Wednesday, October 30, 2019

Minor Wound Refresher

From Comments:

For your next medkit post, have you ever heard of zipstitch?

Be glad to hear your practical thoughts...


The problem with that kit, like everything else, including the laceration, is multi-fold:

Do you know which lacerations to close, and which to leave open?
Do you know why?
Are you sure that's a lac, and not the evidence of an open fracture?
How would you know that without an X-ray?
Did you clean and debride the wound first, with surgical thoroughness?
How did you do that without any local anesthesia?
What structures underneath the skin were affected/damaged?
Did you repair them correctly? With what?
Would antibiotics be appropriate?
What about tetanus prophylaxis?

The supplies necessary to close a lac, in every ER I've ever worked in, comprise enough material to fill a military-sized footlocker, and 95% of them are RX only.

It is not, ever, one alcohol wipe, one gauze pad, a zip-tie gadget, and a big band-aid.
(As IF.)
Oh, and alcohol on an open cut? Tell Dr. Mengele you said "Hi."
When your patient swings at you, don't forget to duck.

More importantly, you need a Masters-program level Physician Assistant instruction to cover all the medical knowledge and precepted training by board-certified MDs you don't get in that kit. (That's 3-4 years after college, kids.)

Look, I can buy a scalpel online; it doesn't mean I'm therefore a qualified surgeon.
Any more than buying a Formula car means you can drive a race in F1, or buying a jet makes you a Commercial Air Transport Pilot.

Any fool can close a wound. And has.
The mark of a medical professional is knowing the other 50 considerations are for when to do it, when not to, how to go about it in either case, and what else to worry about.
Screw it up, just once, and you could cost your patient normal function, a digit, a limb, or even their life, in a week or two. There are seldom do-overs if you fuck it up. Doubly so if you're doing it on the cheap, at home.

Gangrene and tetanus aren't funny, and learning on the first 20 patients you maim or kill is unethical in the best (for you) cases, and criminal in the worst cases.

If you want to learn what you're intending to do, and then get the toys, go ahead on.

For everyone else, first aid consists of betadine and saline (or at least clean tap water), hemorrhage control, and a dry sterile dressing, possibly non-stick nearest the injury site. Then accessing definitive care from someone with the tools, training, and knowledge to know what to do next.

Will that kit work?
It will close small wounds.
Which is exactly the problem.

Should any idiot buy it?
No way in hell.
Unless the patient is someone you won't miss if/when you cripple or kill them.

You can close wounds with staples, medical sutures, Derma-Bond (or the non-medical Krazy Glue, which is not "the same thing"), or with ordinary thread, fishing line, spider web, barbed wire, and twenty other field expedients. Just like ranchers do with cattle. It might even work, some of the time.
For some values of the word "work".

People, however, are not beef on the hoof, and if they subsequently die, you cannot eat your mistakes for dinner.

As a general rule of thumb, for anything but scratches and extremely minor cuts, laymen (and that includes me, with only 25 years' nursing experience) closing wounds that need surgical closure, without all the training, and all the tools, is a very bad idea, with a poor prognosis. Proper medical treatment under first-world conditions has about a .998 batting average. You will not do that well free-lancing it, I promise you. You may get lucky a few times. In dire circumstances, and less-than-ideal conditions, you can expect to have patients die. For relatively minor wounds in the First World, that ceased to be acceptable any time in the last 70 years or so.

Stick with what you know how to do.
If you're highly motivated, learn how to do better.
But simply buying a gadget or some gear isn't that.


Unknownsailor said...

I may be dipping my toe into hostile waters asking this, but what if that professional opinion is not available?

Would keeping the would clean and covered for a few days work as a check against the infection you discuss? I.e. only close it if there is no sign of infection after a few days of keeping it cleaned and covered? Or, if the would is minor, doesn't affect function, just let it heal on its own, even if it leaves one helluva scar?

