Saturday, February 2, 2013

Twenty Lessons On First Aid Preparedness: Antiseptics

After the recent post on supplying oneself for austere conditions, a couple of questions have made it obvious that I should dredge up a series of posts I contributed on the subject. I wrote these originally and they were posted for pretty much the same reason, i.e. personal preparedness, for "The Other Side Of Kim", the then-regular blog of Kim DuToit. The loss of the contributions of that crusty, cranky genius to the internet has been notable, but he moved on to other things, and thus the content there is no longer available. I'll pop them up one-a-day until they're all up.

So for general edification, reviewed, proofread, MSWord-edition and content updated as appropriate, here are the lessons:


I’ve noticed in kit lists and after-action reports, quite a number of people here (just like everywhere else) always want to fling alcohol, hydrogen peroxide, or povidone iodine in/on/all over wounds. (Not to mention pee on them, or smear in butter, mayonaise, or Aunt Hilda’s Secret Recipe. We’ll ignore those for now.)
Pro: That’s better than rubbing dog doo on them. And it’s usually better than nothing.
Con: Didja ever notice most of that stuff stings like ####??

There’s a reason it hurts. It’s killing healthy tissue. Along with the germs.

Isopropyl alcohol
War story: I was working the 20-Mile Aid Station at the LA Marathon back in the day, when some Poor Guy shuffled in, both knees a bloody mess. He’d fallen, and been trampled by the pack, who couldn’t stop or avoid him in time.
Old School Nurse decided that two big kerfluffs of gauze soaked in isopropyl alcohol would clean those hamburger knees right up! Being a mere EMT, I bit my tongue and averted my eyes. The bloodcurdling screams could be heard for blocks.
And Poor Guy finished the last 6 miles—on a massive adrenaline and endorphin high induced by the screaming agony.

Consequently, as I tell friendly Teamsters on movie sets, I only use alcohol on people I don’t like.
It's also flammable, and setting your pt. on fire is rather inconvenient.

If you want to use it to soak a hemostat, knife blade, needle or what-have-you in, for 15 or 20 minutes, that’s a much better use for it.

Hydrogen peroxide
Peroxide hurts too, and for the same reason. And it only works where it hits, so you’re missing a lot of germs with it as it bubbles up. It also does nothing to disinfect inanimate stuff.
It is great for getting blood out of your hospital scrubs, socks, t-shirts, wife’s towels, or carpets after you move the body.
But it’s less than optimum for disinfecting wounds. You also have to keep it in that dark bottle, because heat and sunlight will turn it into H2O, instead of H2O2. This also makes it a poor choice for car/travel/backpack kits.

Povidone Iodine
Great stuff.
10,000 hospital ORs can’t be wrong.
Unless you or your patient are allergic to iodine.
Treating anaphylactic shock, in addition to a minor puncture, especially in the field, is a serious bummer. Trust me.
If you’re patient isn’t allergic to it, and you know that, g’ahead with it. It does also stain everything, so be careful. It also makes a great topical smear on the OUTSIDE. Like on skin around a blister on your foot, BEFORE you use that sterile needle to drain it, if you must. Or to mix with clean water to soak a cut finger or infected toe in to help heal and kill the cooties.
So of the three, other than potentially life-threatening allergies, it’s not bad.

is the king for a first aid kit.(and I hold no stock nor receive any royalties from its maker).
Why is it so good?
It uses benzylkonium chloride to kill germs. That stuff kills darn near EVERYTHING, and without stinging like ####. Not having your patient take a swing at you is always better than having them do it.
Bactine also has a tiny amount of lidocaine, which is a painkiller. The risk of allergies to that is far smaller than for iodine (unless YOU are allergic — caveat emptor) and the lidocaine helps numb your own “Ouch!” or that of someone you’re helping when you accidentally poke holes in your people-cover.

So as you pack your first aid kits, perhaps you’ll keep this advice in mind.

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