There is More Than One Way To Sterilize a Wound

I know. I know. If I steer away from the beloved alcohol post, you won't be able to enjoy the bitter beer face anymore. Don't cry, moving on is an important part of life.

Yes, the sensational appeal of an old scary man bringing his bottom lip up high enough to swallow his whole head just brings tears to our eyes, but... No more beer for you! ;)

Since, alcohol is such a volatile substance to be pouring on any wound, I'm going to move to more gentler and practical means of sterilizing and cleaning wounds.

Cleaning wounds:

Everyone loves having their wounds cleaned, especially when we have to take a wire scrubbing brush to them just to clean out the debris and dirt.

In a different post, I will discuss the need for analgesics and the favorite question of how to administer lidocaine. Although, if you were wondering, it would be good to have 1% Lidocaine and topical Lidocaine gel in your trauma kit. Otherwise, your patient, if they are still conscious when you start messing with their wound is going to beat you like a red-headed stepchild in a drunk family.

So moving on to wound irrigation and cleaning. I, personally have a dozen lactate ringers, three dozen normal salines, and a bunch of contact lens cleaner (works just as good) in my personal kit for wound irrigation. But I like irrigating wounds, it's fun to watch big chunks of crap fly out an open wound to hit your assistant.

Rule one of proper wound irrigation: Aim the irrigation so that it sprays and hits your partner. It never gets old.

Tap water also can be used to clean a wound as long as there has been no earthquake or radiation in the area. Tap water is obviously not as good as sterile saline, but oh, well... if you're not a wound cleaning junkie like me, then you might not have the solutions on hand.

But just for the heck of it, a good home solution for wound cleaning is tap water and Johnson & Johnson Baby Shampoo.

People always ask me about Hydrogen Peroxide (H2O2) in connection with it being an antiseptic, because they see it a lot be mixed with water and used to flush out some wounds, especially things within the ear. It's a good cleaner, just as water is a good cleaner.

Yet, unfortunately, H2O2 isn't that great as an antiseptic, because it has only minimal bactericidal effects, especially the dilutions of less than 3%, but it does make cleaning the infection funner... ahem, I meant easier.

Ever wondered why hydrogen peroxide foams: Cells contain an enzyme known as catalase, which floats around in wounds and also many bacteria are catalase formers. When catalase and peroxide come in contact with each other, they react to form water (H2O) and Oxygen (O2). The bubbles that you see are oxygen being released from the liquid.

A good way to test this is to put hydrogen peroxide on a cut potato. Cut potatoes are rich in catalse.

So all in all, it really doesn't do jack, but watching it bubble makes us feel better.

So you clean the wound by hosing it down with enough saline to hydrate a dehydrated camel (yes, they too can get dehydrated), and remove all of the debris.

Anyway back to the real reason why I wrote this post: Antiseptics.

There are many great antiseptics out on the market today, most of which have been tried and tested in clinical studies.

According to the Wound Health Society, the best antiseptics would be Chlorhexidine, Cadexomer iodine, Ethacridine Lactate, Polyhexanide, and Betadine (which is 10% Provodine Iodine).

I prefer Cadexomer then Chlorhexidine then Ethacridine (for topical wounds) and Polyhexanide (name brand is Pronotosan, and is good for wound cleansing). The effects of betadine are not lasting and it has to be applied without re-introducing more bacteria to the area. (Note: On the other hand, the shelf life of betadine is one of the longest.)

I want to add to this list also a gentle antiseptic benzethonium chloride which is a great antibacterial solution for children that can be also used as a hand sanitizer. (Note: alcohol based hand sanitizers can be used as well for would disinfection, but like the regular alcohol: they will burn like a Biggest Loser workout.)

Benzethonium Chloride can be found in products from a company called Pureworks. www.buypureworks.com.

On the natural end of things, I would say 10% Calendula officinalis (pot marigold) and Manuka Honey.

Here are a couple links scientifically comparing many of the different types of antiseptics and wound treatments, just for the fun of it:


Antiseptics on Wounds, Part 1

Antiseptics on Wounds, Part 2


Emerging Treatments in Diabetic Wound Care

What? You thought I would write more? Eh, I'm being lazy today.

But I will leave you with this wonderful add put out by some very well meaning individuals. Enjoy:

To Booze or Not To Booze: Alcohol as an Antiseptic

Disclaimer: I am not promoting the drinking of alcohol: I personally think it is devil's urine. The stuff eats through livers like the government does tax payer dollars. (Image taken from: myrightword.blogspot.com)

Yet, there have been many questions concerning alcohol being used as a wound antiseptic. So, I thought this might be a good subject to post on. (To all my American Preppers followers, I have already posted the majority of this under the Little Doc section).