Ive had a few cuts after I retired from USN that I probably could have gone and got a stitch or two for, but I didn't bother. Just kept it clean and covered.

FredLewers said...

Best case is learn and employ techniques to prevent/mitigate infection. I've read of many third world techniques ranging from packing with honey to allowing maggots to eat out the necrotic flesh. I wouldn't be willing to try ANY of those methods except under the most dire circumstances. Minor wounds... I've lost count of how many times I've used a paper towel and electrical tape as a bandage. After gritting my teeth as I wash the wound. But there is no substitute for expert service. At least the first time and maybe the second and third too.

Anonymous said...

If a wound is not closed rather quickly,it stays open. There is no closing of a days old laceration. Aesop is correct, if you dont know what you are doing, don't do it! Clean, bandage and inspect daily. Do no harm, remember?

Robin Datta said...

Yes indeed there are so many issues; critical enough that they become second nature and are not brought to conscious awareness until each specific issue becomes a consideration. The literature and the lore is replete with tales of wound care effups, and anyone who has worked in the field for a while has a substantial repertoire. Retained foreign bodies is yet another item on that menu.

Robin Datta said...

If it is a necrotic wound with maggots under consideration, wound closure ain't on the horizon. And maggots are indeed effective debridement with necrotic tissue. Just be sure that they are not botflies. Likewise a wound that warrants honey is not yet a wound that warrants closure.

If professional help is not available, the best trained/experienced person in the gang must do.

Aesop said...

If all else fails, clean the hell out of open wound, get out everything you can, and let it drain and close on its own.
Neosporin and a daily change of dry sterile dressing won't look pretty, but it also won't kill you.
Anaerobic bacteria locked inside an improperly closed wound will.

And get your Tdap booster every five years, like clockwork, while you have the option.

Linda Fox said...

One of the worst wounds I ever had was in 7th grade. I'd cut my foot on the sole, near the toe, and my mother used a new product, Liquid Bandage. It worked great, and she made several more applications of it over the next few days, re-applying after I bathed at night.

It was still tender, very tender. One day at school, I went to the nurse, and told her it was hurting. She didn't even look, just gave me a bandage and told me to go back to class. Instead, I left school, limped home, and told my mother about it. She removed my shoe and sock, saw that it was black up to the ankle, and called a cab to take me to the doctor. I was lucky not to lose my foot.

I do NOT close cuts and wounds now - at most, I'll apply antibiotic, and a temporary bandage until I get home. At night, I leave the bandage off. I've told this to many kids, that bandaids are NOT good for a cut - they need to be open to the air. Only reason for them is a temporary cover, until they get home.

Anonymous said...

Full time wound specialist MD here. Agree with Aesop on almost everything. Neosporin, is quite allergenic. Bacitracin is the go to.

Know your limits. Don't do stupid stuff. Don't win stupid prizes.

Anonymous said...

You talk about not closing lacerations, don't forget puncture wounds, which by their very nature may want to close on their own. They are very sneaky as they appear to be quick and easy to close which unless they have been cleaned thoroughly is very bad juju.

cyrus83 said...

Had a family member die to necrosis. Still not sure where the wound was that caused it, nor how long it had been festering, the best the doctors could say at the end was they'd never seen a more aggressive case and they ran out of tissue they could amputate. Likely it was a wound simply treated with betadine and gauze and the ER visit came too late.

Anonymous said...

Off topic but I like to hear what you think about this hazmat incident. Sounds more like what allegedly happened in Britain during the Skirpal affair

DaveS said...

Could have been lots of things. Hydrogen Sulfide is one of the compounds we're trained to be aware of when approaching a closed vehicle with an unconscious victim inside. The days of just walking up and opening a car door with an unconscious victim inside ~should~ be long past. There are some nasty things out there. Some of them can kill you very dead quite quickly. And a lot of stuff can be whipped up using standard home chemicals. Bunker gear and an SCBA system provide a decent first level of protection. Sounds like the cops were blue canaries on the Oberlin incident. Hope everyone fully recovers.

