Tuesday, February 12, 2013

Lesson Eleven: Priority Item

Lesson Eleven: The Most Important Thing In Your Kit

Whatever you've packed in it, something in your kit has to be the most important thing. Think about it a minute, and come up with what you think it should be.

Bandages? Scissors? CPR mask? Aspirin? Your EpiPen?

All good choices. But if you picked these, I'd suggest you rethink the question; and I'd offer that the most important thing in your kit is your barrier gloves. (You knew that, and you already have them in your kit, right? RIGHT??

I'd say latex gloves, but some of you may be sensitive or allergic to latex. Or you may have been concerned that a patient might be, so you opted for non-latex gloves. Score yourself extra points if you've already considered that and/or prepared for it.

A set (or hopefully several sets) of barrier gloves should be the first thing you think about having for first aid emergencies. Gloves do two things:

They keep your cooties on your side.
They keep the patient's cooties on their side.

This is exactly what we want. While HIV and AIDS are a concern, the virus is incredibly fragile outside the host, and you need blood to blood contact, like through open sores or cuts. Barrier gloves stop this better than intact skin.

But there are other far worse things than HIV. Hepatitis A, B, or Q, X, and Z are much tougher to kill. Hep B or Hep C can live for hours to days in a single drop of dried blood. Like the one you didn't see on the steering wheel when you leaned in to check on that guy after his car crash.

The first thing you're liable to need to do or want to do when you help someone is touch them. That's why the first thing every medical professional is liable to be doing in the hospital or out on the field is slipping into a sturdy set of yuck-proof gloves, in latex, heavy vinyl, or other materials. Because I don't know about or want your Hepatitis, influenza, plague, Ebola, or even whatever's on your hands because you don't wash after you poop, that I might inadvertently touch if I touch you barehanded. And you want to avoid the same crud from me, and more. Maybe I pick my nose or scratch my other end.

With the simple expedient of barrier gloves, we no longer need concern ourselves with each other's regrettable lapses in sanitation and personal hygiene, and can get down to helping or being helped and concentrating on the important stuff.

They need to be tough enough to withstand average usage (some are highly puncture resistant), but still thin enough to allow you to be able to feel a pulse beat or find a vein through them. And if you're really sensible, you'd be well-advised to wash your hands before and after using your gloves. If there's no sink where you are, or you're just smart enough to prepare for that, a small bottle of stuff like Purell hand sanitizer is basically jellied alcohol with a bit of skin moisturizing stuff in it. You pour it on, and rub until it evaporates. It's great stuff.

And when you're done, put your weak hand into your strong one, and peel the weak-side glove off, holding it and rolling it into a ball. Take your now uncovered weak hand, and pull up the glove cuff on your dominant hand, keeping that hand in a loose ball, and strip the second glove inside out over the first glove, and thus sealing all the yuck inside a ball of latex, with the clean inner side now facing out. And throw it in an appropriate receptacle (usually an ordinary trash can is just fine).

 Gloves, especially latex, can weaken and break down over time, especially with temperature extremes. Carry several pairs in a ziploc baggie, and check them monthly. Replace them if you find they tear easily. For what they provide, they're a bargain at twice the price.

 And in a pinch, you can use a latex glove (unpowdered) as a mini-water bladder. Tie that water-filled glove off and freeze it, and it's an ice pack substitute for a ziploc baggie. You can cut a finger off to make a waterproof finger cot for someone else's injured and wrapped up finger. A thumb can be snipped off to make an impromptu rifle muzzle "condom" with a rubber band to hold it. You can even cut the palm/back into a large flat piece to tape over and cover the dreaded sucking chest wound. If you're a clown, or you need to distract a younger patient, they make great balloons for kids, and an inflated glove looks like a rooster with a couple of penned on eyes once you blow it up and tie off the wrist. So they're rather versatile well beyond the original medically intended use.

Gloving up is important because it protects your patient from the normal bacteria and viruses on your hands. And protects you from all the nasty crud out in the World, especially on your patient, which means you stay healthy, in order to help someone else another day.

So pack gloves, and glove up!

1 comment:

Anonymous said...

I don't even pull a pt up in bed without wearing gloves. I glove and wash like a madman. I was around in the early 80's when HIV first came out and we didn't know what it was, didn't even have a name for it. We didn't know how it was spread, how to protect ourselves from it. If our PPD would protect us or not. And flesh eating bacteria came out at the same time and the treatment of choice was amputation. I thought to myself, "Boy did I pick a great time to go in to healthcare."