Wound Dressings

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    • #91941
      Joe (G.W.N.S.)
      Moderator

        I figured I would ask our Medical Professionals their thoughts on my current favorite dressings.

        After suturing or any wound with much blood or discharge I like using a ADAPTIC Non-Adhering dressing until things start to dry up then change to a Non-adherent dressing.

        I’ve been using a lot of 3M Medipore Soft Cloth Surgical Tape as my go to choice for tape, holds well, seems to breath well.

        Thoughts?

      • #91942
        wheelsee
        Participant

          wet, dry, wet-to-dry, occlusive, non-occlusive, ointments, no ointments, etc. The choices are daunting and, in the end, tends to be based on what your instructor said.

          I’ve been full circle, and repeating again what was in vogue, then out-of-favor so many times.

          My current practice –
          1. for areas that have been sutured – dry dressing (your patient would appreciate a non-adhering – think bandaid versus gauze) for 24 hours, then open to air. NO ointments, lotions, creams, etc for at least 2 weeks (6 if a major incision and over a major joint, think knee replacement) – these soften the skin and can cause the wound to open.

          2. for areas that needed an I&D (incision and drainage), think abscess – absorbent dressing for 24 hours, or as long as draining (to keep the body fluids somewhat contained), then open to air.

          For anything other than a small area (i.e. 1″x1″), I use roller gauze or elastic wrap versus tape. This keeps the dressing in place and doesn’t fall apart with movement or sweat (if done right). Plus, too many people having reactions to the adhesives. You can also use Coban or vet wrap – sticks to itself – think what they use after having blood drawn.

        • #91943
          Joe (G.W.N.S.)
          Moderator

            Good stuff, though with some of my patients being K9 I have to keep bandages on longer, between the “cone of shame” and normal dog stuff they lack concern for their recovery. ;-)

          • #91944
            wheelsee
            Participant

              Ya got me….. I should have prefaced with ” for human patients ” :yes: :yes: :yes: :yes:

            • #91945
              Joe (G.W.N.S.)
              Moderator

                Ya got me….. I should have prefaced with ” for human patients ”

                Well most of it is the same.

              • #91946
                Andrew
                Participant

                  In the pre-hospital setting of EMS basically it will be 4x4s, sterile water for minor stuff that is not bleeding heavily, more 4x4s, rolled guaze, and coban.

                  Big heavy bleeds get pressure bandages or possibly a tourniquet.

                  It’s pretty routine to set up a saline lock, just in case you need to actually run an IV or give meds.

                  Volunteer first responder (no medical director or protocols) BP cuff, stethoscope, and some 4x4s, pressure bandage, and a tourniquet. NO IVs, meds.
                  Nasopharyngeal airway use is still up in the air.

                  Oh! And most important a cell phone.

                • #91947
                  Joe (G.W.N.S.)
                  Moderator

                    In the pre-hospital setting…

                    Also good stuff, but this was more about after the first responder or when your treating without medical care available. Patient is stable time to suture or conduct a more through cleaning after initial first aid to access what if anything else needs to be done.

                    I do a lot of my own basic patching things up for myself, my dogs, and occasional neighbors animals.

                    I’ve sutured myself many times over the years due to necessity and sometimes because it was such a quick easy thing and wasn’t going to ED and all the waiting, hassle, and in one case I could be back to bed before even getting to Hospital.

                  • #91948
                    Andrew
                    Participant

                      Joe, the short answer is in the pre-hospital setting that (suturing) is not even in the protocols for paramedics. We can be as little as a mile away from the hospital to as much as 60-70 miles. You cannot count on air to be available, either rotor or fixed wing.

                      I would love to learn how to do it, just in case, but rarely have any antiseptics or other items needed to do it. And I’m not worried about leaving a scar on me or family. Also not sure my remaining shepherd would allow it. ;-)

                    • #91949
                      Joe (G.W.N.S.)
                      Moderator

                        …in the pre-hospital…

                        Just remember part of my preparations is for no hospital available. ;-)

                        I’ve found that putting parts back together to be mostly common sense; at least with knowledge and training, obviously within limitations.

                        Like many preparations I play the what if game. Proposed scenatios, proposed solutions, I consider this to be an essential part of preparations.

                        With quality medical care available things must be viewed with caution regarding any self-care. For most people I wouldn’t recommend it.

                        I have supplies that will never be used beyond extreme post-event emergency since they are beyond realistic expectations of my abilities. my reasoning that I think it may be possible to find people with the skills, but without equipment in a post-event situation.

                        Lastly I can foresee extreme situations requiring having to step outside of your training and comfort zone where to do nothing would result in certain death even though the attempt may still see that same result.

