Thursday, July 31st, 2014

Cleaning Necrotic Wounds In A Collapse Scenario

Lizzie Bennett
Underground Medic
February 20th, 2013
Reader Views: 1,450


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Necrotic wound debridement…the sight of those three words was enough to fill me with dread when I saw them on my operating list. Unpleasant, often disgusting and always extremely foul smelling, these were the cases you really did not want right before going home for your evening meal. Always done at the end of the list so as to avoid the possibility of contaminating a ‘clean’ case, you have to believe me when I say some of these wounds were the stuff of nightmares.

Imagine for a moment, dealing with a foul smelling wound, full of dead and dying tissue, without the backup of an operating theatre and the equipment and staff that goes with it. Not good eh?

Necrotic tissue is dead tissue, and when tissue dies it starts to rot, to decompose, and that smells, it smells awful, it is a smell you will NEVER forget. It does not always occur through neglecting a wound, a simple scratch, something that you would not have considered going to the doctor or hospital about, can turn necrotic over night if the right bugs get into it. Necrotising fasciitis is an extreme but prime example of this. Necrotic tissue is soft and spongy to the touch, there is no form to it. It may be black in color  but any shade of green and/or yellow is quite common. The wound will probably be oozing pus and fluid, and it will stink to high heaven. This decaying tissue has to be removed from the wound as soon as possible to avoid overwhelming infection.

It goes without saying that if you have antibiotics they should be given immediately, providing the patient has no allergy to the drug.

Those who live a long distance from medical assistance, or who find themselves embroiled in a situation where medical assistance is no longer a viable option would do well to know how to deal with such wounds.

AUTOLYTIC DEBRIDEMENT

This is simply allowing the body to resolve the situation itself, such as allowing a frost bitten finger or toe to drop off on its own without intervention. The digit is wrapped in a damp dressing, and kept damp until the situation resolves.

MECHANICAL DEBRIDEMENT

Mechanical debridement is the simplest way to try and get the dead and dying tissue out of the wound. Water under pressure is the simplest way of doing this. Clean sterile or boiled and cooled water if forced into the wound, flushing the dead tissue out. This can be done via a large syringe if available. An acceptable substitute is a squeezey ketchup or mayo bottle that has been cleaned and treated with bleach prior to being filled with clean water to be used on the wound. The water should be forced into one end of the wound, working systematically towards the other end of the wound. This may need to be done many times in order to remove as much decayed tissue as possible. If chlorhexidine or iodine scrub solutions are available they can be used, well diluted to assist in cleaning the wound.

Opinion varies on what should be done next. Years ago the wound was packed with a large, sterile, wet to dry pack, which was left to soak up any exudate and then allowed to dry. This was then pulled out of the wound, bringing necrotic, and healthy tissue with it. This is very painful. I do not favour this but it was/is a recognised practice depending on where you live and the availability of ongoing care.

My choice would be to remove the bulk of the decaying tissue with pressurized water as described, and then do it again with salt water. The wound should be checked every few hours and the treatment repeated, with salt water as often as is needed. This may need to be done for several days, several times a day until the wound no longer smells and is no longer purulent(producing pus). These wounds should not be sutured as the smallest amount of decaying tissue left behind will fester inside the closed wound. The wound should be covered with a clean non-adhesive, damp, lint free dressing and checked twice daily for signs of regression. If you are fortunate enough to have a supply of alignate or hydrogel type dressings or packs these should be used in preference to other types of dressings.

CHEMICAL DEBRIDEMENT

Certain chemicals contain enzymes that can target necrotic tissue whilst leaving healthy tissue undamaged. These chemicals are not available other than in a hospital setting, they are target specific components of decaying tissue depending on the type of wound. Some articles state that chlohexidine and iodine are suitable for chemical debridement, they are not as they contain no enzymes. They are useful for wound cleaning if available but that is all.

