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#45448 - 08/01/05 04:20 PM Re: Sutures
Anonymous
Unregistered


Okay, first: I am a Registered Nurse (not MD, EMT, or Paramedic)
I was certified to work under an MD's direction, either directly or indirectly.
1. Nope, don't know how, wouldn't attempt to try it.
2. No, because it just doesn't make sense. You won't get a sterile environment, I probably wouldn't have antibiotics to give, and a good bandaging job will give better results "in the field".
I can place arterial and venous catheters in premature babies, in the hospital, with sterile equipment and sedation if needed. No way does this translate into the experience necessary to suture someone outside the hospital setting.

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#45449 - 08/01/05 05:38 PM Re: Sutures
Flotsam Offline
Newbie

Registered: 03/13/03
Posts: 35
Loc: Connecticut
Would I ligate a bleeding vessel - yes. I've done it hundreds (if not thousands) of times - if the choice is bleeding or ligating, I'll ligate. If I can control the bleeding in other ways(pressure/wound packing, etc...), that would be my first choice.

Would I close a wound, probably not - again,as stated before, the risk of infection is too great. I've closed more wounds than I can recall (I'm a PA, working in surgery), from operative wounds to traumatic wounds. I've also treated more wound infections than I can recall (some from operatiions, some from trauma, some just localized infections from folliculitis, etc..). The open wound will more than likely not kill you, overwhelming sepsis can. Control the bleeding, apply a dressing, get to a higher echelon of care.

Sam

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#45450 - 08/24/05 06:48 PM Re: Sutures
Anonymous
Unregistered


My first post here <img src="/images/graemlins/smile.gif" alt="" />

Short presentation: Scandinanvian MD with some ER practice and who recently did the (American) AdvancedTraumaLifeSupport course (the most used and probably best course in this field for MDs and Surgeons currently available)

Over to your questions:

1. If practically possible the absolutely best way to stop bleeding is manual pressure. Just look in the wound where the bleeding comes from and press there just hard enough to make it stop. This way no further harm is caused and the bleeding is stopped. Tie-off and suture damages tissue and complicates definitive surgery later on.
Suture is the most efficient of these two alternatives in some cases but also more technically difficult and might cause more damage.

2. Not sure I understand your question correctly. In the field the only wounds I would suture are scalp wounds without cranial fractures, if it bleeds profusely and the bleeding cannot be stopped in any other way. The suture in this case is a very efficient way of stopping the bleeding and infections are not as dangerous as in other parts of the body.
If a patient arrives to the hospital with a wound closed in the field I would suture it after rigorous flushing with saline if:
* The wound is caused by a clean object.
* It is no more than 8 hours old.
* Pulse,skin temperature, sensitivity and motor function "below" the wound all are ok. (Otherwise surgery might be required.)

The above answers are based on my personal competence and experience and might differ from what is the best solutions for other people in other places.

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#45451 - 08/24/05 08:50 PM Re: Sutures
Reddave Offline
Journeyman

Registered: 02/06/05
Posts: 50
So ladies & gents,
can I assume that unless you have a decent level of competency/skill/practice/knowledge that comes with working in the 'hands on' medical profession, then for us luddites its best to stop the bleeding using direct pressure & elevation of the area affected and if that doesnt work, use indirect pressure on the arterial points before the wound..... clean up and cover to prevent further contamination and then hightail it to medical assistance.
Bear in mind, the UK is not that big so a day is the furthest from contact in a worst cas scenario. AND I never travel alone so if 1 goes down others can cover.

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#45452 - 08/26/05 06:54 PM Re: Sutures
NAro Offline
Addict

Registered: 03/15/01
Posts: 500
Reddave, you said what I believe... except the part about skilled individuals going ahead and suturing in the field. Even IF YOU ARE a trauma surgeon or some other similarly skilled practitioner, I disagree with suturing to close a wound in the field. This thread seems to always come up, and I guess there are always going to be forumites who still would suture.

So.. fair WARNING TO ANYONE who goes into the back country WITH ME:
1) Expect to get lost, and/or injured. Usually it's me who does so, but once (just once) it was the other guy.
2) If you get cut enough so bleeding is a problem, I promise to do my best to stop it with direct pressure or as a last ditch step with clamps or ligatures.
3) I promise I will not suture or staple to close the wound. I'll steri-strip, butterfly, ..even duct tape.
4) And if I'm the wounded party, I promise I'll cut or shoot you if you try to suture me! Then we can do it your way..on you!

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#45453 - 08/27/05 02:04 AM Re: Sutures
CJK Offline
Addict

Registered: 08/14/05
Posts: 587
Loc: FL, USA
Many have pointed out that you shoud clean the wound....having seen many things used, I would like to point out that the best is still soap and water. Don't use the peroxide or alcohol or much of anything else. KISS. Soap and water.

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#45454 - 08/27/05 04:13 PM Re: Sutures - NAro
Reddave Offline
Journeyman

Registered: 02/06/05
Posts: 50
Thanks for the confirmation of my thoughts. With reference to the suturing, I just accept that I'm not medically proficient so that would be their call, as opposed to giving it the ok.
As for comment 4... yes you are absolutely right, because if I'm in big pain from bleeding cut, there's also the embarrassment of it. AND then you think I will willingly let someone hurt me by stickin' a big ole needle n thread through somewhere that's REALLY hurtin..... I take the same stance as you on that.
As for the duct tape.... have you tried pulling that stuff off after its been on for more than twenty mins?? Now changed over to using electricians tape for skin contact. Duct tape could be used instead for the grlfriends leg waxing, or substitute for your cars tow rope to pull it home. Its adhesion is lethal ( made more mess of my thumb than the cut it covered)
Anyway, thanks for putting my mind at ease

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#45455 - 08/29/05 01:20 PM Re: Sutures - NAro
NAro Offline
Addict

Registered: 03/15/01
Posts: 500
Re the duct tape. Actually, when we use it to butterfly an eyebrow and eyelid lac. it was because it was handy and waterproof. It was no problem to remove: we just instructed our buddy to leave it alone untill the hunting trip was over and he got back home. Then.. let his doctor look at it and possibly remove it. So you see.. no problem to remove (for me!).

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#45456 - 08/30/05 12:20 PM Re: Sutures
Trusbx Offline
addict

Registered: 01/16/02
Posts: 397
Loc: Ed's Country
Q1: If there was no other way to stop the bleeding and the vessel was critical yes. I would ligate the vessel leaving plenty of remnant suture for the attending surgeons to locate the vessel ligated later. This situation would most likely apply to limb injuries and the collateral flow in the limbs are sufficient even if you ligate one major bleeder.

Q2. As I have stated many times before in this forum, NOT if I had a choice. The best option would be for it to be cleaned and dressed and secondary suture done in the ER/MD office where things are more controlled. That being said, if I had to insert a chest tube for a soldier with a tension pneumothorax in the field, I would.

_________________________
Trusbx


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