Discussion in 'Bush Medicine' started by Jason, Oct 25, 2008.
Finally a voice of reason.
There is a ton of misinformation out there.
Superglue is stupid. Its been said time and time again by medical professionals on this board from Surgeons, Docs, EMS providers to RNs, etc. Clean wound, Direct pressure to controll bleeding, apply bandage, seek medical help if aplicable. All the other junk is not needed. I have no idea why folks would disregard the advise of trained people who have years in the field to listen to the advise of bubbas with rolls of duct tape, tubes of super glue, and self suture kits. Ive been working EMS for a decade and have never once had a wound that couldnt be controlled with direct pressure, - serious traumas that a TQ or surgical intervention was required to fix. Leave the glue to model airplanes, and the duct tape to fixing junk not attatched to your body. Listen to the pros. Take a class, hell, take 3. I bet not a one will advocate the use of duct tape or super glue.
let's see how this shakes out...
ignore the bubbas versus listen to the all-knowing medical professionals who gave us mrsa.
generally, as i read this thread, i got the impression that a solution was needed when skilled professionals weren't available or not wanted.
did i miss something?
the times i've patched myself up with duct tape and superglue then subsequently seen a medical professional didn't result in even a disapproving frown.
just another bill.
Hmmmm. I have never given anyone MRSA, and never said any medical professional is all knowing. However, I do believe the value of advise given from those of us whom have multiple years of experiance dealing with traumatic injury is faaaaaaar more valuable then the shadetree backyard doc who got lucky a few times.
Yes you did miss something. The right way to treat wounds. You dont have to be a doc to practice the appropriate first aid.
You wont see a dissaproving frown. That happens after you leave.
This thread is about first aid for treatment of wounds, and the appropriate way to deal with them. Which is very much doable in the bush with the correct advise. This is serious stuff and could very well save a life. People who try to cut corners and make it up as they go along are passing off potentially dangerous advise. Its not about personal politics about how people view the medical field. Theres a reason our health care is the best in the world. Im not talking about a financial debate either, Im talking about the actual medicine practiced and lives prolonged and saved.
In the end I could care less how anyone decides to treat their wounds. Do what ya want. Rub some dirt in it and walk it off. However when that silly advise is handed out to those seeking real information, with no real leg to stand on other then Grand dad did it, or old guy knows best, or it worked for me a few times, that bird wont fly with me. Ive had my hands bloody enough to know there is most certainly a right or wrong way to perform aid.
OK....lets just throw this out there.... You're a mile away from the car, you buddy screams for help and this is what you are faced with....
This is an axe wound. I'm pretty sure it's safe to say it's one of the worse one minus cutting the femoral artery.
Are you reaching for super glue or duct tape?
Ouch! Imagine putting duct tape on that then having to pull it off after its nice and sore a day or two later, even later than that it would still rip open...yikes.
Although tape will be ok to put over bandages with out skin contact to wrap a wound up tight to aid in prevention of blood loss.
I just went and re-thanked the original post. I posted after the upgrade that I was not going to be doing that, but the original post is as fresh and vital and appropriate today as the day it was first posted. The only problem with it was that Jason did not lock it and make it read only as it truly is perfect as written and needed no further comment.
320 why dont you keep it on topic and not resort to personal insults. mkay?
As I said, do what ya want. Just dont expect people with real training to jive with your thought process.
If you have further issues take it to PM with me.
why don't just listen to bear grylls and piss on it! haha
I don't know if this is the right thread, but I didn't want to start a new one for my question.
Can you pour salt directly on a wound? Would it even help at all? I understand it would burn like a mf*er but does it help with blood coagulation? and is it advised against for any other reason than pain? (possibly not being sterile or some such)
While saying it and doing it; my EMS Training kicks I: 1) stop the arterial bleed; if trestrictionrestictiotruncate turincate that is what I do; 2) Get a bandage on it (if there is more than friend and I step one and two get done at same time!) 3) It is now a HBR (Haul Butt Run). The only way duct tape gets into the situation is to hold the layers of whatever I can find to bandage with on the wound!
I would never use super glue to close a wound; there is a reason that what you can buy at wally world is there. Yes, the makers plan was for a wound closer but there are those allergic to the over the counter super glue! Yes, there are medical versions at the docs and hospitals but you will not buy it except from a med supply house!
