Megadoom's Gunshot wound/post crash management (Official multi-post series)

[Megadoom]

Insert Quote
Quote from: houseoftang on Today at 11:22:14 PM
I figure no matter how many sutures you stock up on, you'll run out eventually.

Let's hope not...I'd rather give a post on MZB recepies than anyone on our side being hit by bullets, knives, or machetes.

I'll also go over caring for a deep wound without suturing. A wound not closed by suturing isn't necessarily a death sentence. Many wounds can be left unsutured, kept clean, and the body will scar in very effectively. Although, suturing - in most cases, is preferable because too much scarring could causing deficits or disability in the affected limb, especially if the muscle or tendon tissues are involved.

There's always the normal range of injuries, increased because of an increase in manual labor and decrease in free time (so you're working harder, faster).  Plus I figure you (and probably much of my own group of friends) will be doing a lot of work on the people of other communities, either because of battle-related injuries or just the usual range of work injuries.  And since this stuff won't be getting manufactured, it's the kind of thing you can pass on to your kids and grandkids (the reusable needles, too).

Excellent point! I'm going to go inventory my needle stock. Fishing line can be used as suture material very effectively.

[Fishsurfer]

Dont forget to irrigate the wounds to push out bacteria and debris.  My standard as a navy/marine corpsman was at least two liters before i even begin to think about suturing.  In the 8 years of suturing (including surgical closures and arterial suturing) i never once had anyone come down with a bacterial infection. 

The water, yes water, does NOT have to be sterile.  Its great if you can do that, but at the least it needs to be clean or treated.  the easiest way to do this in the field if you know a suture job is at hand is to boil a few liters of water for at least 5 minutes while you are doing an assessment or other things to secure more important things like ABC's. 

How to irrigate?  A syringe with an IV cathedar or needle attached works great because it conserves the water while using a forceful stream to wash away the nasties and debris.  If you dont have a syringe on hand, use anything that makes a spray of water to clean it out.  Even a clean turkey baster would work, bulb suction for a baby, etc...  You dont want it to squirt like a fire hose, more like a rolling stream with intermittent bursts of higher pressure as tolerated by the victim. 

Another big part in preventing post suture infection is the method in which you suture.  Typically its a sterile process in a hospital.  I learned in an OR environment with heart and vascular surgeons.  A big culture shock comes when you have to do a clean procedure rather than a sterile one.  Wash your hands!  Use iodine, betadine...make sure your instruments are clean as a whistle, rub them with alcohol or betadine, heat them up etc... 

Finally, in regards to infection control, approximation of the wound is very important.  You dont want to cinch down on the sutures like your tying a rope for climbing.  Just tight enough to bring the edges together, make the knots secure and DO NOT OVER TIE THEM.  Swelling wil disappear, and the wound will "loosen" up.  So keep your eye out, you may have to reopen the wound and resuture. 

If a nice clean scab forms over the length of the suture wound, and there is no drainage, redness, or swelling after a few days...you are probably in the clear. 

If you see indications of an infection, redness, swelling, drainage, etc.... reopen the wound and rinse and repeat.  In a clinical environment they would potentially instal drains in combo with antibiotics.  You dont have that. Do the best that can be done. 

Also, if a wound is large and dirty enough, you will have to avoid suturing and use a technique of dressing changes that allows for wound debriedment and brings the wound slowly to the surface over several days to weeks and perhaps months. 

One of my patients from the USS Cole bombing was injured so badly, and loaded with veggies inside his abdomen and organs, that we had to pack his wounds for 4 months.  The wound was nearly a foot long and 8 inches deep.  Almost all the way down to spine.  Chances are though, if you ever get something that bad, you're not going to save them without modern medicine (vacuum dressings, IV antibiotics, etc...   See the concept of reverse triage in this case.  Save who can be saved.  Horrible way to work, but it does work. 

[rocketgirl]

Curious question.  Anyone familiar with Steripens?  They're made for backpackers to sterilize water.   I believe they use Ultraviolet light.  so the question is, would this work for sterilizing medical tools?  Maybe put them in the water and then insert the steripen?  Just wondering.  Love the thread BTW.  I always wondered how to suture.  Is super glue useful at all in this?  A friend of mine is an electrician and he swears by superglue.  Again, just curious.  Sorry about the rookie questions.

[Fishsurfer]

Curious question.  Anyone familiar with Steripens?  They're made for backpackers to sterilize water.   I believe they use Ultraviolet light.  so the question is, would this work for sterilizing medical tools?  Maybe put them in the water and then insert the steripen?  Just wondering.  Love the thread BTW.  I always wondered how to suture.  Is super glue useful at all in this?  A friend of mine is an electrician and he swears by superglue.  Again, just curious.  Sorry about the rookie questions.

