Irrigating a wound in an austere environment: "The solution to pollution is dilution"

  It must be said, always seek medical advice and a higher medical authority, but now that is out of the way. For those of you who are new to this, before you learn to suture, you need to learn wound care. Treating an open wound is a direct testament to,  "An ounce of prevention is worth a pound of cure." Aggressive irrigation is a basic, low-level medical intervention that is cheap and simple to perform. What's not to love? Your first response can save the wound from being infected, needing further antibiotics, or possibly having to go back in and debride or cut away tissue that isn't healing well. I find some new to the austere medical community are infatuated with doing sutures, yet don't know how to properly irrigate a wound... That is a recipe for infection and why we are here to talk about Irrigation, Irrigation, Irrigation.

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  Irrigation is flushing  wound with water in order to get all the "bad stuff" out. With an open wound such as a laceration (cut),  Keep in mind the saying, "The Solution to Pollution Is Dilution." running_wound_care3   It means don't be skimpy with your flushing, use a ton! Your skin protects us from many foreign bodies we take for granted, so when the skin is opened up, we need to be there for the wound. You now know the "why" of irrigation, next I'll go over some cost-effective and simple methods to irrigate wounds.

      " What fluid do I use... Normal Saline, Purified Water, or anything available?"

Normal Saline:  In an Austere environment, we don't have the luxury to stockpile Normal Saline and do an irrigation as clean as we'd like in a hospital room. It's simply not cost effective, or worth its weight in a Rucksack as far as I'm concerned.  Many studies have come out referencing potable water's effectiveness rivaling, if not exceeding the effectiveness of N.S.

Purified Water: If you have enough stored, I'd recommend "Pool Shock" granular calcium hypochlorite over Bleach. Both work just fine, however Bleach has a short shelf life of around a year as opposed to nearly a decade with properly stored pool shock. While boiling water is the best for purifying drinking water, you may not have those capabilities for wound irrigation on you.

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⦁ Non-Potable Water: Water that is not safe for drinking or has not been tested or purified is still good to go for wound care if you have to in an austere environment. The benefits of a flush from a non-purified water source outweigh the risks. The benefit with using a local body of water or other source is you are not as worried about wasting a finite resource and can afford to be as aggressive as needed.

  As you can see, it's not a big deal about how purified the water is or what is in it. You want to use a ton of water and most importantly you want to create enough pressure.  I recommend you act like you KNOW something is crawling around on the surface, so you don't underestimate how much you need. [caption id="attachment_1411" align="aligncenter" width="300"]2315700 Povidine iodine solution[/caption]

" What can I use to irrigate this wound?"

  1. The most obvious choice is using a syringe as previously shown in previous pictures. If it's not an Irrigation Syringe, using an 18G-20G catheter will increase pressure more than using the syringe by itself. When using a Catheter on a syringe to draw your irrigation fluid, hold it approximately 1/2" to 1" inch away from the wound and steadily keep pressure. Whether a syringe is 10cc, 30cc or 60cc or any other size, it can be used for many roles and is an easy addition to any medical kit.   2. A second option would be using a bottle, preferably 2L but smaller can work, too.  Poke a couple of holes, but keep them small so you can still maintain high pressure by squeezing the bottle.   Remember its the turbulence that knocks loose the sticky stuff, that's why we strive for a jet like stream when we irrigate. two-holes-drilled-into-lid-of-bottle

[caption id="attachment_1412" align="aligncenter" width="271"]    ( Urine not recommended for wound irrigation, This is purely comic relief ) ( Urine not recommended for wound irrigation, This is purely comic relief )[/caption]   There are endless ways you can improvise, even an old fashion turkey baster and flavor injector will work. This is less about a strict set of ways and more about getting the job done right. After the thorough cleaning place a clean bandage on the wound; Now find a Medical Pro, Get Them to One, or Be The Medical Pro, as discussed in the article: "Where Are The Doctors? The Reality of Casualty Evacuation in an Austere Environment." [caption id="attachment_981" align="aligncenter" width="300"]Firearms, Tactical & Defense Training Tactical Ranch: Firearms, Tactical & Defense Training[/caption]
Last modified onThursday, 20 April 2017 06:31
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