Yep what the emt said. Plus I'd be tying that arm ta the guys body to prevent aggravating the injury as we helped/ carried him out.
Amusin; yep that would also be wise! I may have thought of it in a real life situation. Sitting at the keyboard, and having already seen the pic in another thread, the situational Epi did not kick in!! To a point keep it immobal is good more to keep it above the heart as much as possible. Especially if the only way out is for victim to walk back to car/truck. I would also be on the cell trying to get the guys with the better equipment as close as possible for an extraction! They have ways that allow them to HBR legal like aka blink-blinks and woo-woos!!!!
That wound needs to be properly sutured. If you can get to an MD within a few hours, here's my professional advice: stop bleeding. Once it is as shown here, wash the wound with mild ordinary soap and clean water. Apply sterile dressing with a firm bandage. Splint the extremity with the hand in the position of use: hand him a roll of gauze then let the splint extend past his fingers. Confirm distal sensation and capillary refill at the nail beds then transport. This would possibly require some absorbable internal sutures first. Due to the stresses at this site, glue would work but would need to be protected. My concern is more for tendons and ligaments damaged, too. Those require surgical repair. An MD would probably give you a tetanus booster and an antibiotic for a dirty wound. This may look graphic to the layperson but is just another day in any emergency room. At least the bleeding stopped before he ran out. The radial artery is near the top of the wound found in a groove between the radius and tendons. As long as this patient is hemodynamically stable with no loss of distal pulses or neuro sensation and still has use of the hand, then I don't see this as a code 3 emergency and not justification for a medevac or driving like a lunatic. Just package them up, put their seat belt on and get them to the ED in one piece. This is where taking the EMT course and spending 10 hrs. in the ED watching lacerations such as this get sewn up helps lose that Hollywood response and keep your cool. You cannot take good care of your patient if you get freaked out or become Ricky Rescue.
Potassium permanganate is one of the better sterilisation agents to be carrying IMO.
Easily carried in flake form & can be quickly & easily mixed into an irrigation solution.
The medical community is getting away from strong antiseptics such as Betadine in favor of just cleaning a wound. If it is a dirty wound that needs to be irrigated before closure, again soap and water are the recommendation. PMnO4 is ok as long as you don't mix it too strong. Just add one crystal at a time until the water turns pink and remains pink for a few minutes. When it gets purple, you're too strong, on a non-scientific basis. It has other survival uses such as marking snow and sterilizing water. You can make a poor man's ink to write messages with it, too. Hollywood uses it to 'age' things as it leaves a patina.
Yeah; I will say the the EMT Class has made me a whole lot more laid back, as has run time as a tech. I also think that those in the EMS/Med field are those who will not freak out as easily as others. I have found that since getting out at being the "Person careing for the victim; waiting on the Ambulance" I do my EMT Thing until we get the person packaged and out the door; then the epi rush goes back to normal/sub normal and I have to regroup my poo! I have had to care for people at work who were "Unknown Down" twice; I was fine till after then I had to take a walk to recover.
So last Friday I was making a hatchet only fire to straighten some arrow shafts the ABO way. I was too focused on my shavings and forgot my hand was there. a little swipe laid my index finger open down to the tendon. Woops. Rinsed it out with most of a full camelback, squirted some hydrogen peroxide and rinsed that out . Packed with a tiny bit of bacitracin and just laid on the ground with my hand in the air applying pressure with some sterile nonstick gauze pads.
I want to reiterate that irrigation is the best thing you can do. For me, it saved me a trip to the emergency room since it cleaned my wound to where fibrin could glue it back together.
Lucky for me the angle made for a lot of surface area for my platelets to work with. The blue line is where the axe cut through all the skin. You can see where the edge of the skin flap went a smidge necrotic. I'm not worried about it. It's been 3 days and there aren't any signs of infection. Huzzah!
If I can do it, so can you.
Great post Jason. Lots of good stuff to think about. How do you feel about "alternative medicine"? I've read some about Jewel Weed being used to treat poison ivy (and it seems to work for me). More to the point on the above article, I read about the anti-septic properties of the Plantain (not the banana one). Well, I figured I'd try it. My dog cut her foot about a week ago (broken claw to be precise) and infection began to set in within a few days. On the third day I began washing it, pouring peroxide on it, then wrapping it in a plantain poultice (finely chopped with a little olive oil). I would change it out twice a day and clean the wound. As of today she is not wearing the poultice and seems to be well on the way to recovery. She is certainly not limping any more.