                        Fortunately we are fairly resilient recovery wise giving fairly basic intervention. This complicates the decision making of balancing when to do something, vice allowing the body to heal up without doing anything.

                        Also not sure my remaining shepherd would allow it.

                        Dogs are surprisingly tough; though a muzzle is appropriate for most, I’ve had dogs wagging their tail trying to lick my face while suturing them.

                        Of course that was my dog, I wouldn’t try to suture someone else’s dog that way.

                      • #91950
                        Andrew
                        Participant

                          Another thing to consider (in any setting :whistle: ) is expiration dates. Personally I keep a lot of stuff beyond the expiration date.

                          Pharma is now putting not only the month and year, but the date (now usually the first of the month, not the last).

                          It is shocking how much stuff we have to dispose of at work because it is beyond the expiration date on the package.

                          Not trying to hijack your thread.

                        • #91951
                          Joe (G.W.N.S.)
                          Moderator

                            Personally I keep a lot of stuff beyond the expiration date.

                            So do I, in fact the military among others have done extensive studies disproving quite a bit of expiration dates.

                          • #91952
                            First Sergeant
                            Moderator

                              Personally I keep a lot of stuff beyond the expiration date.

                              So do I, in fact the military among others have done extensive studies disproving quite a bit of expiration dates.

                              The expiration dates on a lot of stuff is a gimmick to force you to buy more stuff.

                              FILO
                              Signal Out, Can You Identify
                              Je ne regrette rien
                              In Orbe Terrum Non Visi

                            • #91953
                              Joe (G.W.N.S.)
                              Moderator

                                The expiration dates on a lot of stuff is a gimmick to force you to buy more stuff.

                                :good:

                                No doubt!

                              • #91954
                                Joe (G.W.N.S.)
                                Moderator

                                  A concern I have is many go as far as having a IFAK, but insufficient training in its use.

                                  Of those that actually maintain their knowledge of an IFAK contents and use, many don’t take the follow-up step to have any clue to what’s next.

                                  Obviously we can’t all be trauma surgeons, but I feel strongly in the need to address this issue. Most I feel ignore it.

                                  Obviously getting to know some people with medical training is ideal or even just knowing who might be in your area to seek out post-event. Another overlooked source of post-event skill is Veterinarians.

                                • #91955
                                  Andrew
                                  Participant

                                    Obviously getting to know some people with medical training is ideal or even just knowing who might be in your area to seek out post-event. Another overlooked source of post-event skill is Veterinarians.

                                    And vet meds!

                                  • #91956
                                    wheelsee
                                    Participant

                                      The biggest issue with “expiration date” is actually potency.

                                      On the helicopter, our turbines were rated for 20k hours (though the mechanics said they were actually good for 100K). Then our company cut the 20K to 10K. So my helo had its turbines changed out every 10k hours. All as a part of safety (read liability). Same issue with meds.

                                      Most meds can go FAR beyond the exp date but the pharmaceutical companies limit their liability by cutting the date not in half, or even by a quarter. A lot of drugs, we just don’t know how long they will last, talking potency-wise. And generic med bring in a whole nother issue (they’re allowed to have a 10% above/below name-brand, so they could be 90% potency up to 110% potency – some disease states won’t tolerate even that much).

                                      NOT to be construed as medical advice – I had meds (antibiotics) that were 20-yrs beyond expiration that worked when I took them though it did require me taking a bit longer than normal, so I knew the potency had dropped. Would I do it again?? probably not…..

                                      Re: suturing – if your’e going to make your own, be sure to use fishing line (monofilament nylon) or similar as it won’t draw bacteria inward (like cotton thread will).

                                    • #91957
                                      Joe (G.W.N.S.)
                                      Moderator

                                        Regarding expiration date of meds, the military study went into detail about effectiveness for type by age allowing for a way to adjust dosage. I agree most should save such that for emergency post-event use.

                                        With sutures I’ve become spoiled with the real prepackaged variety. I’ve used fishing line and a somewhat larger than needed curved sewing needle. It was a pain to use due to needle. It’s easier to learn now with great videos online vice books back in the day.

                                        If your contemplating having th see materials and skill remember to study not just how to do it, but when. Type of injury, how it occurred, etc… Many of the K9 injuries I’ve sutures were due to bites and even tearing from these attacks. With the high likelihood of infection it maybe advisable to provide for drainage even with antibiotics use.

                                        This is definitely a work at your own risk endeavour, I don’t have credentials to jeopardize by sharing, but still you need to have some knowledge before getting into this.

                                      • #91958
                                        Roadkill
                                        Participant

                                          Speaking of sutures, Amazon has sterile practice sutures with attached needles pretty reasonable price. Also think of staples. They are less painful than sutures and can be installed pretty easily. Remember if you get the staples also order the staple remover.

