Wound treatment away from civilisation.

bungie

Mors Kochanski
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Late last week I had a fight with a hole saw in a drill, imagine a power saw but the teeth are on the lip of a cup. This gave me a good bite and I ended up at ER getting stitches. That was Thursday, today is Monday and I have been to the doctor, as infection set in, to get antibiotics.
This has got me thinking, what would I have to do out bush had I had the problem out there. I used my FAK and flushed the wound with clorhexidean to remove saw dust and left over bits of me from the hole. Then used sterile dressing to cover it. Then went back to work and finished off the job before going to the ER. And I still got infection. Out bush the infection would compromise the leg.
So, out in the bush what is available to prevent and treat the wound? A solution of blood wood gum and warm water over the wound? or is there something better to use if you knew there was no antibiotics for a Couple of weeks?
 

Askew

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I have heard geebungs referred to as bush band aids due to their antiseptic properties.
Other than that I'd just make a point of doing my best to make sure my hands were clean before treating the wound, and clean it thoroughly.
Just out of curiosity, was the infection due to insufficient cleaning of the wound before heading to emergency? Or it got infected despite everything?
 

pap11y

Richard Proenneke
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I'm sure plantain chewed and put on the wound is supposed to be good for this.. I know it helps healing but don't know if it stops infections...

I also thought there was a sap from one of out native trees that could help with this as well.. (but maybe I saw that on Ray mears and its a UK plant..)

Disclaimer - I know very little about this stuff so don't quote me on this..

Plantain -



Thanks Blake. I learn't about Plantain from you and its the only plant I can easily recall....

Edit - Here is an interesting article about it - http://www.herballegacy.com/Ahlborn_Medicinal.html
 
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Cam

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Hi,

I know a little, mainly theoretical.

Plantain, as mentioned, is suppoed to be good for cuts and burns. And to help with stings. I have had mixed success with stings, and have applied it to a small cut for a few hours that didn't get infected and healed up ok, but maybe that had nothing to do with the plantain as it was a small and clean cut anyway. Some plantain (e.g. Broadleaf) seems to work better than others (e.g. Thin leaf) with the stings though. I am little skeptical of putting it on a deep puncture style wound or anywhere else you couldn't clean it out though. Puncture style and/or jagged rip wounds are bad because they are hard to clean and tend not get much oxygen and this can encourage certain nasty bacteria (e.g. tetanus) to grow.

Pine sap is supposed to be antiseptic and aid healing. I had a bleeding bite (?) at least I think that's what it was. I noticed it leaking blood everywhere, but I am actually unsure what caused it! Given I didn't feel it, I suspected a bite - there were some nasty biting flies in the place I was so I suspect that was it (but they usually hurt a lot when they bite, so maybe not). Anyway, I applied some Japanese Fir sap (Pinus, despite the name) froma tree blister that happened to be handily on a tree right next to me. The wound felt fine and stopped bleeding. Hours later I remembered I had the wound and as I was now near normal antiseptic - alcohol based, so in theory slightly likely to impair healing in and of itself - I decided to stick some of that on. Interestingly the wound started itching and hurting a bit for a maybe an hour after this (not just the initial alcohol sting), but eventually settled down. there was no discomfort before that. I almost felt the sap was doing a better job! Still, again, a very minor injury that probably would have healed ok on its own.

Bloodwood you already mentioned. I have no practical experience with that though. Still, Bob Cooper (amongst other sources I have read since) told me it is antiseptic and he has personally used it, so I am inclined to think it would be effective to some degree.

Maybe a Tea tree poultice may also be of use?

Supposedly Liquid Ambar sap is also mildly antiseptic (but you probably won't find that outside of a city park or northern forest!)

A Mallow poultice is supposedly good for dry sores and I think skin infections (but not so much for cuts).

Soap plants may be of use in the initial wound cleaning, I guess, in the absence of anything else.

I agree that the best thing to do is to clean it well with purified/boiled water (and any soap or FAK antiseptic you have), and then keep it clean. i.e. you pretty much did what you could. But with the wound you describe, I am not entirely sure there was a really good option available for basic bush first aid or that the bush treatments would have been enough to fix the infection afterwards! Scary, isn't it? But I hear infected wounds killed a lot of people before antiseptic and antibiotics became common!
 
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bungie

Mors Kochanski
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Just out of curiosity, was the infection due to insufficient cleaning of the wound before heading to emergency? Or it got infected despite everything?

I cleaned it, then ER did too. But still got infected. The cut was very torn as you would expect from a saw style devise. So maybe that was the problem.


Hi,


Scary, isn't it? But I hear infected wounds killed a lot of people before antiseptic and antibiotics became common!

Well that's what got me thinking. The fear by the medical fraternity of over using antibiotics is that we start dropping dead from what we now consider a simple infection on a cut or blood poisoning.
 

