with hand infections and tendon injuries you wouldn't even think twice about doing this. I know ignorance is bliss but now I've seen it all. Consider yourselves appropriately warned and educated, if you hurt yourself or others doing this it's not going to be on my conscience. But what do I know anyway, I'm not a youtube guru.
     
  25. Pawoodsman

    Pawoodsman Guide

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    Point well taken Koa, hopefully others follow so said advise.
     
  26. Rubarb

    Rubarb Contributor

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    Saw the same video Koa, nothing like using a filthy multi tool to help close a wound up is there and then running the suture through blood caked and bacteria infested hands prior to stitching yourself up, utter stupidity in my opinion, especially as the emergency room was not that far away either - my hero swooon - NOT:mad:
     
  27. Faol

    Faol Guest

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    Which video was this?
     
  28. Pawoodsman

    Pawoodsman Guide

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  29. Faol

    Faol Guest

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    Gotcha. Should have known what the answer would be.
     
  30. Rook

    Rook Staff Staff Member Super Moderator Vendor

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    Amazed at the stupidty that's out there. I had a liner lock fail on me several years ago. Cutting the side of my index finger on the middle knuckle. Just at a 1/2" gash and could see the knuckle. Rinsed it and closed it up with heavy duty surgical tape. Thankfully I didn't hit the tendon. But other than some stiffness from the wound, it healed fine and scar is barely visible.if I can't fix it with tape, I'll go to the trained ones to put stitches in. I'd rather risk a scar than some self inflicted nasty infection.
     
  31. Jason

    Jason Founder Staff Member Administrator Vendor

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    That video should be pulled from youtube.
     
  32. Iz

    Iz MEMBER of a BANNED Bushclass I Bushclass Instructor

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    Wow.:confused: What people won't do for a little attention.
     
  33. Faol

    Faol Guest

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    HOLY CRAP! Not sure I could do that, Frau. Actually, I am pretty sure I couldn't.
     
  34. Rubarb

    Rubarb Contributor

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    Bleedin 'eck Frau, that's way way braver than i am where anything to do with teeth is concerned, i take my hat off to you
     
  35. FrauHilda

    FrauHilda Guide

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    Wasn't brave at all, and it was not my point to suggest that, despite the ending sarcasm. This kind of thing demands immediate attention, it's just incessant torture until you do something about it.
    Much smarter to have called-in to work and made an emergency trip to the dentist. I could have passed-out, got a nasty infection, etc.
    But it sure felt good to get it out :)
     
  36. Rubarb

    Rubarb Contributor

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    i still take my hat off to you
     
  37. Mattnu

    Mattnu Guide

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    I've patched more than one wound, NON LIFE THREATENING, with brown paper towels and hundred mile an hour tape. Kept wounds flushed and sterile, and let them breathe/dry on occaision. Found the towel (gauze works fine too) and tape combo stayed in place and was flexible. Same combo works for arche supports, blister padding etc.

    As a note, keep your tetanus shots current. If it is a puncture wound, or penetrating wound tetanus is a real threat.
     
  38. rik_uk3

    rik_uk3 Guest

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    That video needs to go, the guy is one beer short of a six pack,,,,,,:mad::mad::mad::mad::mad::mad::mad::mad::mad:

    I HATE DIY first aiders, the guy is a prick.
     
  39. BushBum

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    I think that was Bear gryllis's Dad..al he needs to do is unnec. climb up a freezing waterfall and drink his own urine and he could get his own show...
     
  40. BOD

    BOD Scout

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    What about irrigating with blood?

    If its a wound from a "clean" cut from a blade as opposed to say a sharp branch that goes through your shin (as happened to me) which is likely to (and did) turn septic. Many a self inflicted knife cut has healed without irrigation.

    Mors Kochanski advocates using the bleeding wound to irrigate itself
     
  41. Jason

    Jason Founder Staff Member Administrator Vendor

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    Bleeding can irrigate a wound but it is not foolproof, sometimes it's all you got. The wound will do much better if left open in those cases and just bandaged. Remember that many a self inflicted knife wounds also turn into raging infections requiring multiple surgeries and ultimately result in loss of function. You just don't hear people admitting to those. I am not going to go into complex hand anatomy but you'd be amazed at what a simple cut can do to a hand. Trust me when I say it's nothing to take lightly.
     
  42. Nightside_Eclipse

    Nightside_Eclipse Scout

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    I normally find Dave Canterbury to be pretty informative but that was just pain stupid... :eek:
     
  43. Knight

    Knight Supporter Supporter

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    Not sure what he was trying to prove with that one.
     
  44. Outrider

    Outrider Scout

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    Great thread!

    Question... A lot of first aid products, such as new skin, say not to apply to "puncture" wounds. What is the best procedure for puncture wounds from say from inch long and bigger thorns that get driven straight into muscle mass in the bush when you know you are going to be there for a while?
     
  45. ruck66

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    KOA

    An old Sneaky Pete medic by the name of James Donahue used a combination of Phisohex and Hydrogen Peroxide to irrigate wounds in his books on the Mobile Guerrilla Force. He mixed it in a squeeze type bottle , shook it up and applied. Does this work well. Is a small squeeze bottle of this mixture a good idea for the trail?
     
  46. Jason

    Jason Founder Staff Member Administrator Vendor

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    For puncture wounds just irrigate, leave open to drain, and apply a dressing. Puncture wounds have a propensity for getting infected because of the depth at which the contaminated material is injected. Animal bites (especially cats) are especially dangerous. Dog bites tend to be larger and cause more structural damage while cat bites are deeper and tend to inoculate the wound with nasties.

    The James Donahue mix is fine with me, just make sure to irrigate with water after you apply those substances since they are considered cytotoxic.
     
  47. ruck66

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    Interesting on the animal(cat) bites. I believe large cat bites in africa were at one time treated with Potassium Permanganate crystals directly into the wound. I imagine this was pretty painful but the alternative was probably even worse given rural travel times over almost non-existant roads. Is this still an alternative where evacuation is not an option?
     
  48. moxonone

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    So Koa,
    If I were searching for a disenfectant to keep with my first aid kit what would be good for a general purpose type thing.Cuts and small puncture wounds mostly. I carry those little antiseptic towel thingys in the package are they adequate?Also you mentioned irrigation of the wound maybe said disenfectant could serve the same purpose?Sorry if I repeated one of the questions but I couldent understand the answers Im just a stupid miner. Any help you could give would be appreciated Respectfully Roger.
     
  49. Jason

    Jason Founder Staff Member Administrator Vendor

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    You need to irrigate a wound and that cannot be done with a towelette. Carry a small bottle of povidine-iodine solution and dilute it with water until it looks like iced tea rather than a double shot of espresso. Can't comment on the crystals in the wound, I don't use them in real life. You only 20-50 mL's to make a nice cocktail.
     
  50. Outrider

    Outrider Scout

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    Thank you for that. I need to add a small bottle of P-I to my FAK.
     

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