I’ve been thinking about wound care. Developing The Place and other prepping or emergency activities often involve sharp tools, lots of muscle, and people doing tasks they don’t do every day — good conditions for traumatic injury. I’m no expert on wound care (Not a doctor so these are not specific recommendations), so I’ve been reading up.
Wound Care – The What and Why of Debridement
Debridement of wounds comes up a lot, no matter where I look for wound care. To ‘debride’ a wound is to get rid of anything that’s not healthy tissue and may interfere with wound healing: foreign materials like bits of dirt and wood, dead tissue, eschar (think of the hard cap of scab that forms on a skin wound), etc. For an acute injury for which you can seek medical attention, it’s pretty easy: Control bleeding but don’t otherwise mess with it and get to the medical care.
If there isn’t anywhere to go for professional help it gets trickier. It’s important to debride wounds. Does anyone seriously expect rinsing with water to get out all the bacteria? Absolutely not; that’s not happening. The goal is wound care to reduce the bacterial load in the wound; it’s understood that the victim’s immune system must finish the job. Rinsing helps a lot though, as the dirt in the wound is full of microbes, and your own dead tissue can also host plenty of microbe growth.
Besides removing bacteria, tissue that isn’t healthy needs to come out because it will be in the way and will delay healing. The immune system will wall off anything it can’t break down, and the resulting cysts interfere with proper reorganization as the wound heals.
Here’s me not posting an image of a wound that needs debridement wound care. You’re welcome.
Wound Care – What Method to Use?
Some methods of debridement are technically tricky enough that I’d be very hesitant to try then and more hesitant to try and describe how to do them (such as sharp debridement where you cut out the dead bits — the trick being determining what stays and what goes). Also in this camp is autolytic debridement, where docs essentially seal up the wound to let natural healing processes do the dissolution of the dead parts. What makes me shy away from that is the way the experts do note that this approach can encourage anaerobic microbe growth if not appropriately applied. Gangrene is nobody’s idea of fun. And yes, maggots will debride a wound but they’ve got to be the right species and themselves be clean – not something I want to guess about.
So what I’m going to do for home use is make sure to keep an effective tool for mechanical debridement by irrigation on hand. In other words, a good tool for washing out the wound. Why this one? The pros agreed it was one effective method and had less room for error than alternatives. Also, it’s very workable in a prepper setting.
Not the right equipment for wound irrigation … but the right theme. Thanks Alupus* for the image.
Wound Care – Materials for Irrigation Debridement (Wound Washing)
What is needed is a wound care tool to produce a moderately strong stream (4 to 15 psi suggested, 10-15 psi favored) of wash fluid; and the fluid flow might have to be angled this way and that….so what could I stock that would do that job?
Laugh away, I did, but here’s what I came up with:
Portable bidet bottles have a good aiming and streaming nozzle. Please don’t use the same bottle for the wound and the labeled use.
Bonus: Also good for, er….diaper rash, adult variety; and eye irrigations (essential when anything foreign gets into an eye).
Wound care – What fluid to use to irrigate?
There’s a little lack of consensus here, with some going for isotonic saline (that’s ½ tsp table salt per cup of water), while others find better results with plain clean water. I’ve decided to go with water. The critical thing is that the water be clean.
Although I’ve seen no research on this, I suspect physically purified water (ultrafiltered) is better than chemically decontaminated (bleach, iodine, or the commercial tablets) but that either is better than potentially microbe-laden. Bringing the water to a boil is also a worthwhile approach, better yet if it’s filtered first.
I keep some sterile water on hand produced by the simple method of running a few jars through the canner one day when I was making pickles and had space for extra jars.
Water for irrigation needs to be clean (safe drinking) but not sterile…but that’s what I’d use, preparing jars whenever I happen to have room in the canner.
Plenty of clean linens/towels to soak up the overwash will keep the work area cleaner. The wound will need to be bandaged as usual afterwards, so those materials should be on hand.
How to debride by irrigation as adapted from the advice of Laurie Swezey, a registered nurse and certified wound care specialist (http://www.woundsource.com/blog/8-key-steps-performing-proper-wound-irrigation)
Wound care – When to debride?
Not when the wound is bleeding heavily.
Before every bandaging for most wounds.
Wound care – How is the irrigation debridement done?
The person performing wound care should put on personal protective equipment including goggles and gloves. It’s best not to share blood, and this procedure invites it.
These should be in your med kit; and are recommended when caring for wounds.
The person with the wound should be situated so the irrigation fluid will flow from the cleanest part of the wound toward the dirtiest, and the overflow fluid will get sopped up by the towels.
Irrigate the wound. It’s suggested to be thorough without driving the fluid up into tight crevices, as that can shove bacteria into spaces low in oxygen. Some bad bugs like that kind of habitat. In trying to visualize what “4 – 15 psi” of wash pressure would look like, I’m supposing a flow hard enough to rinse visible pieces loose, but not restart serious bleeding or cause major splashback.
The wound is patted dry with something sterile and can be rebandaged.
Note: I read through a variety of different sources to come to my conclusion of how I’d handle debridement. There was a strong consensus of information; the only challenge was adopting information meant to inform current patients and practitioners to a ‘what if’ prepper situation. One site that had a lot of aspects in a single site was woundsource.org.
*By Alupus (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
You should check out hydrotherapy for wounds. We used it on our horses when they would cut themselves and I used it on myself as well and it worked very well.
I did read up on it a bit. It wasn’t clear to me how to keep the water clean enough in a prepper situation. That’s always a concern with water baths in lab work. That may just be because I was only reading it and haven’t seen it in action.