Robin Datta said...


Aesop said...

Neosporin is infinitesimally allergenic, or they wouldn't have sold metric tons of the stuff. But if you are allergic, just like with anything else, wave off and do not use.

That said, the third ingredient (neomycin), which is what makes double antibiotic ointment (Polysporin - i.e. bacitracin and polymyxin B) into triple antibiotic ointment (Neosporin) is the one that usually affects people.

If you've used Neosporin, it's not a problem. For you.

If you're using it on someone else, and don't know their allergy status, single antibiotic ointment (bacitracin) as the doc suggested, is always the safest route.

And bear well in mind that all three are something like 97% petroleum jelly by volume; it's the other 3% or so that has the antibiotic, and turns petroleum jelly into Magic Spackle. The jelly is just to keep the active ingredient against the tissue, and form an ad hoc protective layer to keep new bacteria out of the open wound until you can scab over on your own.

Tina said...

This is all good information to have. Thank you, Aesop, and commenters as well - the questions and answers, also the note about puncture wounds, are helpful. Linda Fox, appreciate you sharing your story. We also learned from experience how dangerous infection in a closed wound is.

Modern wound care is a specialty that we are grateful for. My husband had surgical wounds that got infected in hosp or rehab. We discovered it from the odor after I brought him home. The wound doctor packed them with silver-containing bandage and would not allow anyone to treat or interfere with the cavities except the Dr during weekly cleanings, including the home health nurses who came and changed his outer bandages every other day.

It was quite an ordeal, took months to heal (on top of his other health problems) but thank God he did not have diabetes. One gentleman who rode the bus with us (we had to have a wheelchair lift) had been going for treatment for more than two years for a wound on his foot that would not heal.

Anonymous said...

Thanks, Aesop, for answering my question!

This is what the internet is for. (By which I mean, widespread sharing of locally specialized information, together with appropriate dosages of style/snark.)

More often than not, it's the obvious stuff you don't know that ends up causing you the biggest problems.

Hopefully, my willingness to ask a basic question helped keep someone out there a bit safer. I know I certainly appreciate the information.

McChuck said...

These kits aren't for "normal times". They're for when TSHTF, and "normal" has no part of current operational parameters. Doctors and hospitals are great, when they're not on fire or behind enemy lines.

Your advice to leave medicine to the medical profession is exactly correct - until it no longer applies, because there are no professionals available. In that instance, do the best you can with the materials and knowledge you currently have. And try to prepare both the materials and knowledge beforehand.

Reltney McFee said...

Aesop's refrain of "get training" is SPOT ON!

If you have training, you can make do.

If you make do, AND DO NOT HAVE TRAINING, you will march into a clusterhug.

Example: cooking. One co worker told us recently that her husband had made stroganoff, using Southern Comfort, not wine.

It was awful, according to multiple reports.

"Making do", without clue. Bad outcome.

Extrapolate, yourself, to safety-of-life issues.

Anonymous said...

What about colloidal silver as an emergency disinfectant?

Night driver said...

1)Oberlin incident was an opioid, fentanyl or carfentanyl.
Local LEO Narc detectives are NOT getting any more info than publicly being released (interesting THAT!)
The word is we got VERY lucky with only 7 down...

2)Before you get all the way up onto the CS bandwagon do the research and check our the Brigham Young study (in vitro test of CS) It is SERIOUSLY interesting as to what it outperformed and what it was ineffective on.

BUT READ THE FINE STUDY (RTFS) so you have a clue, and THEN do the research to understand how it might be used, and how it gets made. I regularly have arguments with Bandwagon dwellers on this. it ain't for EVERYTHING. Can it HURT? Not really if made and stored properly. It certainly won't get in the way of other treatments.

