In a previous post I mentioned I have a .5 oz bottle of Betadine in my FAK. Several people have suggested replacing it with Betadine wipes to reduce bulk.

From what I can tell, there are three possibilities:

- .5 oz Betadine bottle (what I have now)
- Betadine swabs
- Betadine wipes

I can see for small wounds that the wipes would be fine, if not overkill.

The swabs might be good in the case of small cuts so that you can get in there easier.

It seems like the bottle would be better for larger wounds since you could just pour it in. On the other hand, it seems like it would be harder to handle for small wounds, perhaps.

So what does everyone think? What type of Betadine should be in a kit and why?

Thanks,

-john

I have a small bottle (10 ml) with a plug in the neck. The plug is designed to place a drop precisely. That way you can put a drop on small cuts or scratches. It can be used on bigger wounds too. If you need a wipe you can always put some antiseptic on a gauze pad or in a pinch on a reasonably clean piece of cloth.

The comment of having a bottle to just "pour it on" is rather telling. We have this idea wounds should be dressed in ointments and then bandaged. A small amount of controlled bleeding will naturally flush any debri. Betadine and a loosly fitted bandage ( air circulation) are a good followup. I've seen to many horses ( and people) with injuries smothered in ointments not unlike cement repairs. The doctors/staff usually have to remove this stuff to see the extent of the wound, causing further pain and tissue injury.

The idea of having the plug is to squeeze out single drops and to avoid overly generous application (the writing on the bottle also instructs to use it sparingly). Some shallow wounds will not produce a suffient amount of bleeding to flush the debri so some additional cleaning may be neccessary.
When a wound is bad enough to see a doctor applying ointments may not be a good idea in most cases. Around here doctors get really angry if people do so.

Hi everyone,
What is the difference between a triple antibiotic ointment made with 1. Bacitracin 2. Neomycin Sulfate 3. Polymyxin B Sulfate and one made with Gramicidin instead of Neomycin?
Because Polysporin® claims that it doesn't contain Neomycin. Why is that so? Is Polysporin® a good choice for our FAK?
Thanks

I believe some people are alergic to Neomycin. I know that some people can't use Neosporin because it causes a reaction.

John:

This may help clear the "air" on Betadine.

Betadine (a.k.a. 10% Povidone-Iodine sol) should never be used "full strength" from the bottle into an open wound. In clinics and hospitals, it is always diluted further. The reason this is done is because "full strength" is still considered caustic to tissue. The only time it can be used directly is when the skin is still intact, e.g. prior to surgery and surface area needs to be cleansed. Iodine allergies also contribute to potential problems for some people, hence the hospitals are moving away from Betadine use to a degree.

Simple wound care should be done in the field if such care does not require evacuation of a patient.
Patients need to be evacuated if...

The wound is highly contaminated by debris.
The wound has a medium to large amount of crushed or dead tissue.
Any human or animal bite.
Deep wounds on the hands or feet.
Wounds requiring care for cosmetic reasons, such as, a laceration to the face.
A wound involving joints, or opens into a fracture. (Ankles, knees etc.)
Wounds associated with medium to large blood loss (uncontrolled bleeding > 10 minutes.)
Any gunshot or stab wound. This should be followed up with a police report.
The patient is limited in trip participation.
Any previously field cleaned wounds that are not healing correctly, or showing signs of infection.
Burns involving the head, face or trunk e.g. campstove explosion.
Environmental exposure will cause further complications, such as, hypothermia.

REMEMBER: Always error on the side of caution, if you are unsure whether someone should be evacuated or not, plan to evacuate.

Simple soap and water can be used for most wound cleaning, water clean enough to drink is clean enough to cleanse a wound. A minimum of 500mL (about ½ quart) should be used.

Betadine can be used as a cleansing adjunct, but only if diluted.

A good resource for more information is a book called “Field Guide to Emergency Medicine” by Dr. Paul Auerbach, M.D. and Dr. Eric Weiss, M.D. There are also the usual U.S. Military field manuals and survival books. Check your local library.

NOTE: These are common recommendations and I did not offer any recommendation for closing a wound in the wilderness setting.

Stargazer

ASAP= Always Suspicious, Always Prepared

Max:

Ever since I learned that the most dangerous knife to you is a dull knife, and about allowing a cut to bleed, I have kept my knives sharp, and I have always allowed wounds to bleed before any treatment or bandaging. I do also take it one step further in that any small injury I get or help treat that does not bleed well by itself, I massage and force the tissue in that area to cause more bleeding to the injury. Before all you professional medics out there have a heart attack, please remember I am talking about relatively small cuts and puncture wounds.

An example; the other day I was opening a new purchase packed in one of those plastics that defys the sharpest razor with my knife. I was using a controlled cut with my thumb braced opposite the blade and going through that plastic as fast as a speeding turtle. I pushed just a little bit too hard without the thumb control in place, jumped out ot the cut I had been making and jammed the knife point under the nail of my left thumb. After the appropriate expletives, and self directed insults, I stuck my thumb in my mouth and sucked as hard as I could; no blood. I then started massaging the base of my thumb and forcing blood toward the point of impact; no blood. After all that, I washed it with soap and water, flushed it with a little 90% alcohol, put some triple antibiotic and a bandage on it. Despite the fact that there was no skin broken, that thing hurt for a good four days.

I, like Chris, believe you should let any open wound bleed out some, but unlike anyone I have ever talked to, I also believe in forcing more blood from a slow bleeding wound in order to flush it better before it coagulates.

Bountyhunter

When you have a shallow skin abrasion, it often doesn´t bleed. The lymph that seeps out doesn´t flush too much either.
Allowing a small wound to bleed a little is Ok. Forcing the bleeding doesn´t add a real benefit. You simply can´t create a flow that makes enough difference. I´d be really careful with puncture wounds. It´usually hard to tell how deep it is. The rubbing may well help to make the infection worse.
When the skin wasn´t broken with your acccident you may have suffered a small bruise. In that case increasing the bloodflow actually makes it worse.

Oh I forgot to mention, with shallow skin abrasions, I cut an opening above the abrasion which is as wide as the abrasion and induce a waterfall of blood to flow over the abrasion in order to help cleanse the abrasion. I then bandage everything up.

Bountyhunter






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