Now, one part of me wants to claim that the herbal poultice did the trick. These are the claims I read about on various websites. However, another part of me realizes that there were too many variables (e.g. antibacterial soap and peroxide) to objectively conclude this.
What are your thoughts? Are you confident in these herbal remedies?
Great thread Jason. Important information considering the group penchant for playing with knives and axes.
I was about 0.75 miles from the car, and about 8 miles from the hospital on a day trip. My razor sharp Swedish ax, and one mistake by me means right down to the bone. Thankfully, there isn't much in terms of arteries there.
I was prepared. Large gauze, tape, alcohol, apply pressure, and the bleeding was stopped in 5 minutes or so. I pretty much had it closed, but I knew I could make it in time to get it stitched. If It had been worse, I had to oh so controversial quick clot. Thankfully it wasn't. The ER doctor told me I must be very good at sharpening axes because it was a beautifully clean cut.
I'm glad I had my large, over prepared first aid kit, and I learned something about ax safety.
It is a fallacy. While dogs' saliva is part of their excellent immune systems, it's meant to kill the bacteria that's on them. I read just a couple months ago, however, that human spit actually carries antibodies for certain bacteria, and that if you lick (not recommended) or spit on a wound, it can help with the healing process. Makes sense, but I haven't tried it.
Something I noticed recently. Childrens band aids are cheaper and usually hold a lot better than ones made for adults. If ya don't mind lookin at them.
One time when I was on a couple weeks trip just wandering down the coast my foot slipped on some rocks while I was walking barefoot around rock pools. I checked and found that I had a blood blister with a small gash right next to it. I irrigated the cut with a chlorhexidine amp and taped on a gauze dressing. I decided not to open the blister and just leave it be as it was sealed and not punctured at all.
This happened in the morning. Everything was dandy when I went to bed and I replaced the dressing on my toe. No pain at all.
About two in the morning I woke up with the my toe in major pain and throbbing like mad, the other time I had am infection this painful it took a few days to get this bad, this sprung up in a couple of hours.
So I was super worried and expected to not be able to walk properly and have to leave my trip and see a doctor for antibiotics in the morning. I got up grabbed my FAK and opened the blister with a sterile splinter probe, couldn't open it properly so had to sterilize my knife as best I could with alcohol wipes and betadine. Well I got it open and irrigated it with a 20ml saline and then a 30ml chlorhex solution, while intermittently dropping betadine into the blister. I finished off putting more betadine in to leave their and encased the whole toe with sterile gauze and first aid tape, by the time I'd finished I noticed that it wasn't hurting at all anymore, no throbbing nothing at all. I didn't know infections could go so quick but more importantly I didn't know they could get so serious that quickly! It was a pretty stupid idea not to open that blister and disinfect it straight away because anything in there will do more than fine. This is how quickly infection can come along and ruin your day/week/appendage. Carry some sterile irrigation solution and plenty of antiseptics, sterile gauze and good dressings to keep things covered.
Also I now carry sterile scalpel blades since I don't want to have to use my knife again on a dirty wound.
That story scares me! On the Gulf Coast, any cut gets a trip to the doctor. We have the flesh eating bacteria in our bays and every year people die from it. Like you, it can go from okay to very bad in a few hours and, if it spreads, it can kill. A hook stick or a stingray wound can be fatal. The most we can do is check every wound and at the first sign of trouble get help. I'm glad yours turned out well.
Medical pros: questions about wound glue in the bush
A friend of mine who is a nurse was giving me some supplies for my first aid kit. One thing he had was little ampoules of this bluish superglue-like substance (I forgot the name) used to seal wounds in surgery.
Medical professionals: would it's use be indicated in the bush assuming that the wound was properly irrigated? Would it offer advantages over other interventions like Telfa pads or even bandaids? Is it's use limited to situations where either bleeding has stopped or is difficult to stop?
Without proper training, don't use it. It's cool stuff, but if you can't guarantee that everything is sterile, there's a big chance of a nasty infection with it all sealed up.