Ive never used a steri-pen honestly so i dont know.  Super glue can be used, although its typically sterile.  But hey, if thats all you got then thats what it is.

[golddust]

I'm jumping in late, and with little to offer, but I sat and studied that gory picture for 10 minutes trying to figure out what it was supposed to be or what it used to be before I read your response. I had a feeling it was someone's face. I called in my husband to look at it, who is prone to having some bad depressive episodes, and said SO, committing suicide anytime soon? Seem like a good option to you? He backed away from the screen quickly. Perhaps that's the REAL desensitization therapy. 

[Fishsurfer]

I'm jumping in late, and with little to offer, but I sat and studied that gory picture for 10 minutes trying to figure out what it was supposed to be or what it used to be before I read your response. I had a feeling it was someone's face. I called in my husband to look at it, who is prone to having some bad depressive episodes, and said SO, committing suicide anytime soon? Seem like a good option to you? He backed away from the screen quickly. Perhaps that's the REAL desensitization therapy. 

I wish everyone could ride in an ambulance or do some time in the ER.  We take kids in the city to the morgue so they can see where theyll end up if they join a gang.  id prefer to just let them see the people as they die, its much more dramatic and effective. 

[rocketgirl]

My family has always told me I should have gone into medicine.  Actually being the one to raise the children I brought into the world has never been a regret and never will be.  The point I want to make is this is a fantastic thread and I appreciate the technical explanations.  I can understand on a more technical level so keep it commin.
I know we're in for a rough ride.  surgeries done in caves and under candle light is not out of the question.  We do need to go there in our minds and in our planning and I have a lot of catching up to do.  Nothing bothers me when it comes to blood and guts type stuff, in fact I find it fasinating. 

Thanks to everyone who takes this seriously and contributes their skills and knowledge.

I am the sponge.

[golddust]

I'm jumping in late, and with little to offer, but I sat and studied that gory picture for 10 minutes trying to figure out what it was supposed to be or what it used to be before I read your response. I had a feeling it was someone's face. I called in my husband to look at it, who is prone to having some bad depressive episodes, and said SO, committing suicide anytime soon? Seem like a good option to you? He backed away from the screen quickly. Perhaps that's the REAL desensitization therapy. 

I wish everyone could ride in an ambulance or do some time in the ER.  We take kids in the city to the morgue so they can see where theyll end up if they join a gang.  id prefer to just let them see the people as they die, its much more dramatic and effective. 

No arguments from me. What better way to show a kid the cold hard reality of their bad choices by showing them the cold hard corpse that is at the end of the road they're on?

[Fishsurfer]

I'm jumping in late, and with little to offer, but I sat and studied that gory picture for 10 minutes trying to figure out what it was supposed to be or what it used to be before I read your response. I had a feeling it was someone's face. I called in my husband to look at it, who is prone to having some bad depressive episodes, and said SO, committing suicide anytime soon? Seem like a good option to you? He backed away from the screen quickly. Perhaps that's the REAL desensitization therapy. 

I wish everyone could ride in an ambulance or do some time in the ER.  We take kids in the city to the morgue so they can see where theyll end up if they join a gang.  id prefer to just let them see the people as they die, its much more dramatic and effective. 

No arguments from me. What better way to show a kid the cold hard reality of their bad choices by showing them the cold hard corpse that is at the end of the road they're on?

When i walk into the morgue, it freaks me out.  Im not even a gangster.  I can imagine that showing kids a body of a 17 y/o that got shot up last night is either going to change their minds or make them go home and cry.  Either way, im for it.

[JurisDoctorOfDoom]

mega, I honestly think you are THE most important person on the forum.  This is horrible to look at, but we definitely need to look and learn.

Thank you so much for this.  I'm going for a walk and then I'm going to come back and listen and learn.

Mods, could we stickie this?

MD,

Mt. Louie is right, thank you so much for this Megadoom.

[crossbowX]

OK, left off at bottom of pg 5. This is a subject I have been trying to get some answers about. Will this post continue? Seems to have stopped in midstream, or do I just not know where to find the rest of it? Thanks.

[Megadoom]

OK, left off at bottom of pg 5. This is a subject I have been trying to get some answers about. Will this post continue? Seems to have stopped in midstream, or do I just not know where to find the rest of it? Thanks.

Yes, it has stopped midstream for several months. I've been wrapping up my nursing study and have been meaning to get back to this when I had the time. Plus, my educational coordinator position at work has taken up much of my time. I wanted to pickup where I had left off - a video of suturing GSW's and deep tissue wound care, antiobiotics and pain management in GSW cases. 

Soon.

[DNVRLIZ]

THANKS MEGA DOOM-   I for one will be waiting with bells on !!!!!!!!!!!

Lizzy

[crossbowX]

Thanks Mega Doom. Will be looking forward to your continued posting.