First Aid Kit: Which Betadine?

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






I wonder how many readers are actually going to believe the above before they get to this tag line that says;----------NOT!

Hmm. I had just read this Betadine FAQ which lead me to think that using it "full strength" was not only OK, but recommended:

http://woundcare.org/newsvol2n2/ar1.htm

"
Q. Does Betadine Solution "dry" or "blister" wounds?
..............................

A. No. Betadine Solution does not dry or blister skin or wounds. Betadine Solution is film-forming and leaves a protective antiseptic film over wounds and skin which decreases microbial counts and subsequently provides excellent antimicrobial substantivity for several hours.

Q. Should Betadine Solution ever be diluted when treating wounds?
..............................

A. The use of full-strength Betadine Solution on wounds has been proven to be safe and effective.

[...]

We therefore recom- mend the use of full-strength Betadine Solution on wounds and skin injuries.
"

Hmm.

-john

Considering Betadine has the approximate viscosity of water, I don't see why this should be a huge issue. You can pour the stuff on or over the wound, dab or let the excess run off and you are set. It seems the really cool part here is that it is not a paste.

-john

As has been stated many times in this forum before:

Irrigate all wounds copiously - water, normal saline solution, chlorhexidine. We don't really irrigate a wound with betadine unless you had a lot. The key here is volume to wash out the dirt and gunk. Of course if you had lots and lots of betadine..... If you had only one bottle, it would be better to dilute wht amount in a larger amount of water to get more bang for your buck.

Don't induce more bleeding. Water is cheap, blood is not.

Don't close any dirty wounds in the field. If you can get it clean with irrigation and you are trained, you do so at your own risk.

DO NO HARM, to your wound, yourself or others!

I just thought I should clear something up. I tried to set the context up in this post, but I realized I didn't link that post here. While it is obviously an importaint issue, I'm not really thinking of what you should do for wound care when professional help is imminent. In those cases I would be just peachy doing the minium needed and letting the professionals take over. I'm more thinking about in a disaster or remote emergency when it is likely that I'm the best that is available for some time.

Thanks,

-john

There is a fourth possibility ...I carry a 50 ml dry powder spray can of povidone/iodine. Dont know if its available where you are though.

For cleaning out wounds I carry 500 ml of clean water and a 20 ml tube of sterile saline. Plus the usual wipes. The povidone/iodine spray is for treating the dogs as it is much easier to get to awkward fur covered wounds with it in the field.

Very good advice, stargazer... you sound like you'd be a good person to have along in a pinch. I was going to ask your background, but after a quick look at your bio, I saw that you'd already answered that for anybody curious enough to look. You sound like you'd be a good bug-out buddy.

Troy

John:

I recently reported that Betadine straight from the bottle into a wound was considered caustic to tissue and should therefore be diluted. Well, today (July 5, 2004 at 0100 MST) I spoke with the Doc at the ER and learned the "old school" of thought were along those lines. Seems in the late 1980's a series of anaphylactic reactions to iodine were noted. This subsequently led to an investigation by the FDA. The hospitals and clinics were quick to adopt the idea of diluted Betadine. In about 1998 it became recognized through product research to return to using Betadine full strength. Now a wound is irrigated (depending on the need and amount of debris) and just prior to closure about 10cc of Betadine is literally dumped in and after about 2 minutes it is rinsed out and the wound closed. CAUTION: Be sure your patient is not allergic to iodine, or shellfish, as this may cause problems.

I learned two things today…

One: I was still under the “old school of thought” and should therefore consider full strength Betadine in wound irrigation. About 10cc should work, anymore and you need professional help.

Two: When you are in the ED at 0100 with a heart attack (transported by ambulance) and the Doc is getting ready to suture a wound closed, you can learn something from them while they suture if they know you and are willing to instruct. BTW I observed the doc literally flush the wound with Betadine and then flush with sterile water.

Hope this clears the air yet again and the Doc did refer me to the website as you have. HMMMMMMM

I apologize to you (and all) if I caused any confusion and gave incorrect information.

Stargazer

Thank you, I enjoy good comments like that.

Stargazer

Stargazer:

To paraphrase the bank robber in "Dirty Harry", "I gots to know".

Was the heart attack you?

Was the sutured wound you?

Did the wound induce the heart attack, or vice a versa?

Bountyhunter

Trusbx:

I was just kidding about cutting an opening for flushing an abrasion.

Water may be cheaper than blood, but you can't always get safe water.

Since you are medical professional, I wonder if you can tell me wheather urine is really a good antiseptic? I used to hear stories about it being used by some soldiers when medical supplies ran low or out, but since a lot of these stories came from friends, I never knew if they were kidding or not.

Bountyhunter

Bountyhunter

Nah; the heart attack and the wound closure were two different people. I wasn't either one of them. As far as I know I am in somewhat good shape. Need to loose a few pounds though and other than that I am ok so far. That's what the doctor said anyway. <img src="/images/graemlins/cool.gif" alt="" />

Heart Attack was a pt. I took to the ED via the ambulance service I work for. <img src="/images/graemlins/smirk.gif" alt="" />

Sutured wound was on a young lady in the room next door. I think she was the victim of a domestic fight <img src="/images/graemlins/mad.gif" alt="" /> The doctor asked me to come in and tell him about the patient I had brought in.

Thanks for the concern and I enjoyed the comment about "bleeding the wound!"
Stargazer

Not at all. Thanks for your comments and I'm glad we were able to get to the bottom of the conflicting information.

I certainly can see how the iodine allergies can complicate matters.

-john

ok i admit it you got me.

i was thinking what the...he must either be really tough or stupid or both.

nice trick about 3 months too late hehe.

NY RAT:

I lost tough a long time ago, but am desperately holding on to stupid in some catagories so as to not go mad.

Bountyhunter <img src="/images/graemlins/cool.gif" alt="" /> <img src="/images/graemlins/wink.gif" alt="" /> <img src="/images/graemlins/smirk.gif" alt="" />

Ewww!
Urine should never be used for drinking, cleaning wounds or any other medical purposes! It has no antiseptic, curative or magical properties. While you may be able to flush out debris from the wound and while urine in the bladder is sterile, it picks up the bacteria on the way out to contaminate the wound.

<img src="/images/graemlins/grin.gif" alt="" />
However, if your car radiator ran out of coolant.......

another uses of pee... :http://www.rotten.com/library/medicine/bodily-functions/pissing/practical-uses/

well as long as you got smarts and wisdom im listening.

Medicinal

Urine has been used in various ways as a healing substance, both when taken internally (see Drinking Pee) and when applied externally. Native Eskimo people are but one of many cultures to use fresh urine as an antiseptic, and certain tribes of central Africa who mix it with mud to form a paste which relieves insect bites.


i dunno ive never tried it, it just doesnt sound right to me.

AFAIK mid flow urine is an antiseptic. However, only if you do not have a UTI. If you have a UTI it will contaminate the wound. You would have to be in really desperate straits to use this though IMHO.

Betadine gel (ointment) is also available - ideal for small to medium sized wounds.

Nice thread!

Chris, why wouldn't you coat a wound with vaseline or ointment after letting it bleed or flushing it out? It helps seal out the bad stuff. As an aside, the wildernessFA guy who taught my class 'cited' studies that plain old petroleum jelly was just as effective as antibiotc.

If the wound needs advanced medical attention aren't they going to scrub it out regardless of whether there is ointment or not? (I now pause to thank medical science for Xylocaine infused scrub pads after a severe case of road rash)