Wound dressings/bandages

[Jonas Parker]

The question came up as we had some friends over last week: what are the best bandages? I explained that when treating a wound, the material touching the wound was a "dressing" while the material(s) securing the dressing to the wound was/were the "bandage". Once we were on the same page, I recommended a telfa pad covered with bacitracin as a pretty-much universal dressing for anything other than a sucking chest wound or a burn, though it might work on a sucking chest wound if it seals off the air to the thoracic cavity.

I also recommended "Kling", a "self-adhesive" gauze put out by Curity, or it's Johnson & Johnson equivilant. Since this is rather expensive stuff, and somewhat bulky to boot, I have about 20 rolls of 4"X6' "headroll", thick gauze to hold on dressings. I'm not particularly worried about sterility with the gauze, since it's merely holding the dressing in place, and is not in direct contact with a wound.

Finally, I recommended the "Nam"-era sterile dressings that the Army issued, which are available in most Army-Navy stores, still in their original sterile wrappers, for maybe a buck apiece.

Does anyone else out there have a different approach? If so, please let me know.

[Dr. X]

The question came up as we had some friends over last week: what are the best bandages?

I would've guessed Ninja Turtles or Blue's Clues...:p (I still owe you fer the "photography interpretation". Gawd! :D )


as ever,
Dr. X

[tedbo]

I have heard that for flowing wounds a Tampon would work as that is what they were meant for,eh?i have not been shot,cut or ripped up that bad (yet!)but I have some in my bob if I ever got that injured.It really does sound like a feasible cheap alternative.Anyone else?

[SwampFox320]

As I threw up a little in my mouth and then suppressed the 15 year old inside, I started thikning... man, ted's right, that is what they are designed for, could it work?

Jason 8D

[tedbo]

SwampFox,yup,I didn't like the idea of a TAMPON either,but it and a piece of cellophane or plastic would do the trick of closing a gaping hole in the chest if I were to ever get shot and immediately killed.I thought about it after seeing the video of someone getting knifed and not able to get an ambulance in any amount of time.
I would do the tampon if needed ,but I could really care less if it matched my ninja turtle band-aids!:D

[tedbo]

Come to think about it,why not put a baby diaper in your bob?It could be used to cover a larger area.:p I know,I know,......"that boy ain't right!"...some of us would prolly draw the line in there somewhere.I think of this only 'cause I remember when I was 5yrs old and fell out of a treehouse I was not supposed to be in and scratched the livin' hell out of myself on the way down.It is a wonder I am still here as I fell about 20-25 ft!My left armpit and chest area were one big case of roadrash from a few boards that broke on my way down.
I don't know,the chances of ever REALLY needing a diaper would probably be slim to none,just trying to get other folks thought juices goin'.

[Dr. X]

I didn't like the idea of a TAMPON either,but it and a piece of cellophane or plastic would do the trick of closing a gaping hole in the chest if I were to ever get shot and immediately killed...D

If you are shot and immediately killed a tampon is gonna be of little or no consequence. You'll be too dead to be indignant! :D :D :D

as ever,
Dr. X

[Dr. X]

Come to think about it,why not put a baby diaper in your bob?It could be used to cover a larger area...

And it could serve double-duty replacing the drawers you shat in a particularly hot firefight...:p

as ever,
Dr. X

[tedbo]

YUP!:eek:

[DrBaboon]

I know that Professor Parker is up to speed on this, so I'm mostly looking to encourage discussion among other members. His post lends itself to that discussion.

Reading the replies so far, it sound as if people are mostly focused on blood flow.

So... What happens when you have to remove the dressing?

I'm not in any way trying to say you can't remove the dressing, but I am encouraging people to anticipate what may happen when doing so.




JP also mentioned sucking chest wounds, which is an example of a wound type that may not be well suited to gauze or other absorbant materials.



Next question: Does gauze (or other common absorbant materials) encourage or discourage wound healing (with continued application to a wound)?

