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W1IM said: ↑
I agree, for some reason people like alcohol swabs for cleaning wounds. This ends up stinging a lot and also damaging tissues and prolonging healing time. You want to be able to wash away debris, not just apply an ointment and then bandage. Sterile water or saline do this just fine. You can purchase small bottles of eye wash in pharmacies which work well for portable kits. Just make sure you are getting saline only and nothing with medication in it like some eye drops.
Bottled water works just as well if you have to clean the wound. A bottle of sterile water or solution is no longer sterile as soon as it opens and hits the wound, at that point it contains environmental contaminants as well as whatever is in the wound. Bottled water is just as safe.ObiHann said: ↑
Bottled water works just as well if you have to clean the wound. A bottle of sterile water or solution is no longer sterile as soon as it opens and hits the wound, at that point it contains environmental contaminants as well as whatever is in the wound. Bottled water is just as safe.
I would respectfully disagree with the statement that sterile water loses it’s sterility once it leaves the bottle. Are you saying that as the water leaves the bottle and travels several inches through the air to the wound, it becomes contaminated? In an ER that is exactly how a wound is cleaned out. Your example of shards of glass does pose an interesting point though. If there are very, very tiny splinters of glass, then yes, water (under some sort of pressure) may push the glass into the tissue. In this case, forceps or tweezers would be used to remove the objects. But some sort of irrigation of the would would be done first. Dirt or other debris will be flushed out of the wound with simple irrigation. It is the same premise of washing a small cut at home in the sink before applying a band aid. And yes, bottled water is more than likely just as safe as sterile water. But sterile water IS sterile.cap6888 said: ↑
I would respectfully disagree with the statement that sterile water loses it’s sterility once it leaves the bottle. Are you saying that as the water leaves the bottle and travels several inches through the air to the wound, it becomes contaminated? In an ER that is exactly how a wound is cleaned out. Your example of shards of glass does pose an interesting point though. If there are very, very tiny splinters of glass, then yes, water (under some sort of pressure) may push the glass into the tissue. In this case, forceps or tweezers would be used to remove the objects. But some sort of irrigation of the would would be done first. Dirt or other debris will be flushed out of the wound with simple irrigation. It is the same premise of washing a small cut at home in the sink before applying a band aid. And yes, bottled water is more than likely just as safe as sterile water. But sterile water IS sterile.
Its the same truth for a bandaid, it is sterile until you open it. A ER is a sterile, controlled environment. In a ER there is no risk of car exhaust, cigarette smoke, pollin, dander, etc getting in the way. Also, you should in most cases NEVER remove foreign debree from a wound, more damage can be caused than prevented. If you have a clump of rocks in a open wound, that could be what clotted around the artery, when you remove it, you start the bleeding again. If it is something sharp, or longer than you think, you can easily shred a nerve or artery by removing it. Red Cross, St John Ambulance, etc all tell you in even the most basic half day first aid courses to not remove anything and be extremely careful when using any liquid. A even more extreme example, what if it is a chemical issue, perhaps you don’t even notice. By adding water you can move that chemical further into the wound and cause even further damage.ObiHann said: ↑
Bottled water works just as well if you have to clean the wound. A bottle of sterile water or solution is no longer sterile as soon as it opens and hits the wound, at that point it contains environmental contaminants as well as whatever is in the wound. Bottled water is just as safe.
All water dilutes the contaminants in the wound and carries them away, that’s why we wash them, sterile water adds no new contaminants. Bottled water is designed to be safe for your stomach which is not the same as an open wound as many things can aggravate the stomach that are safe on a wound and, more importantly, visa versa (Put your bottled water under a microscope and compare it to sterile wash). I’d go with bottled water for sure but I’d use sterile wash in preference if I had it. Anything in the air is already on the wound so the water will not be adding anything but will probably be carrying it away.As for your chemical comment the first aid treatment for chemical burns is lots of water as well, what do you think most of your body is made up of? Better the reaction is with water you have added than that in your tissues.
Both Obihann and VinnyP have points on chemical burns. Obi is right in the point that certain alkali chemicals can burn more with water added. But if you continually flush that alkali burn with COPIOUS (I am talking constant running water in large volumes) of water, then it will work.
I will stand my ground on the sterility issue. Yes sterile items can become contaminated when you open/exposethem. However, as long as you keep them out of any sort of dirty matter, they are better than using something non sterile at all. As far as debris in a wound, i still do agree, there are some items (such as glass) that can cause further damage if not treated properly. But how many of us have scraped gravel/dirt/sand, etc out of a wound? I don’t think clumps of rocks would clot around arterial bleeding. If anything, they need to be removed, so the artery can be appropriately manage.
Disclaimer: Just as an FYI, I am a paramedic, and served as a combat life saver in Iraq. My medical knowledge is a bit more advanced due to my various training. I tend to look at treating wounds differnetly than some.
cap6888 said: ↑
Both Obihann and VinnyP have points on chemical burns. Obi is right in the point that certain alkali chemicals can burn more with water added. But if you continually flush that alkali burn with COPIOUS (I am talking constant running water in large volumes) of water, then it will work.I will stand my ground on the sterility issue. Yes sterile items can become contaminated when you open/exposethem. However, as long as you keep them out of any sort of dirty matter, they are better than using something non sterile at all. As far as debris in a wound, i still do agree, there are some items (such as glass) that can cause further damage if not treated properly. But how many of us have scraped gravel/dirt/sand, etc out of a wound? I don’t think clumps of rocks would clot around arterial bleeding. If anything, they need to be removed, so the artery can be appropriately manage.
