Tuesday, May 7, 2013

Wound Care 101 For Dummies

For today, a few thoughts on that hole you made in your slipcover:

Prior to the dawn of the 20th century, and inoculations and antibiotics, "simple" cuts and scrapes that turned septic accounted for a respectable number of annual deaths.

So for your general fund of knowledge, if you cut, punctured, burned, got bitten by anything*, or otherwise screwed up the factory finish on your shiny pink carcass, unless you were bathing in Betadine at the time, it's infected.

Now, mind you, your ordinary immune system can handle quite a bit, but there's nothing quite as good as prevention when it comes to infections, which is 100 times better than treatment after you gave it a good head start. So let's cover the highly secret, only available to medical professionals, revealed in secret lectures during training, method to prevent a lot of trouble for you:

Go to the sink or shower, and wash out the wound. Using soap isn't a bad idea either.

If you have phisodermahexagoo, great, but plain old soap isn't bad either.
If you have a bottle of Betadine (Solution, NOT Scrub), and you aren't allergic to iodine, please, alternate that with the washing, i.e. water-betadine-water.

Quite literally, lather-rinse-repeat.

Every medical student learns "The solution to pollution is dilution.", right?
So keep washing, and washing, and washing, until it's really next-to-godliness clean.


Yeah, yeah, call the waaahmbulance, and get over it. The treatment for losing a pint of blood is...wait for it...a glass of orange juice and a cookie. That's how the Red Cross treats people who donate a full pint, 24/7/365. Unless you're spurting blood forcefully, you aren't going to lose a pint washing the wound.

While you're washing it, take note:
Is it all the way through the skin? (i.e. can you see some of your stuffing down inside there, like fat, muscle, tendons, bone, etc.)
If that answer is "Yes", you've already answered the "Do I need stitches/staples?" question.
Finish washing it out, cover it with clean gauze pads, and wrap it securely. You may need to apply firm pressure for several minutes, and elevate the part higher than your heart, to get the bleeding to stop. If we're talking arms, legs, or head lacerations, there isn't much likelihood that you can't control the bleeding, unless you have underlying issues like being a hemophiliac, or if you're taking aspirin or coumadin every day to decrease your risk for things like clots, strokes, and heart attacks. If that's you, take a few more minutes with the pressure and elevation.

Once things are stabilized, have someone take you to the ER.
If they don't stabilize, call 911 to take you to the ER.

And when you get there, one of the first ten questions we'll ask is "When was your last tetanus shot?"
If it was less than 5 years, you're good.
Between 5-10, or for larger wounds, you may get a booster.
If it was more than 10, OR YOU DON'T KNOW, you're getting a booster.
{Hint: Write "Tetanus booster", and the date, on a Post-it, and stick it to the back of your driver's license. Then you'll have it, without having to remember it.}

The description of someone who dies of tetanus (old term "lockjaw") is one I reread recently, from an early 1900s era description. Picture someone bent like a bow, with their head and heels touching the bed, and their body arched to the ceiling, as all their muscles go rigid (tetany) until they finally die from asphyxiation from paralysis of the muscles of breathing, fully conscious, dehydrated, hungry, and in incredible pain, with no possible cure, as they suffocate. That's what happens when you don't get your booster, if tetanus takes over. It doesn't live on rusty nails, it's everywhere. The spores sit dormant on everything forever, including in the dirt on your skin, and if they get in you, and make a home, and you don't have current immunity from inoculation, put your affairs in order.

Or stop crybabying, and take the shot.
I usually ask my patients: Shot? Or Horrible Death? Shot? Horrible Death?
I have yet to be turned down, although I've seen some godawful crybabying and whining.
Please don't be That Guy.
(Though if you're the 6' 275# Crip with four gunshot wounds, who's crying about a 1" needle like I was going to castrate you, I'll probably blog about you too, just like that giant pussy.)

That's it. They numb the area with a local anesthetic (another couple of shots) then when you can't feel it, they clean it out some more, make sure you didn't slice anything else more important, like tendons or blood vessels, they stitch or staple it closed, you get them out in a few days: problem solved.
Keep it clean, dry for a couple of days to let scabbing seal the holes, and watch for infection signs, then keep the follow-up appointment to take them out. This isn't rocket science.

Now, about all those other things you want to do.

Hydrogen peroxide: it bubbles up, and looks all sciency and high-tech.
Unfortunately, it only kills organic stuff, and only what it hits. It doesn't penetrate very well. And it stings, because it's killing healthy tissue. It's better than rubbing doggie poo in the wound, but it's not a good choice unless your only alternative is the doggie poo.
(Save it for getting the blood stains out of clothing - like scrubs; ask me how I know - carpeting, and upholstery. Like if you need to move the body before the cops get there.)

Alcohol: kills germs, if left in place for 10-15 minutes. During which time it's slightly more comfortable than pouring scalding lava on the wound, and that's once again because it's also killing healthy tissue. Save this for people you really, really loathe, and be sure to duck after you put it on, because they're going to swing at you - once they let go of the ceiling.

Merthiolate: (or, as Bill Engvall calls it, "monkey blood"). A tincture (weak solution) of iodine, popular with people from circa 1930-1960. If you're going to use iodine, don't dabble. Get Betadine, and go full strength. You're supposed to be doing first aid, not art class.

Everything else that's not water, betadine, or topical antibiotic ointment: probably belongs in the same category as doggie poo.
This includes butter, Crisco, dog spit (hey, ever notice that dogs eat their poo?), and most other magical witchdoctor concoctions your grandaunt, shaman, or witch doctor told you would work. The only exception is topical honey, provided it's covered with the same clean dressing afterwards, you're on a desert island, and there's no drug store or ER anywhere.

If your wound is superficial, not requiring stitches, your tetanus shot is up to date, and you decided to skip the ER visit, put some topical antibiotic ointment on the injury, dress it with a clean gauze and a good wrap, and change the dressing daily, watching for any signs of infection.
If you see any, come in anyways.
Ditto if you waited over 12 hours for something you knew needed stitches, but you're lazy or brain-challenged. We aren't going to stitch it up after half a day, but you may still want/need the tetanus booster or antibiotics, especially if you noticed it's growing red streaks up your arm/leg, or it's huge, hot, painful, and/or draining nasty pus.

For the other 90 million people who can't grasp this, we'll be ready and waiting to scrape the peanut butter, drywall spackle, axle grease, and every other wild thing out of the holes and treat the wound. For the few folks who read this and pay attention, thanks. This'll just be our little secret, 'kay? 

*("anything" includes, but is not limited to, power tools, power fools, people, dogs, cats, small pets, large pets, wild animals, fish, birds, reptiles, insects, velociraptors, vampires, werewolves, Bigfoot, and alien embryo implants bursting from your chest. Clear?)


  1. Acceptable in "medication of any kind not available here" situations: clean it with salt water(boil water, add salt, do not use sea water) and put sugar in the wound. Yeah regular old granulated sugar has anti microbial properties.

  2. If you can boil water, you've reached the gold standard of aseptic cleansing. Best to stop there.

    At that point, adding salt (hoping you get the concentration close to correct), followed by sugar, which may have some antibiotic properties, but is also a growth medium for bacteria, has a strong likelihood of becoming counterproductive. Plus you'll need the spices for your survival rations. ;)

  3. I always felt that wound care nurses were very valuable. I was taught a lot in terms of taking care of myself thanks to their wisdom from proper dressing to using tegaderm products. I'm glad I went to see one after my surgery. It helped my recovery a lot!