Joe

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I watched a doco on penicillin the other day and the one of the first test cases was on a guy who had an infection from a rose scratch. He died despite the treatment as they couldn't produce enough penicillin to finish the course. Crazy to think you could die from a rose thorn without modern medicine.
 

jd1

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g'day all. ok i'm a senior ED (not ER...that is an Americanism...it is not a room...it is, in Australia an Emergency Dept) nurse who has extensive trauma training and have nursed for over 40yrs. when i'm not putting people back together I have spent a lot of time in the bush camping and bowhunting.

ok for those of you bored now the short answer is that there is no ready bush fix for the kind of wound you describe and I can think of no reason in this age of ready communication and transportation to remain in the bush for several weeks after sustaining this kind of wound. common sense should take precedence here and once a wound of this type is sustained that should be your last day in the bush until you get the wound addressed in an emergency department.

as you may have realized from the original authors story time is very much of the essence. the kind of wound cleaning that you can manage even at home in a fairly clean environment with running water is very often not enough compared to the kind of wound clean that you would get in hospital. the author states that he washed and dressed the wound and then delayed his attendance to finish his task. the mechanism he describes of the hole saw means that the wound is jagged, dirty and deep. the spinning teeth of the saw would have driven a LOT of bugs very deep into the wound and at this stage a trip to my ED would have involved a surgical consult and very likely a trip to theatre to have the wound deeply explored and thoroughly cleaned out. trust me this is not the kind of wound clean that could be done by yourself!

this may sound like overkill but it is much better than a massive infection or worse still sepsis that left untreated is fatal...and very unpleasantly so.

given the tendons in the hand and the likely proximity of saw teeth and bugs to the tendon sheaths even more caution is needed. if there has been ANY tendon sheath involvement then those pesky little bugs will migrate up the tendon sheath quicker than you can say "oh dear" and then your hand wound becomes your whole arm wound...oops.

if as the author posits you at this stage decide to stay in the bush the next step is sepsis. those hand and arm bugs now multiply by the zillion and shock, fever, hypotension and multi organ failure await you....that hypotension I was talking about means your blood now longer perfuses your organs well enough and they die...oops.

nothing topical...zilch...nada...f..k all will make an ounce of difference to bugs and dirt embedded deep in a wound that is too deep for a simple washout to fix.

a very superficial wound maybe but deep and dirty....well if you pardon my pun, you shouldn't chance your arm on it

I could go on and as I have seen many such wounds over the years could provide boring evidence of my findings and mans seemingly endless abilities to (a) find new and creative ways to injure himself and (b) his sometimes quirky (and often costly and ineffective) ways of treating his injuries.

I wont however as if you weren't already bored you probably are by now. I don't mean to sound harsh or disparaging but walk a mile in my shoes and see what I have seen and I see it as a duty to try and warn ppl about poor self treatment options. with wound care please take no chances. live to come back to the bush we all love so much another day. don't make a bad call and make your next trip to the bush your last

am happy to answer questions about wound care if anyone wants to ask.....stay safe all
 

Thrud

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Good words of advice. Regard all wounds as contaminated. Don't close any wounds over 6 hours old(an exception might be the face or scalp(very good blood supply)) make sure you're up to date on tetanus . Sterile fluids are rare, mechanical debridement of grossly contaminated wounds Irrigate either with or without pressure (syringe with needle)


There is nothing wrong with leaving wounds open.

Clean incised wounds are a totally different ball game from jagged wounds.

" the solution to pollution is dilution"
 

bungie

Mors Kochanski
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JD1, thanks for the reply it's very interesting. Sorry for the U.S. Slip :(
i can see how the problem I explained could be a major concern in the bush, even with 2 1/2 days of antibiotics I am still infected and return to the doctor in a couple of hours.
I fully understand were you are coming from with getting straight to medical help, the original question was more the injury made me think about a bit of bush medicine and the possibilities around us we might not aware of.
 

jd1

Les Stroud
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Bungie with the kind of injury you describe there is really nothing that is going to be use at that level....best bet go to hospital or have me and my first aid kit with you lol
 

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Bungie with the kind of injury you describe there is really nothing that is going to be use at that level....best bet go to hospital or have me and my first aid kit with you lol
Some great info above mate, very interesting.

However I don't think the discussion should stop with an implication that there is really nothing else that is going to be of use. I think it is sound advice that hospital should be the first visit and any attempt of self treatment that purposefully disregards emergency care is not a good life choice. However I think the point of this thread either is or IMO should be discussion around practical techniques that can be used if the professional emergency care is not available for whatever reason (lost, natural disaster, delay to being able to get to hospital).