Myth Busters: Alcohol and Wounds

There are better forms of disinfection than cracking out a cocktail, but to some extent, it is true that certain liquors do in fact treat wound infections. They burn like a monkey beating, but they do work. (Image taken from: Closebutsofar.com).

It is true, there have been actual cases where men have been mauled and bitten by wild animals, such as bears, and icing them with Toddy saved their lives. So it is definitely not a myth that spirits saves lives.

[Man, can you believe this kung-fu-monkey kicking the crap out of that guy? It's seriously giving him a Jackie Chan smackdown. Like a Chuck Norris chimp kind of thing.

So, I'm assuming that the guy might have needed some antiseptic after that punk-slapping.]

Anyway, while in the field and there is no other source of disinfectant available, liquor is a great alternative to field water. Granted, your buddy will want to kill you as you pour that firewater on his open wound, but think on the bright side... he's injured and you can run faster.

There is one problem though. Alcohol can, unfortunately, work too well and cause tissue damage due to its ability to penetrate and lyse cells. Hence, the reason for its effectiveness against bacteria.

You pour moonshine on an open wound... bye bye bacteria, but also many good cells go down with it. It's like Rambo saying, "I'm taking you all down! And your little dog too!"


The 'Proof' is in the Pudding.

Anyway, on a more scientific note, it is the alcohol content that determines the hooch's antiseptic abilities.

When you see an old drunk in a western movie down some diesel fuel and make a face like he's dying. Then he chokes out a barely audible gasp with satisfied smile, "Now, that's the good stuff." You know he's talking about at least 35% alcohol by volume (ABV) or 70% proof. See and you thought old westerns weren't scientific.

And that type of liquor is the "good stuff"

In order to cleanse a wound, the drink must be at least 35% alcohol (ETOH) or it's disinfecting capabilities are practically nil. Not at least 35% ABV then you might as well pour apple juice on the wound.

Anyway, let's see how some sauce's measure up:

Beer 3-12% ABV. Sorry guys, your beer isn't worth Jack.

Wine 9-16% ABV. Ladies, the romantic films where the woman pours a bottle of wine on her dying hero's wound to save his life, are liars! Woman pours wine. The bacteria remain and cause sepsis. Hero dies, end of story.

Next!

Fortified wines. (aka port, madeira, sherry, etc.) 15.5-20% ABV. Only good for cooking.
Brandy 36-60% ABV. Brandy does well against infections.

Pure vanilla extract. The poor man's ponto. >35% ABV. What do you know! You can totally sterilize a wound and smell like vanilla at the same time.

Vodka. I understand the Nazi German's used this substance to turn Russian prisoners into human flame throwers. Yikes.

Is it potent crap? Rating in at 32-80% ABV, yes it is! (Pure Russian brands coming in at closer to 80%... Go Russians, they can sterilize wounds and kill livers at the same time.

Rum and Gin 40-80% ABV.

Whisky. 40-55% ABV. Like you were expecting Whisky to score lower.

Raki. 42-86% ABV. I have never heard of this paint before. I wonder if it is related to Saki, on it's mother's side?

Poten. 60-95% ABV. I love this one's name, especially because it is one of the most potent.

Neutral grain spirit or moonshine 95% ABV. We have a winner. That's practically ethyl alcohol! It might as well be sold in the pharmacy section of Walmart with a sign on it saying, "Moonshine, it's medical grade."

So now all you have to do is open up moonshine businesses in your back yards and when the cops come to bust you, you can tell them that you're running a medical supplies company specializing in antiseptics.

One more word of warning: Do NOT drink and clean wounds at the same time. None of that: "One for the wound, one drink for me. One shot for the wound, two shots for me." Not good. Bad idea.

And remember, "Friends don't let friends drink and do wound care."

The next post will be about better and more appropriate wound antiseptics. TTFN

Here is the site of today:

General Wound care

Just for he heck of it, here are a few more monkey pictures, from zomporo.com and everydaynodayoff.com.

This one is just too funny. Scary, but funny. I think this monkey was ripping the guy a new one one about wound care and booze.



And I couldn't help, but go "awww how cute!" when seeing this picture from EverydayNoDayOff.com.

Superglue: It Burns Us! It Burns Us!

It is amazing how mankind strives for the unattainable treasure, works for the impossible dream, labors to overcome all obstacles... Wait, who am I kidding, we look for the easy way out.

