should you replace an avulsion flap of skin if its covered with gravel?
- Thread starter wutthedutch
- Start date
Do you think it isn't going to be washed when it gets to the hospital?
How long does it take for any bacteria to overcome the immune response?
Did you know that most infections are caused by the patients own flora?
Whether or not the patient gets an infection probably has more to do with what is done when it is reattached than what is done in the field.
Maybe it is a difference in our training, I'm a wilderness responder so I have to think more long term, but I feel it would be irresponsible to not thoroughly clean the avulsion with aseptic fluid prior to bandaging. Whether or not I was going to close with steri strips would determine how thoroughly I clean.
I know abscesses can form in minutes, so even with an urban situation of thirty minutes injury to ER you may have the beginnings of infection to show. Furthermore if you decide not to replace the avulsed flap because it hasn't been cleaned, you may prevent some capillary circulation by the position you transport in.
I know abscesses can form in minutes, so even with an urban situation of thirty minutes injury to ER you may have the beginnings of infection to show. Furthermore if you decide not to replace the avulsed flap because it hasn't been cleaned, you may prevent some capillary circulation by the position you transport in.
mycrofft
Still crazy but elsewhere
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Please, ask someone who has had to perform delayed debridement
Even in a delayed response situation, the only justification for closing a presumably septic and/or foreign-object contaminated wound would be save the life. Like deadly bleeding that didn't respond to packing, or deep chest wall penetration.
In the field, and especially in a wilderness situation, (read lips) you will not be able to adequately clean an avulsion to prevent either infection, or foreign object reaction to the dirt etc. Hard to do even in a clean fully equipped facility. You could conceivably find a way to scrub it, but the result is (degree dependent upon the size and site of the injury) excruciating agony, potentially more injury to the avulsed tissue, and the near certainty the site will still be contaminated. Positive thinking does't come into this.
Having seen the follow-up care for such cases, I know aiming for facilitation of later debridement and allowing the avulsion to fall back into a nearly correct position to help allow peripheral circulation are uppermost, not some armchair argument about how to clean it enough to replace or (!!!) steristrip it back into place. It will rot off, unless you are extremely lucky, and/or heal with tattooing, and could potentially lead to anaerobic sepsis.
Promptly rinse with potable or sterile solution and take out the pine cones and pea gravel. Intimately dress with sterile saline or potable water wetted gauze. Get to care. Treat other problems. Ask about tetanus status.
Even in a delayed response situation, the only justification for closing a presumably septic and/or foreign-object contaminated wound would be save the life. Like deadly bleeding that didn't respond to packing, or deep chest wall penetration.
In the field, and especially in a wilderness situation, (read lips) you will not be able to adequately clean an avulsion to prevent either infection, or foreign object reaction to the dirt etc. Hard to do even in a clean fully equipped facility. You could conceivably find a way to scrub it, but the result is (degree dependent upon the size and site of the injury) excruciating agony, potentially more injury to the avulsed tissue, and the near certainty the site will still be contaminated. Positive thinking does't come into this.
Having seen the follow-up care for such cases, I know aiming for facilitation of later debridement and allowing the avulsion to fall back into a nearly correct position to help allow peripheral circulation are uppermost, not some armchair argument about how to clean it enough to replace or (!!!) steristrip it back into place. It will rot off, unless you are extremely lucky, and/or heal with tattooing, and could potentially lead to anaerobic sepsis.
Promptly rinse with potable or sterile solution and take out the pine cones and pea gravel. Intimately dress with sterile saline or potable water wetted gauze. Get to care. Treat other problems. Ask about tetanus status.
Always BSI
Forum Lieutenant
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Had a similar question when I took my EMT written exam at AMR. I wont dare say what I picked I don't want to get flamed, lmao.