SHARP DEBRIDEMENT

This simply means removal of necrotic tissue with a sharp instrument, preferably with a scalpel being held by a qualified surgeon.

BIOLOGICAL DEBRIDEMENT

This may also be called larval therapy. Maggots are used to clean the wound. In hospitals the maggots are bred in the lab, but a maggot is a maggot and if left to do what they do best they will clean out a necrotic wound very effectively. As much dead and decaying tissue as possible should be removed with washouts and then several maggots should be put into the wound. A damp dressing should be used to cover the wound and the maggots left to do their job. Obviously the maggots will need to be removed before they turn into flies, so having a steady supply would be advisable. A small amount of meat product in a damp jam jar will allow flies to lay eggs and ensure your maggot supply.

Many people will have a psychological aversion to larval therapy, and this is understandable. The patient should be warned that they will feel the maggots moving around, but the maggots prefer decaying tissue and will choose it over healthy tissue if given the choice. It is not in any way painful and really does give the wound an excellent chance of healing as they are very effective cleaning machines.

Once the wound is clean, it will start to granulate, new cells will form and eventually the wound will close. This can, depending on the size of the wound take a considerable time. The use of alignate dressings or hydrogel will speed the process considerably. If not using these dressings keep the dressings you are using slightly damp with either pre-packed or home made saline solution, this will aid the healing process. Antibiotics should be continued for at least five days.

It goes without saying that the decision always has to be to seek qualified medical help if it is available. Dealing with these wounds is difficult and the outcome can never be predicted. Treating wounds yourself should only ever be the first choice if there is NO other choice.

Lizzie.

Delivered by The Daily Sheeple


Contributed by Lizzie Bennett of Underground Medic.

Lizzie Bennett retired from her job as a senior operating department practitioner in the UK earlier this year. Her field was trauma and accident and emergency and she has served on major catastrophe teams around the UK. Lizzie publishes Underground Medic on the topic of preparedness.

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  • Cnsay

    Many thanks Lizzie for these articles. The information you bring is priceless. I pray I never need it however.

  • http://www.TheDailySheeple.com lizzie Bennett

    Cnsay
    I’m with you on that. I hope that should we ever face these situations the info will be useful…but I would very much prefer that it gets thrown away in years to come because it’s no longer required.

    Take care
    Liz

    • jp

      Thank you ,will be making a copy for my BOB.

  • Jeffrey

    There are several products that I keep handy and use quite regularly to prevent and treat injuries and infections. The first product is called Bag Balm. It is designed to be used for dairy cows who get cuts and chafing of their udders. My first experience with this was as a young adult. My entire knee cap area became grossly infected after I slid into home plate playing softball. I had even used a surgical brush and copious soap to scrub the abrasions. Within 24 hours my knee cap had a huge, bulging dome of yellow and green pus on it. I had it covered with gauze and antibiotic ointment when I went to work. My boss, an old farmer type guy noticed me limping and asked about me knee. I showed him what it looked like. He said, “oh, I have this ointment that will clear that up in no time. So, he took a clean large bandage and smeared it with the ointment. I put this new dressing on my knee. Within several hours it felt like a huge suction machine was attached to my kneecap. He said yup, it is working. Just leave the bandage on overnight. When I removed the bandage the next morning it was disgusting…….full of pus AND GRAVEL! My kneecap was clean and pink. Needless to say I always have a green can of bag balm on hand. Buy it at your local farm supply store. Amazing stuff.
    The second product I use is a spray called Vetricin. Amazing product for treating areas of abrasion and injury and infection. It really knocks down the smell of necrotic tissue also. You can buy this at your local farm supply store. It comes in a thin liquid version, good for deeper wounds because it runs into the wound. In the horse section you will find a spray gel version of it. This version dries like a bandage over the area.
    Please get these items and a large supply of gauze. You can stock up on gauze at any animal supply site on the net. I just bought 50 sleeves of gauze pads for a great deal of 80% off due to overstock. So, shop around and price compare.

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