Disclaimer: Just as an FYI, I am a paramedic, and served as a combat life saver in Iraq. My medical knowledge is a bit more advanced due to my various training. I tend to look at treating wounds differnetly than some.
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I think were starting to all get on the same page. Like you said, some chemicals react with water and require LOTS of it, constant flushing. That’s more than you can carry for sure. As for having scraped gravel dirt sand or glass out of a wound, I have seen them all. Shattered glass from a kitchen in a hand, skinning a knee and having rocks and sand embedded, and so on, and so on. And as you said, your treatment is a bit different, because your training is much more advanced. Your trained to be able to remove a lot of the objects within a wound without causing excess damage, but the people that find a guy on the street, or see there buddy with glass in there hand, they are not trained. Heck, I am a first responder and I wouldn’t even start ripping debris from a wound.ObiHann said: ↑
Heck, I am a first responder and I wouldn’t even start ripping debris from a wound.I’m currently training to be an EMT…we are told you never pour anything into an open wound, no matter what it is (water or otherwise)…you dress it, bandage it, and get the person to the ER; if it needs cleaning out, the ER will do it.
ObiHann said: ↑
I think were starting to all get on the same page. Like you said, some chemicals react with water and require LOTS of it, constant flushing. That’s more than you can carry for sure. As for having scraped gravel dirt sand or glass out of a wound, I have seen them all. Shattered glass from a kitchen in a hand, skinning a knee and having rocks and sand embedded, and so on, and so on. And as you said, your treatment is a bit different, because your training is much more advanced. Your trained to be able to remove a lot of the objects within a wound without causing excess damage, but the people that find a guy on the street, or see there buddy with glass in there hand, they are not trained. Heck, I am a first responder and I wouldn’t even start ripping debris from a wound.
Yeah, I think we have met in the middle. And you are 100% correct, I think most people on this forum don’t have any advanced medical training, so simple is better. And to clarify a point (which I think is the point of contention here) when I talk about removing debris from a wound, I am talking more about “topical” stuff. Things that easily brush away like small gravel or dirt from falling off a bike sort of thing. If something is embedded, and would require some sort of pick up to be removed, then you have entered into another arena for treatment. Flushing a simple wound with either sterile water/bottled water/water from a faucet is still something I would recommend, but use caution when the wound is more serious.I think it is extremely important to focus on scope of training. If you are trained to clean a wound and remove and debris, power to you, go for it. If you are not, and you are simply going on what you think, than you can get sued.
ObiHann said: ↑
I think it is extremely important to focus on scope of training. If you are trained to clean a wound and remove and debris, power to you, go for it. If you are not, and you are simply going on what you think, than you can get sued.
:agree:ObiHann said: ↑
cleaning a wound is best left to people that are trained to do so. You can very easily push more debris into the wound and further into the body if you are not careful. In a metro area, your main concern should be controlling the bleeding, the hospital can handle cleaning the wound in there own controlled environments.
A good example, I cut my forearm open on glass, and inside the deep cut is shards of glass. When you start to clean the wound with water you can easily move some of the glass shards deeper into my arm, the hospital will then have spend much more time removing the glass, possibly dealing with nerve damage caused by your cleaning.
when you are bleeding heavily and pressure is applied to the wound, its the same thing? so why not try to remove a bit before you press them inward?My training is older than most in here so I may be out of date. I remeber ABCD; Airway, Breathing , Circulation, Disability or Damage. When it comes to causing damage to underlying tissues by applying pressure to a open and heavily bleeding wound, my guess is if the wound is bad enough to have the need for pressure to control it then you most likely wont see the debris that you need to remove. Also the need to control and stop bleeding for a major injury out weighs the possible damage that “MAY” be caused by the pressure. There are priorities in medical care and keepin the red stuff in the body is even before keeping the extremity working. Same is if they aint breething no need to worry about that bleeding until you get them breathing again.
When it comes to a wound that you “know” has harmful debris i.e. glass where direct pressure may be a problem you can attempt a pressure point for the paticular are of the body affect in an attempt to control the bleeding. All these scenerios are very dependent on the circumstances of the event and the training of the individual involved. If you aren’t trained to do it this day and age then don’t try it.
Like I said I was trained a while ago and have not been fully into the Paramedic world for sometime. I currently only keep my first responder up so if I am wrong then feel free to correct me.
My training is older than most in here so I may be out of date. I remeber ABCD; Airway, Breathing , Circulation, Disability or Damage. When it comes to causing damage to underlying tissues by applying pressure to a open and heavily bleeding wound, my guess is if the wound is bad enough to have the need for pressure to control it then you most likely wont see the debris that you need to remove. Also the need to control and stop bleeding for a major injury out weighs the possible damage that “MAY” be caused by the pressure. There are priorities in medical care and keepin the red stuff in the body is even before keeping the extremity working. Same is if they aint breething no need to worry about that bleeding until you get them breathing again.
When it comes to a wound that you “know” has harmful debris i.e. glass where direct pressure may be a problem you can attempt a pressure point for the paticular are of the body affect in an attempt to control the bleeding. All these scenerios are very dependent on the circumstances of the event and the training of the individual involved. If you aren’t trained to do it this day and age then don’t try it.
Like I said I was trained a while ago and have not been fully into the Paramedic world for sometime. I currently only keep my first responder up so if I am wrong then feel free to correct me.
Viper-
You are right in the order. Although the current NREMT mindset for bleeding control goes straight from direct pressure to tourniquets nowadays. After doing research in the war, they found that tourniquets work the best, and are not as harmful as once thought.
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