                                        • #91959
                                          wheelsee
                                          Participant

                                            Speaking of sutures, Amazon has sterile practice sutures with attached needles pretty reasonable price. Also think of staples. They are less painful than sutures and can be installed pretty easily. Remember if you get the staples also order the staple remover.

                                            Extremely important for staple remover if using staples. It is a special tool, the likes I’ve not seen before. Be aware that pliers will NOT do the trick owing to how the staple is inserted. End result (with pliers) is an open jagged wound…. the only ones I’ve seen in the ED with more than 1 staple removed this way had a high level of ETOH on board…..and a jagged wound that had to heal naturally….

                                          • #91960
                                            Joe (G.W.N.S.)
                                            Moderator

                                              …..and a jagged wound that had to heal naturally….

                                              Ouch!

                                              I can see why they gave up with one removed that way. Certainly an example of knowledge and the correct tool. ;-)

                                              I’ve never used a medical stapler or had them used on me, probably why I haven’t pursued it. Though I have them and the removal tool.

                                            • #91961
                                              idahocajun
                                              Participant

                                                Wound care, what a broad topic. I could grab drinks and spend a ton of time discussing the intricacies of this: where is the wound, how deep, how contaminated, animal vs human bite, preexisting medical issues (diabetes), medications (blood thinners), etc. Or I could give you my basic gist:

                                                1. Immediate care of wound: clean it, clean it good! Tap water just as effective as “sterile saline”. Don’t use stuff on deep wounds like peroxide as it actually can create a problem with healing.

                                                2. Repair: I prefer sutures or stereo strips, allows the wound to “breath”. Glue and occlusive dressings have their place, but trade off is they can lock in shit leading to infection, dehiscence, etc. I also NEVER use a topical antibacterial ointment on bite wounds, dog or human. Don’t treat the actual type of bacteria you worry about and cause major healing issues.

                                                3. Wound care: keep dry for 12-24 hours, then clean with soap and water lightly. After 1-2 days, dressing changes 2-3 times a day with whatever works.

                                                4. Special considerations: someone’s don’t require any kind of repair. It’s actually more beneficial to allow them to heal from the inside out, what we call secondary intention.

                                                5. Long term care: keep it simple right? Keep it clean. Dress/cover it for the appropriate conditions.

                                                I’m happy to discuss this in more detail, as this is something we deal with pretty regularly in the emergency department. But again, it’s a pretty deep rabbit hole With lots of considerations.

                                              • #91962
                                                Civilianresponder
                                                Participant

                                                  There are some good sources for trauma care training out there, but like PT most just wont take the time to do it. I try to take at least one or two of these courses per year. Doing a one off class isn’t enough. Odin medical and Dark Angel have great classes.

                                                • #91963
                                                  Joe (G.W.N.S.)
                                                  Moderator

                                                    Doing a one off class isn’t enough.

                                                    This applies to many things we do; it’s important, but daunting to the beginner since there is so much to learn. Of course one step at a time will get you there.

                                                    …don’t require any kind of repair.

                                                    This complicates the decision making of balancing when to do something, vice allowing the body to heal up without doing anything.

                                                    This is something that’s easy overlook or when you have enough training to be potentially dangerous (directed at myself). ;-)

                                                    I’ve struggled at times trying to decide how much I need to intervene after initial first aid when medical help was unavailable. My philosophy has become when in doubt, consult my reference material, if still in doubt just keep an eye on things. It’s amazing how well healing can take care of just fine.

                                                  • #91964
                                                    Andrew
                                                    Participant

                                                      Along these same lines as wound care, who are you gonna treat first if you have several casualties?

                                                      But that’s a whole different thread.

                                                    • #91965
                                                      trailman
                                                      Participant

                                                        There are some good sources for trauma care training out there, but like PT most just wont take the time to do it. I try to take at least one or two of these courses per year. Doing a one off class isn’t enough. Odin medical and Dark Angel have great classes.

                                                        There are also resources like Red Cross Wilderness First Aid and/or First Responder that we do for scouts. It won’t go into suturing but gives a good solid run on the basics. If anyone knows a veterinarian, they are a good source for those “expired” items like sutures. There are companies out there that sell expired material as such but then how expired is a needle an thread?

                                                        This may be a help

                                                        https://www.sutureonline.com/wound-closure-manual, get some trotters from the butcher and practice.

                                                        The big deal as stated above is when to use what technique.

                                                        Also nearly every county in my area will train you as a volunteer EMT for free.

                                                      • #91966
                                                        Andrew
                                                        Participant

                                                          This site might be useful. Suturing is on the list.

                                                          http://www.operationalmedicine.org/Videos.htm

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