# Wound care



## BateMan (Jun 5, 2013)

is there anything in specific about wound care?

for all I know, its just gauze/bandage/direct pressure for bleeding, and H2O2 for cleaning. 

do i put the hydrogen peroxide on first then bandage?


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## DesertMedic66 (Jun 5, 2013)

H2O2 will just clear up surface debris. The wound should be thoroughly irrigated (something we can't do in the field). For our treatment it is clean off what we can/ stop the bleeding/ and keep anything else from getting into the wound.

Edit: should have also mentioned that H2O2 will kill cells and slow the healing process.


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## chaz90 (Jun 5, 2013)

Hydrogen peroxide isn't really that good at disinfecting tissue and isn't great for healthy tissue either. Those bubbles you see when it contacts blood aren't "killing germs." That's a reaction from catalase in blood that releases O2, which does mean that hydrogen peroxide does an awesome job of getting blood stains out of fabric. That's the only thing I ever use it for on an ambulance.


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## Household6 (Jun 5, 2013)

The only thing you should ever use hydrogen peroxide on, is to remove blood stains from your uniform..


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## Amberlamps916 (Jun 5, 2013)

Household6 said:


> The only thing you should ever use hydrogen peroxide on, is to remove blood stains from your uniform..



True that


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## Tigger (Jun 5, 2013)

Copious amounts of saline are all we ever used to clean wounds. Wound wash saline shoots like 15 feet out of the can, stuff hurts but works real well though.


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## milehimedic (Jun 5, 2013)

In the ED here the techs use baby shampoo and saline to clean wounds, oddly enough.


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## troymclure (Jun 6, 2013)

milehimedic said:


> In the ED here the techs use baby shampoo and saline to clean wounds, oddly enough.



oddly enough when i deployed to iraq our medic/combat lifesaver pallet had several cases of baby shampoo. as far as i am aware it was used for showering, not wound care.


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## Akulahawk (Jun 6, 2013)

I'm going to flat out say that you should NEVER use Hydrogen Peroxide to clean wounds. While it does kill many microbes, it also kills vital tissue that it comes into contact with. Use of the stuff increases healing time by several days because the body then has to clean up all the dead tissue that you just caused along with all the other debris in the wound. I haven't used H2O2 for wound cleaning in probably close to 20 years. 

Saline works, if you're simply washing out wounds. Mechanical wound cleaning hurts like the ****ens. Baby shampoo should work to a degree and shouldn't irritate wounds much. It certainly won't sterilize the area though. I'm going to have to look into that idea... might be something to think about for future wound cleaning endeavors.


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## the_negro_puppy (Jun 6, 2013)

What wrong with good old chlorhexidine


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## Household6 (Jun 6, 2013)

Know what I like? Long term wound care. My spouse was kind enough to grow a massive sebaceous cyst on his chest that required daily packing.. I loved that.


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## chaz90 (Jun 6, 2013)

Household6 said:


> Know what I like? Long term wound care. My spouse was kind enough to grow a massive sebaceous cyst on his chest that required daily packing.. I loved that.



I don't think you're in the majority for liking that kind of wound care. Good on you though.


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## mycrofft (Jun 6, 2013)

Emergency wound care: stop bleeding. Use gauze and don't use ointments and creams before transport to ER. Any goo you put on will need to be cleaned off. Betadine: it can be de-colored from the wound  with peroxide, not that big a deal.

Peroxide: I did dressing changes for twenty years, including coming back to the same patients day after day and seeing how different approaches worked.  Peroxide is a bleach, and it kicks arse on anaerobes. It will kill any tissue if left on long enough and full strength (which for medical is like 2%), so apply, then rinse. Not using peroxide and letting foreign matter clot into the wound (especially abrasions) or letting staph etc. get going: going to lose lots of tissue plus have to fight an infection. 

If it is a bad and dirty abrasion or other open wound in the field, put a sterile saline gauze on it*   then DSD cover, cleaning at the ER will be easier.

I had doctors writing orders for daily bacitracin dressings with telfa, after a week no progress or got worse (greater induration, hot to touch). I'd get a phone order for a peroxide cleanse then saline or betadine dressing, and we'd be closing with good granulation in three or four days sometimes. (Yes, full strength betadine kills cells too, but so does staph, strep, pseudomonas, and foreign object rejection reactions. Dilute with a sterile solution or at least potable water, use to cleanse, then clean it and dress it).

I mean, follow your protocols.


* The term "intimate contact" for these dressings is appropriate; make sure all the wound surface is in a sure firm contact with the compress material.


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## Household6 (Jun 7, 2013)

chaz90 said:


> I don't think you're in the majority for liking that kind of wound care. Good on you though.



The doc at the VA let me watch the removal, it was amazing.
DH's platoon's 68Ws and I would battle over who got to pack it. They said they needed the practice..:glare:

Sterile water irrigation was all it needed.


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## eonefireemt3 (Jul 13, 2013)

Peroxide is awful stuff and should never be used to clean a wound. To flush a wound, I like to use bottled water. After that, I like to use a wet to dry bandaging techniques by wetting gauze with normal saline, cover the wound, then a layer of dry gauze over that, wrapped over with cling wrap.


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## Medic Tim (Jul 14, 2013)

Unless it is a complex lac I will suture or glue it after cleaning and debriding as necessary. For abrasions it is usually just a clean and bandage. They will have a follow up with me.the next day. I have also had to do some antibiotics as a few were quite contaminated and they waited a while before coming to my clinic.


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## Carlos Danger (Jul 14, 2013)

chaz90 said:


> I don't think you're in the majority for liking that kind of wound care. Good on you though.