I mean, gram positive or negative contaminate organisms. Which does it work best on? And how you gonna make the distinction if yaa don't HAVE any gram stain and a microscope with training to use said tool?

having just had my scalp removed from a fair sized area of my skull (it is FREAKY to have the doc thwok on your skull while yer waiting on a quick brain CT to be sure you didn't jar something deadly loose and hear something that sounded like a glass being set down on a table) I MIGHT CONSIDER if ABSOLUTELY NECESSARY FOR LIFE OR TRANSPORT/LIFE closing same....But ONLY if I had COPIOUS quantities of peroxide (and trust me one wants to be CAREFUL using even 3% peroxide because that shit gets HOT if there is enough blood around to lyse) and staples (and ear plugs for me with patient restrained ). But I'd have to be damn certain that NOT doing so meant more issues than closing it.

Aesop said...



The rules of wound closure are not subject to revision just because TSHTF.
Unless you like killing your patients.

Those kits are about worthless anytime, unless you know WTF you're doing, and have the supplies to utilize them, (in which case they're superfluous anyways).

There is a right way to close wounds, and a wrong way, and absent the training and supplies, those kits are ALWAYS the wrong way.

Your job is not to close wounds, it's to bandage them appropriately.
If you lack the training on closure, your next job is to NOT attempt it.

Ignorance of that universality is a death sentence for patients.
It is not subject to revision, ever, anywhere.

That lesson is written in the blood of 1800 years of poorly-treated patients.

Robert said...

Took a two-day austere-medicine class. The takeaway: if it is SHTF and you get an infection, yer gonna die. How uplifting.

Anonymous said...

years ago (at an isolated-remote Af site) I discovered a bottle of benzalkonium chloride in an old AF survival kit. Damn stuff seems to kill just about anything on skin surfaces - even pimples, heh, heh.
Anyhoo I keep packages of wipes(0.13%)from Zee-med in the car and the medicine chest and anytime I do a boo-boo I pull one of those out and lay it on the cut, scratch whatever. Never had any infections pop up. Of course everything is made in China these days so no telling what's in the wipes I buy these days.

Aesop said...


Welcome to 1800.
If you don't make any preparations to limit that.

@Anon 3:12
Benzalkonium chloride: AKA Bactine.
Also benzethonium chloride in Wet Ones Antibacterial Wipes, sold everywhere.

Night driver said...


I encourage you to peruse Survival and Austere Medicine: An Introduction - 2nd and 3rd Editions available via link:

yes it is a HUGE download (700++ pgs with GOBZILLIONS of pics etc)

Take a couple months and peruse that. There are suggestions and recommendations galore in there.

The BIGGEST one is "Find MORE TRAINING!!! WEMT or WEMT-P etc.

I bring this here because the take-away you took away is horse apples!!....


Gotta remember that the primary orientation as far as gadgets, tools, etc it:

1) MINDSET (Have a good aggressive one)


3) And THEN after you have verified #1, and built up your SKILLSET THEN you are ready for a TOOLSET.

As Lee Lapin has maintained for decades.

Robin Datta said...

Prior to modern medicine (our great⁶✕grandparents) tissue infections were treated by incision & drainage, excision (including amputation), warm compresses, antiseptic packs for cavities, etc. Death was not inevitable, but much more likely than now; a return towards those conditions can (and should) be expected in a post-collapse future.

0007 said...

Cool, Aesop, had no idea what that stuff was. All I care about is that it works damned well for what I use it for. 'Course I'm old enough to remember things like gensen(sp?) violet, mercurochrome, merthyolate, and even when one could buy powered sulfa and iodine otc.
Back then most of what worked seemed to be tinctures of metallic salts. And speaking of that I just discovered that Walgreens sells small tubes of powered iron sulfate for clotting small wounds. Tried it on the cats and it worked fine.

McChuck said...

Whatever happened to Mercurichrome?

McChuck said...

I love your work, @Aesop, but damn, you love the sound of your own voice sometimes.

TL;DR: Sealing wounds is bad. Disinfecting and protecting wounds is good.

docretired said...

