Re: [Paddlewise] Puncture wounds, was Re: broken paddles

Bill Hansen writes:
 > Boojum writes...<recommended care for puncture wounds is sterile
 > water, preferably with some level of pressure >
 > 
 > What's used medically is sterile saline solution. Water is hypo-osmolar, and

Is that to say that sterile water is *very* osmotic, meaning it is
likely to permeate the tissues and thus dilute the existing (good)
fluid? 

 > therefore is pretty hard on tissues, especially damaged ones. Large volumes

In what way is it hard on tissues?

 > of sterile saline - several liters - are used to irrigate wounds, with some
 > moderate pressure. Most commercially made irrigation systems include a
 > pulsatile component, which helps to flush out debris.

Bill, This is great info.

 > Sterile water irrigant might be better than no irrigation at all, especially
 > if the original wound was "dirty" in some way and formal medical help is
 > more than a couple of hours away.

Using sterile water is the general advice I remember from my
Wilderness Medical training [note I say 'what I remember, as opposed
to 'what they taught me' 8].  And yes, this is for a back country
scenario where your not going to get ambulance level care for more
than a few hours.

 > In a field situation, sterile "saline" can be made by adding a couple of
 > teaspoons of ordinary table salt to a liter (or a quart) of sterile water
 > and then boiling for at least 5 minutes. Let it cool in the container in
 > which it was boiled and then slosh it into the wound. Deep irrigation and
 > pressure irrigation wouldn't be possible in this situation, but some
 > cleansing would occur, which will probably be helpful.

If you had a [clean] plastic hypo, why wouldn't [moderate] pressure
irrigation be possible?

A question on saline solution - By adding salt and thus 'salinating'
the water, does it make the water less osmotic?  Is the goal to
prevent the liquid from rapidly permeating the wound?

 > I agree with those who have written that irrigation with antiseptic is not
 > good, since antiseptics will damage tissues. I have a similar aversion to
 > the ubiquitous "antibiotic creams". What a victory of marketing over science
 > those are! The antibiotics in them only reach the surface of the "cream", so
 > they can't penetrate into the damaged tissues. Worse yet, most of these
 > "creams" are actually petrolatum-based ointments, not creams at all. That
 > is, they're grease, and they seal a wound, which is just what you don't
 > want. Still, I realize that people are going to use them, just because
 > they're marketed so heavily. Even doctors who should know better use them.
 > Most of the time they (the antibiotic creams) don't do actual harm.

Thanks for the note on antiseptics/antibiotic creams.  Is there ever a 
case where antibiotic (or a specific antibiotic) cream is useful?


----------------------------------------------------------------------
snark_at_tulgey.org     aka Glen Acord	  http://www.tulgey.org/~snark
	if ($snark eq "boojum") {vanish("softly","suddenly")}



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