Interestingly, some of the people I've known who were most passionate about their jobs were wound care nurses. Very low turnover in that specialty, and if you ask them most will tell you they absolutely love what they do.

For sure it's not for everyone - I've never had any interest in it - but there must be something about it....


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## phideux (Jul 14, 2013)

Hydrogen Peroxide, Chlorhexidine, Glue and Sutures, Baby Shampoo??? I though this was a BLS discussion about pre-hospital wound care.

Do you folks carry all that stuff in your ambulance?????

To the OP, ditch the Peroxide for the reasons already mentioned, If you have a wound with alot of debris, some saline or sterile water to rinse some off, wrap it up in some clean, dry bandages, give them a ride in your Boo-Boo wagon.


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## Medic Tim (Jul 14, 2013)

phideux said:


> Hydrogen Peroxide, Chlorhexidine, Glue and Sutures, Baby Shampoo??? I though this was a BLS discussion about pre-hospital wound care.
> 
> Do you folks carry all that stuff in your ambulance?????
> 
> To the OP, ditch the Peroxide for the reasons already mentioned, If you have a wound with alot of debris, some saline or sterile water to rinse some off, wrap it up in some clean, dry bandages, give them a ride in your Boo-Boo wagon.



I have a clinic in the northern alberta oil fields. We don't carry the suture trays or antibiotics in the ambulance but we do in our clinic.
I never read the first page and didn't notice until now this was in the BLS area.


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## Tigger (Jul 14, 2013)

phideux said:


> Hydrogen Peroxide, Chlorhexidine, Glue and Sutures, Baby Shampoo??? I though this was a BLS discussion about pre-hospital wound care.
> 
> Do you folks carry all that stuff in your ambulance?????
> 
> To the OP, ditch the Peroxide for the reasons already mentioned, If you have a wound with alot of debris, some saline or sterile water to rinse some off, wrap it up in some clean, dry bandages, give them a ride in your Boo-Boo wagon.



I have glued many lacerations working as an EMT for a sports medicine department. Not that hard, works pretty well. Irrigation and non-suturing closure were well within my job duties.


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## Ripcord2015 (Jul 14, 2013)

I loved that I got pick scabs for a living for several years in a few ICU's. 

My favorite was Trauma and Burn, I had a patient who had cut his finger off 

and we were trying to reattach his finger using leech therapy. I was giving 

morning report coming of of night shift as we walked by the patients room 

his finger was on the floor, I instantly thought of Monty Python and I 

cracked.

I started laughing so hard I ran into our lounge only to got yelled at. I wiped 

the tears from my eyes from laughing and went to apologize to the patient. 

As I tried very calmly to explain this to the patient, he started laughing and 

could not stop. I could not help it, I started laugh so hard I almost fell over.

As the patient and I where trying to gain composure of ourselves, I hear

what is going on in here, Purple Twinkies I am busted again by the same 

nurse. As I received the look of death, the patient has not stopped giggling

 in background and I started laughing again I just could help myself. Thank 

God for the patient being a Huge Monty Python fan, and refused to make 

any complaint. A week later I received a card that had Monty Python the 

front I opened the card and It said"that was the best time I ever had in a 

hospital thanks". I still have the card to this day and yes I still giggle about 

the incident when I see Monty Python.:rofl: Ripcord2015


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## Anjel (Jul 14, 2013)

We carry peroxide on our truck. I've never used it.

I usually flush the wound with saline, brush off any big pieces of dirt, and bandage.

When I worked medical standby at the tough mudder however.... They had hundreds of bottles of the stuff. It was in spray bottles and people would come in and get doused in it. It was used for cleaning and irrigation. I refrained from using it as much as I could, but it did get the job done.


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## Handsome Robb (Jul 14, 2013)

Just rub some dirt in it...


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## EMTnurse (Jul 14, 2013)

Household6 said:


> Know what I like? Long term wound care. My spouse was kind enough to grow a massive sebaceous cyst on his chest that required daily packing.. I loved that.



I love working with the wound-vac nurse on the trauma floor that I work on.


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## mycrofft (Jul 15, 2013)

Hated to receive field closures, especially J&J "butterflies". Remove field stuff, determine if wound was properly debrided and if it required plastic quality suturing, or vascular surgery, etc., clean the cement off the edges, then often as not having to help it close by secondary intention (open it up wider still surgically then do dressing changes until it granulates and scars from the bottom up).

Suturing used to be a primary means to control battlefield bleeding until the infection rate was scrutinized.

Note: this may be a reiteration, but promptly applying a means to slow clotting/scarring (abx ointment, damp dressings under a dry cover, Adaptic or Xeroform) make it easier to debride (e.g., scub) in the receiving facility. Do not do a peroxide wet to dry, however.


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## jefftherealmccoy (Jul 17, 2013)

Peroxide- no. Got it.

Rubbing Alcohol?


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## EpiEMS (Jul 17, 2013)

jefftherealmccoy said:


> Peroxide- no. Got it.
> 
> Rubbing Alcohol?



Would think that it'd have the same problem as peroxide, no?

Soap and water for me.


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## DesertMedic66 (Jul 17, 2013)

jefftherealmccoy said:


> Peroxide- no. Got it.
> 
> Rubbing Alcohol?



Ouch. Might as well use vodka so the patient can take a couple of shots before hand haha


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## Handsome Robb (Jul 17, 2013)

DesertEMT66 said:


> Ouch. Might as well use vodka so the patient can take a couple of shots before hand haha



If a medic handed me a bottle and told me to take a few swigs I'd happily oblige...you don't have to threaten me with a good time!


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