It's all about convenience. Heck everything has a drive through nowadays. Fast food, pharmacies, grocery stores, weddings in Vegas. Yeah, it's true: you don't even have to get out of your car to say your "I do"s. See: Convenient.

It all started back when some misguided, drunk aliens crash landed their UFOs on Earth and mixed their genes within society, creating a techno-savvy but lazy generation that doesn't care about the consequences as long as the effort is minimal and the execution is fast. ;) It also explains why a vast majority of people drink enough alcohol to kill their livers, but that's another story.

Don't worry: the well-paid government scientists in Area 51 are working hard to this day to find a cure for the laziness gene. Unfortunately their efforts are thwarted by undercover aliens who created the Clapper, remote controls, those reaching sticks with the pinchers on the end, and superglue.

And as we all well know: the easy way is not always is the best way.

Fast food. Result: Coronary artery Disease.

The Clapper. Result: A bigger pant size and annoyed spouses.

That hot dog stand on the side of the road. Result: A bacteria so vicious that it beats your insides with a mace.

Superglue. Result: A myth about its use in wound care.

The highly classified alien project superglue leaked out of Area 51 because some punk paid off a guard, and the glue landed in the hands of medical personnel in the Vietnam War.

Medic 1: "Now that's a biggin'! I don't want to suture wound. What about you, Bob?"

Medic 2: "Nope, too much work. Heck, with all the gunfire raining down over our heads, who has the time. But, look I've got some alien superglue."

Hence the discovery of superglue for wounds.

Seriously though, during the Vietnam war, medics did find that superglue was made of a substance called Cyanoacrylate, which made a great wound adhesive. When the substance comes in contact with liquids, it forms a plastic mesh, thus sealing off wounds.

Now, I can really see the benefit of sealing up a wound at lightning speed, especially when bullets and mortars are your surgical background music. But over a time, they discovered that superglue had some side effects and decided that it shouldn't be used all the time. Unfrotunately, the rest of society are struggling with the lazy gene and believe superglue is good for everything.

When it comes to wound care, my little three year old niece believes that the only cure to anything is to put a band-aid on it. You scrape your knee; put a band-aid on it. You bump your head; put a band-aid on it. You fall down the stairs; put a band-aid on it. You knock your car bumper off by hitting that trash can that came out of nowhere; put a band-aid on it.

And now, superglue has become the 21st century prepper's* version of the "band-aid." I don't think I have heard of a disaster preparedness kit yet, that doesn't have superglue in it attached to the belief that one can put superglue on pretty much any type of wound that needs suturing.

I hate being a myth buster. I love myths. The myth about a dorky nerd flying on Pegasus to chop the head off a chick so ugly that looking at her turns you to stone is a great myth... that I can believe. But the myth about superglue being a great wound adhesive is just going too far.

The superglues out on the market today also contain a chemical called methyl alcohol, which releases energy in the form of heat during the formation of the adhesive. Therefore, because of this exothermic reaction, the good periwound tissue receives a chemical burn that destroys the granulation buds, thus preventing correct wound healing.

I figure this is what happened when Golum started screaming, "It burns us! It burns us!"

What you didn't see was that in a earlier edited scene Golum fell on his buck-naked butt, getting a wound the size of Gibraltor on his scrawny cheek.

Then a wise guy said, "Let's put superglue on it." That's when you see Golum running around, "It burns us! It burns us!" It's in the unofficial director's cut.

To prevent this chemical burn a medical grade superglue (tissue glue) that it is also a form of cyanoacrylate has been developed. This glue has no exothermic reaction and has added ingredients possessing bacteriocidal effects, such as either butyl, octyl, or isobutyl derivatives.

Now, I'm not saying that you have to dig through your gia-normous, end of the world trauma kit and throw out your superglue. You can still use it, if you don't mind the burning sensation...

Provided you follow a few simple rules:

NEVER use superglue on a wound that is deep into the body... seriously bad idea to chemical burn deep tissue. Healing will be delayed on a whole new level.
Don't glue your finger to your patient. That's not good in the wilderness. It can be laughed at in the hospital, but in the wilderness, you might end up pulling a Coyote Ugly.

The Minor Leagues are better. If you are going to use superglue to close a wound, you should probably use it on a minor wound that is straight and of which the skin flaps easily close back together.

Well, I better end my blogging for today. TTFN.

If you have any further questions, please feel free to email me or post a comment.

*Prepper: Person involved in preparedness.