Backcountry Wound Repair - general tips requested

I appreciate the info from the medically trained or experienced like MNS and Brumfield. So just for a regular trip, say along the AT, what minimum recommendations do you all suggest?

Here's what I have so far: neosporin, bandaids and a few gauzes, moleskin or some other blister treatment, 1-2 ace bandages, needles w/ sewing kit and matches (for splinters), aspirin or NSAID, soap

Improvements and insider tips appreciated.

Honestly, a Wilderness First Aid class would be really beneficial. They spend time teaching the finer points of wound cleaning in the back-country, which is different that what you'll find in front-country first aid classes (slap on a dressing, hold pressure, go to the ER).

The best way to clean a wound in the field is with pressurized irrigation. This is easiest with a 20 cc syringe, but can be accomplished by snipping the corner off of a heavy duty zippy bag. You clean with treated drinking water. Deeper wounds benefit from being irrigated with water with enough iodine to make it the color of dark tea... this approximates a 3% solution.

The best pressure dressings are made from sanitary pads and elastic bandages. These absorb a ton of blood and resist sticking. The bleeding should stop within 5-30 minutes (depending the nature of the wound). Wound cleaning should occur within 2 hours of injury to minimize bacterial growth. An oozing wound is ok, the fluid movement helps to keep bacteria flushed out. Large wounds should be packed with gauze soaked in the 3% iodine solution and the patient should be evacuated as expediently as is safe to the nearest emergency room (you can safely by pass clinics with most wounds). Smaller wound can be closed by bringing the edges of the wound together, but not touching. This can be accomplished several ways, such as steri-strips or duct tape. If you bring the edges completely together you will potentially trap bacteria inside the wound, in an anaerobic environment favored by most bugs, and you will create a ridge of scar tissue along the seal.

I am an opponent to stitching up wounds in the back-country, but to each their own. Anyone wanting to stitch themself up it is their perogative, however I would never advocate stitching up someone else unless you have been trained thoroughly on how to do it, and have ample experience doing it at home (i.e. I'm including animals here as many people learn how to stitch up their pets or farm animals). Otherwise, and even with "homegrown" experience, you would be practicing medicine above your level of training, which is an enormous legal no-no here in the US.

MNS

I've watched and assisted my vets for quite a few operations and think I'll do just fine when it comes to triage on the trail <img src="/forums/images/graemlins/smirk.gif" alt="" /> Bring me yer' wounded, but before I have lunch please <img src="/forums/images/graemlins/grin.gif" alt="" />

MNS,
Regarding the iodine solution, isn't there a potential allergic reaction?
Are there other potential solutions? Perhaps a saline type solution?

Just curious.

Thanks for sharing all your knowledge.

T

Me too!

In the past, I have expressed strong opinions on the wisdom of suturing or stapling wounds, especially those that penetrate the skin and involve underlying tissues. In my experience, and training, there is no medical reason for immediate wound closure in the field. Stopping the bleeding is important and so is protecting the wound from further contamination. But, closure by untrained personnel can lead to hard-to-treat pockets of infection or gangrene.

The only possible exception to this would be cuts on the head. These can bleed like crazy and the bleeding can be hard to stop. Use of adhesive butterflies and pressure is usually enough to handle this sort of injury. However, if the injury is big enough, sutures applied by trained personnel could help.

LOL. Will you give us a scooby snack if we are good li'l patients? <img src="/forums/images/graemlins/wink.gif" alt="" />

Tango...

Yes, there is a potential for allergy to iodine. Most people know when they have this allergy, byt you still have to ask because they might not be aware that shellfish allergy = iodine allergy. This is where a good set of SOAP notes is very helpful... it prompts you to ask aboout allergies before you get to doing any treatment.

If someone has an iodine allergy just use treated water to irrigate and get them to medical care if the wound is significant enough.

Thanks for the reminder!

MNS

Why of course <img src="/forums/images/graemlins/grin.gif" alt="" />....now be a good patient and lie back while I get my saw <img src="/forums/images/graemlins/smirk.gif" alt="" />

<img src="/forums/images/graemlins/laugh.gif" alt="" /> <img src="/forums/images/graemlins/laugh.gif" alt="" /> <img src="/forums/images/graemlins/laugh.gif" alt="" /> <img src="/forums/images/graemlins/laugh.gif" alt="" /> <img src="/forums/images/graemlins/laugh.gif" alt="" /> <img src="/forums/images/graemlins/laugh.gif" alt="" />