I am no expert but I am sure there are multitudes of techniques and treatments that have been employed for thousands of years. No doubt success rates would be nowhere near modern times but in comparison to doing nothing or very little, there has to be valuable knowledge out there.

jd1 it would be great to hear your professional feedback on what you could do if you had no other options.
 

Bloffy13

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Paring it back from a major wound to something like a sliced hand due to cutting something wrong, due to a little too much portwhat would you suggest?
Thrud, any ideas? Lol.
Jokes aside, is there anything at a below needing stitches level that can be used?
Cheers
Bloffy
 

Thrud

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Most fruit juice is sterile. Male urine is usually sterile( mid stream) (big debates on this), boiled water ( obviously). Honey is very good for wounds, sugar is not too bad either

The likelihood of a wound getting infected depends on a number of factors, host factors( diabetes, steroids, jaundice, malnutrition etc.) the wound itself ( clean, contaminated, dirty) burn wound, incised wound, ragged wound, superficial, deep what is done to it ( left open, debrided, closed primarily), the environment ( humidity, sterility and hand hygiene of people handling the wound. All these factors need to be considered in wound management.

For example: my finger opened whilst slightly inebriated using a large folding kukri to cut chocolate which could have easily been broken into pieces....clean wound with clean blade. Tourniquet round finger to staunch bleeding, assessment of nerve and tendon damage in finger(none) clean and disinfect wound with alcoholic Betadine sachet (stings a bit). Remove excess blood and paint finger with Friars balsam then steristrip and bandage(checking circulation still intact once bandage on finger). Healed fine no infective complications. This is clearly miles awAy from a chainsaw injury or a piece of wood sticking into your belly.
 

bungie

Mors Kochanski
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Thud, there in laid part of my problem, long term steroids for another complaint. Healing can be a bitch when on them :(
 

Thrud

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Steroids are, if you'll pardon the pun, a double-edged sword.
 

jd1

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Some great info above mate, very interesting.

However I don't think the discussion should stop with an implication that there is really nothing else that is going to be of use. I think it is sound advice that hospital should be the first visit and any attempt of self treatment that purposefully disregards emergency care is not a good life choice. However I think the point of this thread either is or IMO should be discussion around practical techniques that can be used if the professional emergency care is not available for whatever reason (lost, natural disaster, delay to being able to get to hospital).

I am no expert but I am sure there are multitudes of techniques and treatments that have been employed for thousands of years. No doubt success rates would be nowhere near modern times but in comparison to doing nothing or very little, there has to be valuable knowledge out there.

jd1 it would be great to hear your professional feedback on what you could do if you had no other options.

interesting question. I guess the first thing that springs to mind is preparedness...both internally and externally. trauma of any kind is easier to bounce back from if the victim is fit. your pre morbid state plays a big part in recovery. obvious con factors include obesity, diabetes, smoker, heavy drinker and unfortunately age. a key part of fitness also is mental attitude. the positive mindset is always going to stand you in good stead over the negative "oh woe is me" attitude. if you are the little engine that could then you are in front.

external preparedness is having the right gear and the knowledge to use it. bear in mind that anything you have if you are on your own may end having to be used one handed!!!

I have seen a lot of first aid kits over the years owned by guys some of whom have asked me to look over their kits and offer advice, suggestions and training etc. these have varied from a packet of band aids and a bandage to enough to outfit a 3rd world intensive care unit.

whatever you take it is key that you have the training and knowledge and real world experience to use it correctly...alone in the bush and in trouble is not the place to be performing a procedure for the very first time!

ok basic wound care is pretty simple....bleed it...let the body flush the wound from the inside out...a small amount of blood can carry away a surprising number of bugs and debris. then wash it...obviously clean water is best but you will have to make a judgement call if you have limited supplies available but even a limited flush is going to help tremendously. ok now wound closure.

first do you have to? stop and evaluate before you start enthusiastically stitching, bandaging, sticking etc. if blood loss is an issue then go ahead but be careful you don't inadvertently cut blood supply off to distal parts of the injured limb etc. use dressing material that has some give in it. if you are going to wrap something circumfrentially around a wound then that something should have some give to allow for the tissue to swell as a natural reaction to the injury. steri strips if you have them or band aids cut into narrow strips or tape cut into narrow strips are good wound closure options that require no more than a steady hand. bear in mind that "loose" wound closure is better than hermetically sealed wound closure as it allows the wound to drain excess crap out. if you give the gunk nowhere to go you increase your chances of a nasty infection so always give the wound some way to drain! if your first aid kit has some antiseptic ointment/liquid in it use it. I prefer ointment over liquid as its retention in the afflicted area is better. if you can carry a syringe with you then that is great way to try to do some deep irrigation of wounds as you can squirt the water in a very direct fashion and said syringe can be kept clean and used again.

with wound care you have to draw a fine line between leaving it alone and possibly missing the early warning signs of trouble and overdoing the ongoing cleaning and constantly interfering with the wound bed and constantly removing the new healthy granulating cells from the bottom of the wound bed which is why good old plain water is the go for wound cleaning.

with clean water bear in mind that any water based liquid if boiled is good and if you boil liquid and condense the steam from same gives you pure water.

if you have a bandage then fantastic..you now have a sling, a wound closer, a limb imobiliser and a snake bite intervention. Australian snakes have relatively small soft fangs so envenomation is usually transported by the lymphatic system. if you compress the tissue the venom can't move. apply your bandage from the bite site up the affected limb with good stretch as far as you can and then leave it on. this will buy you a lot of time and trap the venom.