NOTE: There is no inherent conflict created by using expedient dressing materials to assist in controlling blood loss, or performing initial dressing of a wound. The problem comes in after the initial wound care, when people continue to duplicate the initial dressing of a wound for days-weeks-months without considering other methods.

So let's stir the pot a little more.

[Jonas Parker]

I think the use of a tampon in a wound would probably cause more problems than it would cure. I can imagine debriding a wound with little cotton fibers spread widely throughout the tissue... and that's something I'd just as soon not have to do. On the other hand, peri-pads (Kotex) work great as a pressure bandage because of their absorbancy, and since they're covered with gauze, there's little chance of contaminating a wound with stray fibers.

As far as healing is concerned, gauze has a tendency to merge with dried blood or a scab... remove the gauze and you've probably got some bleeding to control again. We used a lot of Telfa both post-op and in the ER because it tended to lift cleanly from a wound without reopening it. Another option is Vaseline Gauze, a sterile thin gauze impregnated with petrolium jelly. Personally, I think Telfa coated with Bacitracin works better...

[Goldenspurholderx2]

I do like the Army's current issue Israeli Bandages. They have a small device on them for tightening them down to apply pressure to the wound. I also like the one handed tourniquets too. If you know what you are doing you can shut off or just slow down the blood flow to the limb long enough so someone doesn't bleed out before they can get medical treatment. I have seen but never used the new cellulose bandages that are supposed to help clotting. I have seen Quick Clot in use and the best way to describe it is the old west movies where they put gun powder on a wound then light it.

[tedbo]

If you are shot and immediately killed a tampon is gonna be of little or no consequence. You'll be too dead to be indignant! :D :D :D

as ever,
Dr. X

I meant to say -not immediately killed.My typing is not the best.But ya got me!:p

[tedbo]

OK,y'all are makin' my head hurt!I don't know squat about THAT type of first aid.That is why I bow to those that do.I know that I MIGHT have a veterinarian in the neighborhood if/when the shtf,but I really don't see me banking on it.I really need to get the training to save wife,neighbors,family,friends or myself when that type of medical help is not available.
I have difficulty right now of getting enough hours in the day to play catch-up in the things that slid off my plate since I got hurt in April.I am really praying that I can get caught up and in SOME sort of training of first-aid before the bottom falls out.I would very much like to get in the position of being able to help me/mine and my trusted friends if/when that is all we have for any kind of safety net.
As it is now,if I get hurt again I will be fixin' myself as I have no medical insurance at all.Talk about being driven!

[DrBaboon]

As far as healing is concerned, gauze has a tendency to merge with dried blood or a scab... remove the gauze and you've probably got some bleeding to control again.

I agree with JP.

Now, to come at it from another side, even with the problems associated with gauze use, we don't usually get into trouble in the short run by using gauze - other than restarting bleeding when it's removed.

The more difficult problem comes with ongoing use of gauze in a wound that has not healed. IOW - doing something with gauze for now, for a short period is one thing. Continuing to use it for days/weeks/forever is counterproductive.

RATIONALE: Removing gauze is a method of debriding a dirty wound. The junk sticks to the gauze. Gauze is not a good way to get wound to heal, because healthy tissue that could contribute to healing is also removed when it sticks to the gauze.

JP's plan of telfa-type dressings and bacitracin is a reasonable short-term, as well as intermediate (maybe even ongoing) plan. Are there other products availabe that might be better for a particular use or patient? Sure. But his idea is expedient, available, and reasonable.

Again - part of the rhetorical question I was asking earlier in the thread was about whether someone wanted to deal with blood loss, wound healing, chest wounds with pneumothoraxes or other goals for dressings.


the Army's current issue Israeli Bandages. They have a small device on them for tightening them down to apply pressure to the wound.

Numerous vendors carry this item, so comparison shopping is always appropriate.

http://www.1starmy.com/emergency-bandage.asp There is a video on this site that explains/demonstrates the use of the bandage in question.

As I see it (based on having a brief hands-on opportunity a while ago - practicing on a buddy, not an injured patient)...