There are probably others that are better qualifies to answer this but I would say do not use it. It would ne better to leave the wound open and cover with gauze or a pressure dressing if it is bleeding profusely.
Even though you may feel it is properly irrigated, there is to much risk of infection to close it up un the bush. Not to mention it would make things more difficult for the medical personnel when they provide care.
I agree with what has been said. Jason has an excellent post in the bush medicine section on wound care in the bush. its old but very informative. You don't want to close wounds compleatly in the bush.
Clean and irrigate the wound, apply direct pressure, dress as needed. I would not use the glue for reasons previously mentioned
Read this sticky:
Situation dictates. I would not tell you to use it, however I have closed many of wounds that by all rights should have been stitched, using normal super glue.
I am in no means a medical expert but what about bleeding out? I know that's on the extreme end of the spectrum, but I'd rather seal it up with glue and deal with an infection then die in the woods.
I AM NOT A PRO I have used super glue many times, plain ole' super glue. Almost every time everything was fine, the other time the finger puffed up under the glued, fortunately I was able to use an exact-o to peel the glue loose at the edges and then pul off the glue like a scab. The puss and black strands of whatever that gushed out of my finger were nasty and it kind of scared me. So I mirror what has been said already, if you're not trained don't use it. Just my thoughts and experiences
If bleeding won't stop I don't understand how this would help.
The glue will seal up the skin, but bleeding would continue internally.
Medical pros: questions about wound glue in the bush
Very true. I can close a wound that really should be stitched closed by using Glue. If you have real antiseptic like Betadine then glue is not a bad way to go. Usually you are out of the bush in a day or two and that "bad cut" could turn a situation that you would drop pack and head back into a viable weekend. As always experience and knowledge should dictate a situation but I would have no problem stashing a tube in my pack along with the means to sterilize the area.
I use razor blades quite a bit repairing small gauge wires. I always carry that little spray can of neosporin and seal that bad boy up. Works like a charm. I usually dab some more on top to make a callous so I don't bump it and re open it.
Your right. I didn't think about that. Wasn't super glue invented during Vietnam for this exact purpose though?
Since the question of super gluing wounds has come up again, I want to comment. I am old enough to have experience with a wide variety of "home care" and "first aid" remedies for cuts, abrasions and wounds.
I have NO medical training either, but I have learned a few useful things. First, clean the wound, irrigate with saline if possible, just plain water is better than nothing.
Get it as clean as possible. Second, bandage the wound using pressure, compression, etc. You need to stop excessive bleeding, but you are also protecting the wound from further contamination.
Using sutures, super glue, etc is NOT a field remedy to even consider. Those techniques seal the wound up and if there is any dirt or other contamination inside the wound, you will have an infection. Yes, the doctors use those techniques, but they are also a lot better trained to make sure the wound is clean, sterile, and that there is no nerve damage. And then they give you anti-biotics if they think it needed.
When you come in with a wound already sealed, it is almost impossible for the doctor to examine what happened without re-opening the entire wound. Not fun, and not smart. Carry the means to irrigate, carry a good antiseptic solution _ Povidine -Iodine or Betadine, and carry what you need to cover and bandage a wound. If you are able to self extract and get to a doctor in any reasonable time, even up to a few days, that will leave you the best odds of getting the wound properly treated.
I have had cuts treated with a sugar and coal oil compress, straight Mercurochrome, straight Iodine, salt water, and a few other old time remedies. Guess what, I survived, but I also learned. Now, irrigation and pressure are my go to method, and it hurts less and heals quicker than the old ways.
Dermabond skin glue is an absolute must in a bush kit. Having done some mountain rescue and backwoods medicine taught me that. The key is knowing when to use it.
Can you get out of the bush safely with other simple wound care methods? Then don't use it. But if you have a wound that makes getting out of the bush dangerous or impossible it is the perfect answer.
It's benefits include: total closure, important if you are in a dirty or fetid situation ( like a swamp or such). One handed application. Use of the wounded area inside of 10 minutes.
There are only two down sides if used badly. Misalignment of the closed wound, causing more scaring than necessary. Full closure of wound that is not clean, causing additional infection. Have your nurse give you some training and look online for training videos by Ethicon company for "Dermabond".
Read the sticky Sgt Mac linked!!