I am retired MD after 40 yrs in "medicine", i.e. 20 in the USN as GMO and Internist, then 20 in so-called private practice as "Board Certified Internist", I WAS that, now just a broke dick old sailor in the PI. Loved my ER rotations and working ER at Charity in NOLA, but once I was out in the fleet I was petrified to deal with even any semi-minor, to major wounds, lacs etc. Lucked out, no major issues at sea, but missed a bad bleeder on a CPO initiate, needed local evac to hospital(AUS @ 121 in Seoul). OOPPSie, realized then I was not trained as a surgeon in 'any' sense. Thinking of anything useful to contribute if SHTF, realize my skill set is diagnosis and med management of diseases of the first world. Meds and tests available to me would be nil at best, so just plan to help with first aid as best I can. After 5 yrs out, I doubt I could help/assist even an EMT, much less a trauma trained medic. Was never an elitist, but humbles me to realize how little I have to contribute. YMMV.

Aesop said...

Especially if you only have a box of band-aids and five minutes of medical training.

Mercurichrome is still out there, for die-hards.

It's vastly inferior to things like BZK and Betadine.

Anonymous said...

Clean the wound with antimicrobial soap. Flush with copious amounts of water. You do not need normal saline, but it is better. Debride it thoroughly removing all foreign matter. Cut away any jagged edges of flesh of needed. Close with steri-strips allowing gaps between them so the wound can drain if needed. The wound needs to heal from the inside out so an access does not form. Keep wound clean andDRY. It's not rocket science.

Tal Hartsfeld said...

What about wounds/injuries involving broken glass or projectiles?
Once you stop the bleeding the wounds would still have to be reopened to get the fragments out.

Tina said...

FYI, Povidone (Betadine) is a lot cheaper (by half) at Dollar General than at Walgreens.

Anonymous said...

Anonymous 9:10

It's not rocket science, but you're not worried about an "access', but about an abscess.

Your Delta Tau Chi name is now "Rocketeeer".
Damn glad to meet ya.

-Eric "Otter" Stratton, Rush Chairman '63

G-man said...

Thoughts on Betadine vs Chlorhexidine? Several studies note Chlorhexidine as being a superior disinfecting agent, and it’s usually available in expensively at places like feed stores. Just another option folks should have in their kit-bag, unlike the subject of your post.

Aesop said...

Betadine is still the go-to skin and wound cleansing agent, provided the pt. is NOT allegic to it.
Clorhexidine agents, OTOH, are the superior agent for cleansing surfaces, solid reusable items like instruments, etc.
Stocking both is therefore an appropriate plan.

Anonymous said...

NYC Paramedic - 12 years South Bronx, USN Hospital Corpsman with Marine infantry battalion. Under austere conditions, you just have to do your best. Depending upon your skill set and training, your success/fail rate will be higher or lower, but you WILL lose people. There will be those that would not make it in the hands of the world's best surgeon.

If you expect to treat trauma patients, then get training and EXPERIENCE. Join a volunteer ambulance or fire department. They will usually train you at no cost. Once trained, volunteer at a hospital emergency department.

The only thing worse than buying stuff without training, is to be treated by someone like that.

Brad said...

Aesop. Growing up in the 50's after a hard day of play my mom would bathe my brother and sister and I and then rub us down from head to toe with rubbing alcohol. God help you if it had been a rough day.

She passed many years back and I never did ask what she thought she was doing. LOL

Robin Datta said...

Rubbing alcohol removes lipids (such as sebum) and materials and carried by them from the skin surface. So does soap & water. Rubbing alcohol may kill a few microbes and it makes others drunk.

DogMan said...

My immediate neighborhood has three ER Docs living in it and I know them personally. They are not awake about what is happening and when that something does happen, they will learn that I have stockpiled just the right medical supplies for them to do their job. I am also trained in pre-hospital care as an EMT, so I'll be able to assist, but not do those advanced procedures. Become friends with all the Doctors around you.