I think the keys are mental and physical preparedness coupled with some equipment that you know how to use.

ideally a kit would have a long wide bandage (you can make a long wide bandage smaller you cant make a small one bigger) some combines or other dressing pad....again large is good....those chemist shop first aid kits with cotton wool balls are pretty useless...go big for everything and cut down to size if needed. some medical tape and some band aids...I prefer the fabric ones due to their rosbustness. your antiseptic/antibiotic ointment/liquid of your choice, steri strips if you got em, some good old fashioned Panadol...your body will love not having to cope with pain as well as trying to deal with the trauma! and don't forget a pair of trauma scissors...they weigh **** all and it is much easier to use them one handed than a sharp knife lol

the bigger more extensive kits I have seen have contained everything from suture kits, fancy wound care dressings and wound care creams and all manner of drugs and giving sets etc. again it depends on what you can obtain, what you can transport and what you have the expertise to use!

remember your brain is your best friend....stop!...think!...plan!...execute carefully!...don't rush it and do it right...rest and use analgesia and be your bodies friend.

if you injure an eye cover it and leave it covered

if you injure a leg and have to walk out cut a stick and use in on the non injured side...eg hold the stick in your R hand for a L leg injury

dress your wound and clean it.....NEVER use harsh chemicals like METHO...all you will do is traumatize the wound bed even more!....aqua aqua aqua aqua!

bind your snake bite with a wide bandage from the bite site up the limb as far as the bandage will go

rest when you can and give your body a chance

a black plastic bag over a limb of a bush will give you some water at the end of the day

if you have any pre existing medical condition please please take your medication with you....I have looked after a lot of people who have come to grief after neglecting to pack their usual medication!!!

ok I've rambled on a bit.....ask any more questions at your peril lol


seriously if I can help feel free to ask
 
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Aussie Forager CQ

Rüdiger Nehberg
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jd1, mate that is one of the best first aid informationals I have read!! I think I learnt more then, then all my first aid courses combined! Full of the practical advise and common sense info that is useful and easy to understand. Well done.

If you ever put together a wilderness first aid course with that sort of content quality let me know and I will jump on it!

I will take up your offer of questions as I have plenty! Especially regarding low tech methods.

What are your thoughts on cauterizing a wound? Are there times that you would personally have a crack at it? (context is that emergency care is not an option for whatever reason)
 

jd1

Les Stroud
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jd1, mate that is one of the best first aid informationals I have read!! I think I learnt more then, then all my first aid courses combined! Full of the practical advise and common sense info that is useful and easy to understand. Well done.

If you ever put together a wilderness first aid course with that sort of content quality let me know and I will jump on it!

I will take up your offer of questions as I have plenty! Especially regarding low tech methods.




What are your thoughts on cauterizing a wound? Are there times that you would personally have a crack at it? (context is that emergency care is not an option for whatever reason)

you're welcome mate...always happy to share the love especially if it means you don't get to meet me with my stethoscope hanging round my neck...much rather say g'day over a steaming billy across a camp fire!!!

your question about cautery is interesting...in medicine we use cautery in surgery...its called a diathermy machine and is basically a small electric soldering iron that surgeons use to stop small bleeds during surgery...the smell is unpleasant but it is effective.

in a wilderness scenario I can't help but think that any wound that will not respond to pressure and cautious and timed tourniquet applications is likely to be fatal. you have to bear in mind that cautery of the conscious person would be EXTREMELY painful and the shock alone may have dire consequences.

I personally would only attempt it as a very last resort. if I genuinely thought that I was going to bleed out and die and that all other options had been used to no avail then I might give it a try but I would not personally hold out a lot of hope for this option.

as far as questions go mate feel free to ask...knowledge is power!
 

Aussie Forager CQ

Rüdiger Nehberg
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jd1, Interesting, good info, that helps to paint a bit of a picture in my mind about what it is all about. I don't think I will be warming up a branding iron any time soon :)

You raise another point that I have always had questions about. Tourniquets. I feel they are shrouded with a bit of grey area, for a lay person at least. There is obviously a bunch that could be said about them I am sure. Do you have any general rules of thumb regarding timing and effects that may shed some light?
 
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