I think ALL of the medical professionals here (read actual Doctors) say DO NOT use glue or sutures to close a wound in the bush.
NO! Do not believe everything you read on the internet.
Merged to the Bush Medicine thread.
Haha. It was invented in 1942 but it was used in Vietnam to stop bleeding and close wounds with great success.
Yuppers! They were looking for a way to make an extremely clear plastic.
It was used as a wound closure then and later with OCCASIONAL success, IN A COMBAT SITUATION! Triage and transport. Let the Doctors deal with it.
Use it if you like, just not on me or mine. Same with sutures.
Cut my finger pretty deep this past week on glass while at the cabin with the family. This is what I did.
Step 1: Briefly flush cut using clean cold water
Step 2: Stop bleeding. Using pressure and keeping hand elevated above heart.
Step 3: Apply triple antibiotic to gauze pad. Wrap cut with sterile gauze pad and athletic tape.
Step 4: Take care for 12 hours to keep hand clean and not use/bump hand to cause cut to open up again.
Step 5: Change dressing every 12 hours
Step 6: After 2-3 days cut has healed enough to expose it to some air. Make sure to keep cut area as clean and dry as possible during this period.
Edit: I also did the following. Wash hands with soap and water to prevent contamination of materials. Made sure I was working on a clean/sanitary surface when dressing my wound. Don't want bacteria creeping in on any of the materials that I am handling. I use a triangle bandage laid out on top of the kitchen table. The bandage is made from Tyvek from REI (sanitized with diluted bleach) and is used as my 'working field'. Also properly opening up the gauze packages like nurses and doctors do is important.
The first post of the thread was the best
Well said Jason. I would add the obvious comment that on a big wound, FIRST OF ALL stop the bleeding, if you have an arterial pumper or a big venous oozer, the bleeding will settle the issue before the infection can get to you. Next clean the wound as best you can, with the cleanest water can get, with lots more water than you think you need and and more aggressively than you probably want to. Then bind the wound well, close it if you know how and only of you can't get to a professional (If you know how, where and why you use Vicryl as opposed to Neurolon, Chromic or Silk suture. and actually have said sutures, go ahead and sew it closed, otherwise just bandage it). There is a window of time after the initial 8 or so hours when a wound may be safely closed (after initial wound granulation has begun) at 3 to 5 days after the injury. This is called delayed primary closure, and if you're 2 days away from civilization this may well be the best option. Some ER Docs are leery of this but any surgery resident can handle it; use the phrase "delayed primary closure."
Small wounds can be handled with steri-strips, improvised butterfly bandages, or superglue, if you are familiar with the techniques. But stopping the bleeding and preventing infection are still the most important issues. You can Rambo sew a superficial lac with nylon suture and probably get away with it...but do you really want to explain what happened when you show up in an ER 4 days later needing IV antibiotics for a major wound infection because you couldn't clean the wound well enough out in the woods and you didn't want to drive for two hours (and, yes, wait much longer) to get it done right?
A thought to add to your good advice
First may I just say your caution with regard to not advocating this technique is very appropriate. At the risk of adding a new thought to an old post, recent research has pretty much debunked the "urine is sterile," urban legend. There is a specific article here that explains why it is a bad idea to irrigate with urine.
Posting as a new member, and hoping no one needs to use their first aid skills any time soon!
I'm not sure if it grows in your area, but we have this plant here called meadowsweet. Chew some and mash it into your wound, it's a natural antiseptic and coagulant, makes great tea for a bad tummy too. I'm a new member here, but I've taken advanced wilderness first aid, and my current Fa qualification puts me above the fire services, but just bellow EMT. I consider wilderness first aid, to be one of those indispensable bushcraft skills, that can't be practised or stressed enough.
Hmmmm. Not sure I'd want anything in a wound after chewing on it!
I've cut the snot out of myself a few times in my life that should have been sewn, but I ended up using a good dressing instead. Got the scars to show it.
As an old FMF Corpsman, I know how to suture, but there is no way I would ever sew myself up without a liberal dose of lidocaine.
I've sewn cuts on extremely tough, extremely drunk Marines, who have said they didn't want it nummed. They change their minds real fast once that little curved needle goes in.
I cant imagine anyone thinking that urine is a good idea for anything..... now I am very happy that I have 4 sterile syringes full of saline in my FAK in case of a cut.