Pros: Compact, easy to use, and this one product often replaces several other products.

Cons: Fairly expensive. Lots of people have not used them, and the issue becomes figuring out what's on the patient before removing it for more definitive care.

http://www.1starmy.com/viewproduct.asp?Productno=2446 Retail cost at this vendor is $7 for the 4" bandage, $8 for the 6" model, $10 for the 2 pad/6" model.

I also like the one handed tourniquets too. If you know what you are doing you can shut off or just slow down the blood flow to the limb long enough so someone doesn't bleed out before they can get medical treatment.

There are at least a couple different but similar versions out there.

http://www.1starmy.com/viewproduct.asp?Productno=3931 This is one version.

I've also seen one which has windlass rod that is made of plastic or delrin or whatever.

A good time for a reminder that tourniquet application more or less equals need for more definitive medical/surgical care, assuming the patient makes it that far.

While tourniquets have been life saving, they are also controversial:

http://stinet.dtic.mil/oai/oai?&verb=getRecord&metadataPrefix=html&identifier=ADA444895

http://www.traumacare.no/swf/01_h.swf

These folks advocate other means of controlling bleeding from limbs injured, and their focus is on landmine incidents.


I have seen but never used the new cellulose bandages that are supposed to help clotting.

I have no insight or experience with this product. Do you have a link?

[Jonas Parker]

There's an old saying about tourniquets, which might be an overstatement, but not by much. It goes: "about the time you think of a tourniquet is a good time to apply one!"

Remember also, when you put on a tourniquet, use a marker to write "TK" on the patients forehead, along with the time applied.

[Goldenspurholderx2]

I have no insight or experience with this product. Do you have a link?

Here ya go.
http://www.actiongear.com/cgi-bin/tame.exe/agcatalog/level4c.tam?xax=20830&pagenumber%2Eptx=1&M5COPY%2Ectx=28084&M5%2Ectx=28084&M2%5FDESC%2Ectx=First%20Aid%20%2D%20Kits%2C%20Acce ssories%2C%20Components%2C%20Repellants&level3%2Ectx=level3c%2Etam&BC3%2Ectx=Survival%20%26%20First%20Aid%2C%20Food%2 0Rations%2C%20Water%20%26%20Fuel%20Storage&BC4%2Ectx=First%20Aid%20%2D%20Kits%2C%20Accessorie s%2C%20Components%2C%20Repellants&backto=%2Fagcatalog%2Flevel3c%2Etam

[Goldenspurholderx2]

There's an old saying about tourniquets, which might be an overstatement, but not by much. It goes: "about the time you think of a tourniquet is a good time to apply one!"

Remember also, when you put on a tourniquet, use a marker to write "TK" on the patients forehead, along with the time applied.

And if no marker available use blood.

[DrBaboon]

Here ya go.
http://www.actiongear.com/cgi-bin/tame.exe/agcatalog/level4c.tam?xax=20830&pagenumber%2Eptx=1&M5COPY%2Ectx=28084&M5%2Ectx=28084&M2%5FDESC%2Ectx=First%20Aid%20%2D%20Kits%2C%20Acce ssories%2C%20Components%2C%20Repellants&level3%2Ectx=level3c%2Etam&BC3%2Ectx=Survival%20%26%20First%20Aid%2C%20Food%2 0Rations%2C%20Water%20%26%20Fuel%20Storage&BC4%2Ectx=First%20Aid%20%2D%20Kits%2C%20Accessorie s%2C%20Components%2C%20Repellants&backto=%2Fagcatalog%2Flevel3c%2Etam

Thanks for the link.

Pricey stuff.

http://www.actcel.com/ I tracked down the company site after getting the product name from your link.

Basically, it's a platelet catcher, meant to help erect a clot and maintain it on the wound.

While I haven't used this particular product, I have known about Surgicel for about 25 years or so. It looks as if ActCel is a competitor to Surgicel:

http://www.qualitymedicalsupplies.com/page/QMS/CTGY/WC-HS

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6440959&dopt=Abstract

http://www.jnjgateway.com/home.jhtml?loc=USENG&page=viewContent&contentId=09008b9880ea8baf&parentId=09008b9880ea8baf


After reading the ActCel materials, I'd probably be mostly interested in using it for packing anterior nose bleeds or dealing with dental extractions.

http://www.actcel.com/DENTAL/index.html

The most common uses I've seen for Surgicel over the years have been in neurosurgery and ENT (ear-nose-throat) surgery.

These types of products aren't usually removed soon after being applied.


Interestingly, if we're going to discuss more exotic dressings and wound care products, I think it's worth mentioning having a few tricks for caring for ongoing wounds once they are somewhat cleaned up.

Alginate-based products as a category often fill that role well.

Jonas Parker's approach is a work-around to having products like this available.

Among many products (with or without alginate) that can occupy this niche, are the various Polymem dressings.

http://www.polymem.com/

What reminded me to mention Polymem in this reply, was considering alternatives to ActCel or Surgicel for packing anterior nose bleeds:

http://www.polymem.com/RhinoPak.asp

This is one role where I would really like to avoid traditional gauze - you have to remove the packing sooner or later, and I've never seen gauze removed from a nose where the bleeding didn't resume.

ActCel and Surgicel deal with this need by not physically being pulled out.

Polymem's RhinoPak deals with the need by not sticking.

Polymem isn't cheap, either, but it's not super expensive (combined with being able to leave it in place for 2-3-4 days some of the time). It's use as a nasal pack is mainly via exerting pressure to control bleeding. It's not a platelet catcher the way ActCel or Surgicel are.


People have used vaseline gauze as nasal packing, so bacitracin isn't out of the question. However, I'd personally try to avoid petroleum jelly based products for nasal packing. Sure - they will reduce the extent to which the packing material sticks to the tissue and clot, and lessen the degree to which the clot is ripped off the area that was bleeding.

But there's also a risk of inhaling the petroleum jelly into the lung, which taken to the extreme, can lead to lipid pneumonia (a type of chemical pneumonitis).

http://en.wikipedia.org/wiki/Lipid_pneumonia

http://library.med.utah.edu/WebPath/LUNGHTML/LUNG026.html

There have been cases of people (mostly senior citizens) putting mineral oil drops in their nose, and getting lipid pneumonia. Some of these cases have been thought to only involve inhaling the vapor, and not even getting actual liquid oil running into the lungs.

Risk of Lipid Pneumonia is the reason why the Poison Control directions tell you not to induce vomiting if someone drinks gasoline or other hydrocarbons.



Regarding ongoing wounds and their care...

http://www.medicaledu.com/ahcpr.htm

This is aimed at pressure ulcers. So it's not completely compatible with all aspects of wound care, yet pressure ulcers are overall useful "prototypes" of wound models for general purposes. The guideline is also in need of being updated - I don't recall that there has been a revision since it published in 1994 - but it's still good information.

Basically, any wound that you judge to be not suitable for "primary closure" with suture or staples or steri-strips or super glue or whatever, will hopefully heal by "secondary intention." That's what goes on in pressure ulcers, too.

I'm deliberately leaving "delayed closure" out of the discussion for now, as that's an art unto itself.

[Jonas Parker]

There is a great wound care "orders" format at this link. I probably would use it more as a check list for providers though...

http://www.medicaledu.com/orders.htm

[Goldenspurholderx2]

There is a great wound care "orders" format at this link. I probably would use it more as a check list for providers though...

http://www.medicaledu.com/orders.htm
JP, that's a great website!

If you are perusing this thread and are like "WTF are they talking about?" you might want to give that site a once over. I am only trained at the "Combat Lifesaver" level, give I.V.s, sucking chest wound, blah, blah, blah.... I just know enough to hopefully keep someone alive long enough to get them to a doctor, that site has some good stuff for once you have someone stabilized, continued care if you will.

[Jonas Parker]

Wish I could take credit for finding it... but thank DrBaboon... he's the one that came up with it.